Journal of Aapos最新文献

英文中文

Endoscopic and surgical evaluation of epiphora in children with Down syndrome 唐氏综合征患儿上睑下垂的内镜和手术评价。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104687

Jutaro Nakamura MD, PhD , Mizuki Asano MD , Tomoko Ohno MD, PhD , Satoshi Goto MD, PhD , Nobuhisa Mizuki MD, PhD , Nozomi Matsumura MD, PhD

Purpose

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.

目的：探讨唐氏综合征（DS）原发性上睑下垂患者的临床特点和手术效果。方法：回顾性分析某三级专科儿童医院2013 - 2023年就诊的DS患儿病历，其中63例为原发性上显。分析临床特征、诊断结果和手术干预结果。结果：42例（67%）患者出生后出现显色，12例（19%）患者出生后出现显色。40例接受泪道冲洗的患者中，28例（70%）出现通道，12例出现阻塞。手术干预18例。局部麻醉下的办公室探查或全麻下的腔内泪管再通术（ELDR）与支架插管。在接受手术的18例患者中，手术结果如下：7例患者症状完全缓解，10例患者部分缓解，1例患者失败。泪内窥镜检查显示，数例鼻泪管粘膜表面有致密的白色纤维组织阻塞，提示慢性炎症改变。结论：泪道内窥镜检查结果显示，泪道狭窄不仅是由于泪道引流系统发育异常引起的，而且还包括继发于慢性炎症的纤维性阻塞。限于探查或ELDR的手术干预仅导致三分之二患者的部分症状改善，而没有达到完全解决。

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引用次数: 0

Prevalence of optic pathway glioma in NF1: a systematic review and meta-analysis focused on MRI surveillance NF1中视神经胶质瘤的患病率：一项针对MRI监测的系统综述和荟萃分析。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104701

Michail Angelos Gkikas MD, MSc , Anna Nikolaidou MD, MSc , Athanasia Sandali MD , Konstantinos Benekos MD, MSc , Ioannis Tsinopoulos MD, PhD , Lampros Lamprogiannis MD, PhD

Background

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。

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引用次数: 0

Factors influencing the timing of complete retinal vascularization in infants screened for retinopathy of prematurity 影响早产儿视网膜病变筛查婴儿视网膜完全血管化时间的因素。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104659

Jeffrey Kuziel MD, Margaret Strampe MD, Joel VandeLune, Christian Zirbes, Scott Larson MD, Alina Dumitrescu MD

Background

Premature infants screened for retinopathy of prematurity (ROP) reach complete retinal vascularization at various postmenstrual ages (PMAs). The purpose of this study was to evaluate the factors that affect the age at which the infant eyes reach retinal vascular maturity.

Methods

We reviewed patients screened for ROP at our institution between December 13, 2007, and December 30, 2020. Data extracted included demographics, gestational age (GA) and birth weight (BW), ROP examinations, age and weight at retinal maturity, surgical procedures, ventilation status, antibiotic treatment, positive blood cultures, blood transfusions, and central line placement.

Results

A total of 1,971 patients were analyzed. The mean GA at birth was 28 weeks, and the mean BW was 1,096 g. Mean PMA for retinal maturity was 44.90 weeks. Mean PMA at retinal maturity was higher for infants born at an earlier GA (P < 0.0001). Additionally, infants who underwent nonocular surgery reached retinal maturity at significantly high PMA (P < 0.0001). Infants with stage 1 ROP or greater had a significantly longer time from birth to retinal maturity (P < 0.0001) and those with stage 2 or 3 disease reached retinal maturity at even older chronological ages (P < 0.0001). Chronological age at retinal maturity was also higher for children with positive blood cultures or who received transfusions ≥5 units (P < 0.0001).

Conclusions

Postmenstrual age at retinal maturity and chronological age at retinal maturity both vary widely among infants at risk of ROP, and are associated with a variety of ocular and systemic clinical predictors.

背景：筛查早产儿视网膜病变（ROP）的早产儿在不同月经后年龄（PMAs）达到完全的视网膜血管化。本研究的目的是评估影响婴儿眼睛达到视网膜血管成熟年龄的因素。方法：我们回顾了2007年12月13日至2020年12月30日期间在我院接受ROP筛查的患者。提取的数据包括人口统计学、胎龄（GA）和出生体重（BW）、ROP检查、视网膜成熟时的年龄和体重、外科手术、通气状况、抗生素治疗、阳性血培养、输血和中心静脉置管。结果：共分析1971例患者。平均出生总胎重28周，平均体重1096 g。视网膜成熟度的平均PMA为44.90周。早GA出生的婴儿视网膜成熟时的平均PMA较高（P < 0.0001）。此外，接受非眼手术的婴儿在显著高PMA时达到视网膜成熟（P < 0.0001）。1期或以上ROP的婴儿从出生到视网膜成熟的时间明显更长（P < 0.0001）， 2期或3期疾病的婴儿在更大的实足年龄达到视网膜成熟（P < 0.0001）。血培养阳性或输血≥5单位的儿童视网膜成熟时的实足年龄也较高（P < 0.0001）。结论：视网膜成熟经后年龄和视网膜成熟实足年龄在有ROP风险的婴儿中差异很大，并且与多种眼部和全身临床预测因素相关。

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引用次数: 0

Multiple, bilateral choroidal macrovessels with visible pulsations in an infant with trisomy 18 18三体婴儿多发性双侧脉络膜大血管可见搏动。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104676

Richard D. House BA , Weiliang Wang MD , Megan X. Law MD , Michael P. Kelly FOPS , S. Grace Prakalapakorn MD, MPH

We present a novel finding of multiple, bilateral prominent choroidal macrovessels with pulsations visible on funduscopic examination and confirmed by optical coherence tomography in a 9-day-old infant with trisomy 18.

我们提出了一个新的发现，多，双侧突出脉络膜大血管搏动可见眼底检查和光学相干断层扫描证实了9天大的婴儿18三体。

引用次数: 0

Information for Readers 读者资讯

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/S1091-8531(25)00605-6

引用次数: 0

Examining key factors on the road to leadership positions among pediatric ophthalmology faculty 检查道路上的关键因素领导地位的儿童眼科教师。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104689

Josephine Rudd Zhong Manis BS , Brenton T. Bicknell BS , Haley Chishom BS , Yejin Heo BS , Lance Dzubinski BS , Alvina Liang BS , Taylor Aaserud BS , Shayan Massoumi BS , Thanushri Srikantha BS , Robert Tauscher MD , Steven E. Brooks MD

Purpose

To identify key factors associated with attaining leadership positions among US academic pediatric ophthalmologists, with a focus on gender, fellowship training, years of practice, research productivity, and variables related to their academic institutions.

Methods

This cross-sectional study reviewed publicly available data accessed through institutional websites. Faculty-specific variables included gender, years since residency graduation, academic rank, leadership roles, and research productivity (eg, H-index, number of publications). Institutional variables included public/private designation and location within US census regions. Research metrics were derived from Scopus. Descriptive statistics, Pearson’s χ², the Fischer exact test, and the t test were used for statistical analysis, with significance at P < 0.05.

Results

Of 125 US-based ophthalmology programs, 517 pediatric ophthalmology faculty were characterized. Women comprised 54.6% of faculty. Academic rank and H-index were strongly associated with leadership positions (P < 0.001 and P = 0.008, resp.) in multivariable analysis, whereas years since fellowship completion, gender, number of fellowships, and advanced degrees were not. Women full professors had fewer years since fellowship than men (24 vs 36 years [P < 0.001]). Female leadership distribution mirrored faculty averages by region.

Conclusions

Academic rank and research productivity by H-Index are critical factors for achieving leadership roles for academic pediatric ophthalmologists, whereas years since fellowship graduation was not. Underrepresentation of women in full professor and senior leadership roles may reflect a lag in promotions corresponding to the increasing presence of women in pediatric ophthalmology in recent decades.

目的：确定与美国学术儿科眼科医生获得领导职位相关的关键因素，重点关注性别、奖学金培训、实践年数、研究生产力以及与其学术机构相关的变量。方法：本横断面研究回顾了通过机构网站获取的公开数据。教师特定变量包括性别、实习毕业年限、学术排名、领导角色和研究生产力（如h指数、出版物数量）。制度变量包括美国人口普查区域内的公共/私人名称和位置。研究指标来源于Scopus。采用描述性统计、Pearson χ2、Fischer精确检验、t检验进行统计学分析，P < 0.05为显著性。结果：在125个美国眼科项目中，517个儿童眼科教师被描述。女性占教职工总数的54.6%。在多变量分析中，学术等级和h指数与领导职位密切相关（P < 0.001和P = 0.008，分别为P < 0.001和P = 0.008），而完成奖学金的年限、性别、奖学金数量和高级学位不相关。女性正教授获得奖学金的时间少于男性（24年vs 36年[P < 0.001]）。女性领导的分布反映了各地区教师的平均水平。结论：学术排名和h指数的研究生产力是学术型儿科眼科医生获得领导角色的关键因素，而毕业时间不是关键因素。女性在正教授和高级领导职位上的代表性不足，可能反映了近几十年来女性在儿科眼科学领域不断增加的升职滞后。

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引用次数: 0

A 33-month-old boy with bilateral corneal disease 一个33个月大的男孩患有双侧角膜疾病

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104679

Rachel F. Dolan BS , Deanna H. Dang MD , Ahmad Abdel-Aty MD , Andrew T. Melson MD , Tammy L. Yanovitch MD, MHSc

We report the case of a previously healthy 33-month-old boy with vitamin A deficiency (VAD) who presented with bilateral eye swelling, redness, and photophobia of 1 month’s duration following multiple misdiagnoses. After confirming VAD with serum vitamin A level testing, he was treated with vitamin A, and his eye complaints improved. However, he continues to have a corneal scar and is currently undergoing amblyopia treatment.

我们报告了一例先前健康的33个月大的维生素a缺乏症（VAD）男孩，他在多次误诊后出现双侧眼睛肿胀，发红和畏光，持续1个月。经血清维生素A水平检测确认VAD后，给予维生素A治疗，眼病得到改善。然而，他仍然有角膜疤痕，目前正在接受弱视治疗。

引用次数: 0

Laser treatment for unilateral concurrent optic nerve pit and coloboma with subretinal fluid in two pediatric patients 激光治疗小儿单侧并发视神经坑及视网膜下积液结肠瘤2例

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104680

Mariam Tadross BS, Nancy Arias-González MD, Audina M. Berrocal MD, Kara M. Cavuoto MD, Michelle M. Falcone MD

We report 2 patients with unilateral concurrent optic nerve pit and coloboma complicated by subretinal fluid. Further examination revealed bilateral incomplete retinal peripheral vascularization in 1 case. Laser indirect ophthalmoscopy and the use of carbonic anhydrase inhibitors stabilized fluid levels and prevented worsening visual symptoms in both cases.

我们报告了2例单侧并发视神经坑和结肠瘤合并视网膜下积液的病例。进一步检查发现1例双侧视网膜周围血管不全。激光间接检眼镜和碳酸酐酶抑制剂的使用稳定了体液水平，防止了视力症状的恶化。

引用次数: 0

Incidence and characterization of retinal findings after SARS-CoV-2 infection in children 儿童SARS-CoV-2感染后视网膜病变的发生率和特征

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104660

Nir Zontag , Jacob Perkins MD , Brittany M. Wong MD , Alex V. Levin MD, MHSc

Purpose

To determine whether SARS-CoV-2 infection is associated with retinal hemorrhage in young children.

Methods

The medical records of children <8 years of age treated in the University of Rochester healthcare system between July 1, 2020, and July 1, 2024, who underwent ophthalmologic examination, within 28 days of a COVID-19 diagnosis were reviewed retrospectively.

Results

A total of 8,196 children were diagnosed with COVID-19 during the study period. Of these, 56 had a dilated ocular examination within 28 days of their COVID-19 diagnosis. All fundus examinations were normal except for 1 patient with optic nerve edema. Our findings suggest with 95% confidence, that the true incidence of retinal hemorrhage in children <8 years old following COVID-19 infection is likely to be <9.09% at 14 days, 7.69% at 21 days, and 5.35% at 28 days.

Conclusions

Our data, along with a review of the literature, suggest that there is little if any evidence that SARS-CoV-2 infection causes retinal hemorrhage in young children.

目的：探讨SARS-CoV-2感染是否与幼儿视网膜出血有关。方法：查阅儿童病历。结果：研究期间共有8196名儿童被诊断为COVID-19。其中，56人在确诊后28天内进行了扩眼检查。除1例视神经水肿外，眼底检查均正常。结论：我们的数据以及对文献的回顾表明，几乎没有证据表明SARS-CoV-2感染会导致幼儿视网膜出血。

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引用次数: 0

Short stature in children with primary congenital glaucoma—a retrospective cross-sectional study 原发性先天性青光眼儿童身材矮小的回顾性横断面研究。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104692

Rafaa Babgi MD , Ibrahim AlObaida MD , Adi Mohammed Al Owaifeer MD , Rizwan Malik MD, PhD , Dhabiah Saeed AlQahtani MD , Khalid Al Noaim MD

Background

In our practice, we have observed that many children with primary congenital glaucoma (PCG) seem to have short stature. The purpose of this study was to investigate whether there is an association between PCG and short stature in children.

Methods

The medical records of children with PCG (mean age, 41.1 ± 18.9 months) who presented to our tertiary eye care center from January 2014 to December 2020 were reviewed retrospectively. Baseline characteristics, heights and weights of children were extracted from the record and plotted on standard height/weight charts. Z scores for height and weight were calculated, and short stature and low weight were classified as moderate or severe.

Results

This pilot study included 93 patients with PCG, 43 (46%) males and 50 (54%) females. Forty-three children (46%) had evidence of moderate or severely short stature (Z score < −2), with a roughly equal distribution by sex. Twenty-seven children (29%) had evidence of severe short stature (Z score < −3). Despite short stature, children tended not to be underweight: only 6 children (6%) were moderately or severely underweight.

Conclusions

Our study suggests that children with PCG may be of shorter stature, but of normal weight for age. These findings warrant further evaluation in a larger detailed prospective study controlling for potential confounders such as socioeconomic status.

背景：在我们的实践中，我们观察到许多原发性先天性青光眼（PCG）患儿似乎身材矮小。本研究的目的是探讨PCG与儿童身材矮小之间是否存在关联。方法：回顾性分析2014年1月至2020年12月我院三级眼保健中心收治的PCG患儿（平均年龄41.1±18.9个月）的病历。从记录中提取儿童的基线特征、身高和体重，并绘制在标准身高/体重图上。计算身高和体重的Z分，将身材矮小和体重过低分为中度和重度。结果：本初步研究纳入93例PCG患者，其中男性43例（46%），女性50例（54%）。43名儿童（46%）有中度或重度身材矮小（Z评分< -2），性别分布大致相等。27名儿童（29%）有严重身材矮小（Z评分< -3）的证据。尽管身材矮小，但儿童往往体重不足：只有6名儿童（6%）中度或严重体重不足。结论：我们的研究表明，患有PCG的儿童可能身高较矮，但体重正常。这些发现值得在控制潜在混杂因素（如社会经济地位）的更详细的前瞻性研究中进一步评估。

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