Introduction:
A recent case report in Pediatrics describes the first known case of systemic hypertension 10 days after intravitreal bevacizumab (IVB) treatment for stage 3 ROP. The purpose of this study is to evaluate all cases of neonates with severe ROP (retinopathy of prematurity) for hypertensive crisis after treatment with IVB within 8 weeks of treatment.
Methods:
Retrospective chart review of infants with severe ROP: 77 with type 1 ROP treated with bevacizumab, and 78 controls (infants with type 2 ROP or infants with type I treated with laser). We are also reviewing the available neuroimaging for the presence of vasogenic edema indicative of hypertensive crisis and comparing 77 IVB infants to 78 controls.
Results:
In the IVB group, 4/77 neonates had a diagnosis of hypertension. Of those four, two had an MRI without explicit vasogenic edema. In the control group, 4/78 had a diagnosis of hypertension. All four had an MRI without explicit vasogenic edema. There was no difference in the proportion of HTN when comparing cases to controls (P 5 0.99).
Conclusion/Relevance:
Preliminary data is reassuring. Future analysis includes a review of continuous vital signs to identify cases of HTN that escaped diagnostic coding. A neuroradiologist will also re-review all completed imaging to look for subtle signs of vasogenic edema. This has implications for the safety profile of bevacizumab in ROP.
Introduction:
We have developed a technique of gentle strabismus surgery "STRABO Care." We performed experiments that proved usefulness of radiowave knife and safety of using thin suture material. The goal of the study was to compare rehabilitation of patients after strabismus surgery with our minimally traumatic technique and the traditional approach using conventional instrumental methods (OCT, videooculography). This was a prospective, patient and assessor blind, randomized trial.
Methods:
The study included 60 children (30+30). The groups were comparable in age, strabismus onset, duration and strabismus amount. All consenting patients were operated by recession of medial rectus and plication of lateral recuts and were randomized into two groups: minimally traumatic technique in the main group and traditional approach in the control group. We compared both groups by individual parameters - level of inflammation (chemosis [OCT]), conjunctival hyperemia, swelling of the eyelids, as well as the eye movement on the first day after surgery (videooculography). We used Mann-Whitney and Fisher exact tests, with significance at P # 0.05.
Results:
The thickness of the conjunctival flap over the site of recession according to OCT in the main group (408,35 [221-695] mm) on average was 1.7 times thinner than in the control group (698 [463-1474] mm). The eye excursion on the first day after surgery was: reduced in the main group by an average of 6.27 degrees, reduced in the control group by 14.7 degrees due to pain.
Conclusion/Relevance:
In contrast to the traditional approach "STRABO care" technique: has practically no effect on the postoperative eye excursion; minimizes intraoperative tissue injury, which reduces swelling of the conjunctiva and periorbital tissues; helps reduce patients discomfort; improves accuracy of dosage.
Introduction:
Bifoveal fusion in children with congenital and early acquired strabismus is very important in the binocular functions recovering. This study aims to analyze bifoveal fusion recovering using method of LCD glasses with alternating occlusion of vision fields and compare its efficacy with orthoptic treatment using synoptophore.
Methods:
86 patients with prior esotropia and postoperative absence of bifoveal fusion started treatment on synoptophore. They were united in "synoptophore" group. 43 of them whos bifoveal fusion did not recovered underwent treatment with LCD glasses ("LCD group").
Results:
Mean age of patients in synoptophore group was 6.1 2.1 years, mean age of patients in LCD group 5.5 1.4 years. All patients had hyperopic refraction. Postoperative all patients had orthotropy. Patients in synoptophore group received 4 courses of synoptophore treatment during one year. Patients in the main group wore LCD glasses 4 hours/day. There was no statistically significant difference between groups. The period of observation was 12 months. Bifoveal fusion was achieved in 16 patients in synoptophore group (18.6%), and in 29 patients in LCD group (67.4%). Binocular vision was achieved in 21 patients in synoptophore group (24.4%), and in 20 patients in LCD group (46.5%). Recovery time was 9.2 2.5 months in synoptophore group and 6.8 2.5 patients in LCD group.
Conclusion/Relevance:
Bifoveal fusion recovering 67.4% of cases using LCD glasses compared with 18,6% of cases using synoptophore treatment can be explained by a more effective treatment. Alternating occlusion of vision fields with LCD glasses is an effective mean of bifoveal fusion and binocular function recovery in patients after successful strabismus surgery.
Introduction:
The aim of this study is to present the normative data collected by Plusoptix S12 photoscreener, among children in Israeli kindergartens, in order to determine a good estimate of average pupil size, incidence of anisocoria and normative refractive data among the pediatric population.
Methods:
This is a retrospective study of 101,417 Israeli children between ages 4-5 years old, examined using the Plusoptix S12 photoscreener. The examinations were carried out at kindergartens in major cities in Israel. Data collected included age, sizes of both pupils and magnitude of anisocoria, sphere, cylinder, and SE, obtained between 2013 and 2018.
Results:
The size of the pupil, in our study group, was measured separately for the right and left eyes. The calculated results were 5.83 mm 0.87, and 5.82 mm 0.88 respectively. 13.26% (13,448 children) were found with anisocoria 5 0.4mm; of these, 6.23% (6,314 subjects) had anisocoria of 0.5 - 0.9 mm, and 0.66% (669 subjects) had anisocoria of .1.0 mm. The mean sphere and cylinder values were 0.84 D 0.73 and -0.53 0.48 D, respectively. The mean calculated SE was 0.56D 0.6. No difference found between sexes, or between different cities. According to the Vision Screening Guidelines, 807 children (0.80%) had hyperopia (.3.50 D) and 171 children (0.17%) had myopia (.3.00 D). 6,307 children (6.22%) had astigmatism (.1.5 D) and 11,008 children (10.85%) had anisometropia (.1.5 D SE).
Conclusion/Relevance:
The presented data, which is the largest study group to the best of our knowledge, gives an estimate of normative pupil size, and anisocoria prevalence and refractive data in pediatric population. Further examinations in other geographic areas and in other age groups should be continued.
Introduction:
The computer age has opened many doors to new ways to measure visual acuity and visual performance, but they are generally only computerized graphic images or portions of standard charts. The dynamic optotype (DYOP) is a rotating, segmented optotype. Unlike static image vision tests, such as a logMAR chart, a DYOPis a segmented, circular figure composed of equally spaced gap/segments which spin at a constant velocity. Our research goal was to test a simple visual acuity test based on dynamic target that is minimally dependent on familiarity with symbols and letters. The visual acuity results obtained from children using the DYOP visual acuity were compared with results obtained with the Lea numbers ETDRS chart.
Methods:
Monocular visual acuity was tested using both the new DYOP visual acuity test and the Lea numbers ETDRS chart, alternating the order of administration between subjects. Testing was performed on the subjects eye with the poorest acuity.
Results:
The acuities were shown to have a strong linear correlation (r 5 0.88) and a mean difference in acuity of 0.01 (95% CI, 0.02 to 0.01) logMAR, equivalent to approximately less than one letter, with the DYOP test underestimating the vision as determined by the ETDRS chart. The 95% limits of agreement were 1.2 lines.
Conclusion/Relevance:
This study supports the validity of the new DYOP visual acuity test as a measure of visual acuity in pediatric patients aged 4-17 years with visual acuity ranging from 20/16 to 20/200.
Introduction:
Hyperopia is common in childhood, but can cause refractive or strabismic amblyopia if significant hyperopia remains untreated. While current guidelines recommend treatment of hyperopia with esotropia starting at 1.50-2.00 D, there is no definitive cut off for hyperopia without strabismus. The plusoptiX S12 (POS12) using Option 4, refers for hyperopia at 2.50 D or greater. This study seeks to determine the accuracy of detecting significant hyperopia in preschool children for referral at 2.50 D.
Methods:
Vision screenings were conducted for Head Start children (mean age 55.2 months old) by Elks Preschool Vision Screening using the plusoptiX S12 (option 4). Free onsite eye examinations were performed on all children screened. Statistical analysis for photoscreenings and cycloplegic refractions were performed using R statistical software (version 3.5.0).
Results:
Dilated eye examinations were completed on 45 plusoptiX referrals and 66 passes. Of these 111 children, there were 25 children diagnosed by eye examination with hyperopia exclusively. Of those, 5 children had hyperopia greater than 2.50 D. Glasses were prescribed to 2 of these children. The POS12 referred 1 of these 2 for hyperopia. The sample size was too small to accurately report sensitively and specificity for hyperopia exclusively. Overall, the sensitivity for detection of any treatment-requiring refractive error was 82.2% and specificity of 87.9%, with PPV 82.2% and NPV of 87.9%.
Conclusion/Relevance:
The majority of children in our study had hyperopia plus other eye conditions. The overall sensitivity and specificity of the POS12, when looking at all eye conditions, is sufficiently accurate for a public screening program.
Introduction:
Incomitant hypertropia from mild inferior oblique overaction pose a surgical challenge due to variability across gaze positions. We report the results of a graded marginal myotomy procedure to correct incomitant hypertropias related to minimal inferior oblique overaction.
Methods:
A retrospective chart review of patients having intermittent exotropia with small-angle incomitant hypertropia and minimally overacting inferior oblique muscles (+2) that had surgery from July 2017 to July 2019 was performed. Of the 116 patients, 34 patients that had marginal myotomy of inferior oblique were included. These patients were divided into two groups; group 1 (18) with patients that had small marginal inferior oblique myotomy for hypertropia #4D in primary gaze and #8D in the contralateral gaze, group 2 (16 ) with patients that had large marginal myotomy for Hypertropia in primary gaze .4 and #8 D and #12D in contralateral gaze.
Results:
In group 1, mean preoperative hypertropia in primary and contralateral gaze of action was 1.47D and 4.19D respectively. The mean postoperative deviation in primary and contralateral gaze was 0.04D and 0.14D. In group 2, mean preoperative hypertropia in primary and contralateral gaze of action was 5.06D and 9.80D, respectively. The mean postoperative deviation in primary and contralateral gaze was 0.40D and 0.73D respectively. Mean followup period was 22.77 months.
Conclusion/Relevance:
Graded inferior oblique marginal myotomy is an excellent addition to our existing armamentarium. It offers a safe, easy, effective sutureless alternative to weakening a minimally overactive inferior oblique muscle.
Introduction:
Published nomograms that guide surgery for esotropia are largely based on surgical experience treating nonparetic strabismus. Our goal was to characterize the surgical dose–response among patients with abducens palsy and to compare it to nomograms described for nonparetic strabismus.
Methods:
We performed a retrospective chart review of pre- and postoperative sensorimotor examinations on patients with abducens palsy treated with horizontal recession and/or resection surgery over a 10-year period. Exclusion criteria included prior eye muscle surgery and concomitant vertical muscle surgery including transpositions.
Results:
Of 79 patients with abducens palsy, 42 met inclusion criteria. Mean age was 38€ı 31 years, gender distribution of 21 male, 21 female. The most common etiologies were tumor, surgery/trauma, and elevated intracranial pressure. Mean preoperative esotropia measures were 32D 15D at distance and 30D 18D at near. Surgical dose–response was significantly greater at distance (3.1 +- 0.2D/