PURPOSE:To explore the results and reoperation frequencies in infants with a cataract associated with persistent fetal vasculature (PFV) characterized by elongated ciliary processes, analyze the outcomes of surgery, and determine whether it is essential to remove fibrosis and make cuts around the ciliary processes. METHODS:The criteria for selection included having cataract surgery in one eye before reaching 7 months of age and having elongated ciliary processes along with an anterior persistent fetal vasculature. Patients with involvement of the retina or a follow-up period of less than 6 months were not considered. All individuals received lensectomy, posterior capsulectomy, and vitrectomy as part of their treatment. RESULTS:The research involved 21 eyes from 21 individuals with an average age of 6.3 weeks at the time of surgery and an average monitoring period of 18.9 months. All patients had their eyes aphakic after surgery. Opacification of the visual axis was observed in 6 eyes (28%). Only 1 of the 21 patients achieved a visual acuity better than 20/200. Five of 21 eyes had an incomplete removal of the retrolental membrane without circumferential cuts around the ciliary processes. CONCLUSIONS:Eyes treated for PFV that have elongated ciliary processes frequently require additional surgery. Complete or near-complete removal of the retrolental membrane, along with circumferential cuts around the ciliary processes, can lower the risk of recurrent fibrosis and the need for additional surgery to clear the visual axis.
PURPOSE:To describe a less invasive laser therapy for retinopathy of prematurity, referred to as ridge-adjacent laser treatment (RALT), and its outcome regarding the need for re-treatment. METHODS:This was a retrospective observational review of medical records of all infants treated with RALT as a primary intervention for retinopathy of prematurity between June 2016 and June 2021 at a tertiary care center in Sweden. The intervention consisted of RALT with intraoperative wide-field imaging, and most patients also received postoperative dexamethasone eye drops. The primary outcomes measured were the number of laser spots applied, re-treatment rates, and the maximum stage of retinopathy of prematurity observed. RESULTS:Sixty-one eyes of 31 infants were treated with RALT. The median follow-up time was 24 weeks (range: 17 to 45 weeks) after birth. The mean number of laser spots administered was 859 ± 280. Re-treatment was required in 3% of the eyes (6% of the infants). After excluding infants with aggressive retinopathy of prematurity the re-treatment rate for the eyes was 2% (4% of the infants). Seven of the 61 eyes were diagnosed as having aggressive retinopathy of prematurity. In three of these eyes, the retinopathy progressed to a maximum stage greater than 3 following RALT treatment. CONCLUSIONS:Treatment of retinopathy of prematurity using the RALT technique, in conjunction with intraoperative wide-field imaging and, in most infants, postoperative dexamethasone eye drops, was associated with a low number of laser spots and a low re-treatment rate. All eyes that did not have aggressive retinopathy of prematurity regressed after the RALT treatment. Further longitudinal studies are required to assess the long-term structural and functional outcomes.
PURPOSE:To evaluate the effectiveness of ChatGPT-4o (OpenAI) in enhancing the readability and quality of Spanish patient educational materials (PEMs) on childhood glaucoma, and to determine whether they are written above the recommended 6th-grade reading level (per American Medical Association recommendation). METHODS:This cross-sectional comparative study analyzed 10 original Spanish-language PEMs on "glaucoma infantil." Each was inputted into ChatGPT-4o using a Spanish-language prompt requesting improved readability to a score of 70 or greater on the INFLESZ scale (adaptation of the Flesch-Szigriszt Index for Spanish-language texts), which is equivalent to a 4th- to 6th-grade reading level. Original and revised PEMs were compared using the INFLESZ scale. Additionally, three native Spanish-speaking ophthalmologists assessed each PEM's quality using a published 15-point Likert scale evaluating helpfulness, truthfulness, and harmlessness. RESULTS:Original PEMs had a mean INFLESZ score of 56.6 ± 4.9 (8th-grade level). ChatGPT-4o significantly improved readability to 69.6 ± 2.3 (4th- to 6th-grade level, P < .001). Revised PEMs had fewer syllables, words, and complex words without a significant difference in sentence count. Quality remained high across both groups (median score = 15, P = .74), and no hallucinations were observed in artificial intelligence-generated text. CONCLUSIONS:ChatGPT-4o can be used as a supplemental tool by health care professionals to improve the readability of existing Spanish PEMs on childhood glaucoma, without sacrificing the quality, accuracy, or reliability of their content.
PURPOSE:To present safety and effectiveness data on a real-world retinopathy of prematurity (ROP) telemedicine screening model in Northern Ireland and to evaluate a novel virtual multidisciplinary team (MDT) approach to ROP decision-making. METHODS:Data were collected on all ROP screens performed in Northern Ireland between May 1, 2023, and October 31, 2023. A total of 431 screens (N = 127 infants) were undertaken: 250 by imagers only, 40 by both imagers and ophthalmologists using binocular indirect ophthalmoscopy, and 141 by ophthalmologists only. A survey of MDT members (n = 17) assessed the perceived value of the virtual MDT model. RESULTS:Fifty-eight percent of screens were completed by ROP imagers, with 98.2% sensitivity in detecting any ROP, 100% sensitivity in detecting treatment-warranted ROP, and 100% specificity of determining absence of ROP. Ninety-eight percent of imaging screens were tolerated by infants. The MDT survey demonstrated favorable feedback, including how TeleROP-NI increases the likelihood of trainees undertaking ROP screening. CONCLUSIONS:This study confirms that the TeleROP-NI significantly reduced ophthalmologist workload and streamlined organizational barriers. Imaging of infants by nonclinicians is a safe and valuable practice, which allows an MDT approach to collective decision-making when treating patients in an area of medicine with serious clinical and medicolegal implications if disease is missed.
PURPOSE:To evaluate and compare unilateral recession-plication versus bilateral three-muscle surgery for large-angle exotropia. METHODS:A prospective interventional non-randomized comparative study was conducted involving 66 patients with large-angle exotropia, with deviation between 50 and 65 prism diopters (PD). Patients were divided into two groups: those who underwent unilateral large lateral rectus (LR) recession (≥8 mm) and medial rectus (MR) plication (>5 mm) (two-muscle group), and those who underwent bilateral LR recession (7.5 to 9 mm each eye) and MR resection (5 mm) in the non-dominant eye (three-muscle group). Patients were administered the Adult Strabismus-20 (AS-20) questionnaire before surgery and at the 3-month follow-up visit. RESULTS:The mean preoperative deviation for distance in the two-muscle (n = 34) and three-muscle (n = 32) groups was 56.53 ± 5.62 and 54.89 ± 5.83 PD, respectively (P = .849). The mean postoperative deviation was 9.29 ± 3.16 PD in the two-muscle group and 8.44 ± 3.54 PD in the three-muscle group at the 6-month postoperative visit (P = .303). A successful motor outcome was observed in 25 of 34 patients (73.53%) in the two-muscle group and 24 of 32 patients (75%) in the three-muscle group (P = 1.00). Both groups showed a statistically significant improvement in AS-20 scores. There was a comparable low-grade limitation of ocular motility in both groups. CONCLUSIONS:In patients with large-angle exotropia up to 65 PD, two-muscle surgery achieved acceptable ocular alignment with no statistically significant difference in motor outcomes or motility limitations compared to traditional three-muscle surgery.
PURPOSE:To investigate microstructural alterations in the retina, choroid, and optic nerve head in children with spina bifida using optical coherence tomography. METHODS:Thirty-eight children with spina bifida and 32 children without spina bifida were included in this cross-sectional study. Both groups were matched for age and sex. Comprehensive ophthalmological examinations included optical coherence tomography imaging of the macula, choroid, and peripapillary retinal nerve fiber layer. RESULTS:The mean age was 10.2 ± 3.5 years. Axial length was significantly shorter in patients with spina bifida (P = .025), and hyperopia was more frequent (P < .001). Central macular thickness was similar between the two groups (P = .553). However, single retinal layer analysis revealed significant differences. In patients with spina bifida, the outer nuclear layer was thicker (P = .019) and the inner nuclear and outer plexiform layers were thinner (P = .038, P = .035). Subfoveal and nasal choroidal thicknesses were greater in patients with spina bifida (P = .012, P = .038). However, there was no significant difference in choroidal thickness after comparing the two groups by controlling the axial length variable. CONCLUSIONS:Children with spina bifida may have retinal and choroidal alterations detectable with optical coherence tomography. Choroidal changes may be related to shorter axial length, whereas retinal alterations could reflect impaired macular development in spina bifida.
PURPOSE:To evaluate systemic hematological inflammatory markers in pediatric patients with newly diagnosed idiopathic intracranial hypertension (IIH) and to investigate their associations with optic nerve head involvement assessed by retinal nerve fiber layer (RNFL) thickness. METHODS:This retrospective study included 33 pediatric patients with IIH and 32 age- and sex-matched controls. Complete blood count parameters were recorded at diagnosis. Derived inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index [SIRI], and pan-immune-inflammation value [PIV]) were calculated. RNFL thickness was measured using optical coherence tomography, and associations with inflammatory markers, Frisén grade, and lumbar puncture opening pressure were analyzed. RESULTS:Neutrophil and immature granulocyte counts, as well as the SIRI and PIV, were significantly higher in the pediatric IIH group compared with the control group (all P < .05). Immature granulocyte count showed moderate and significant correlations with average and temporal RNFL thickness and Frisén grade (P ≤ .04). Neutrophil count correlated moderately with temporal RNFL and Frisén grade, whereas SIRI was weak and PIV was modestly associated with Frisén grade; PIV also correlated with temporal RNFL (P ≤ .04). Receiver operating characteristic analysis indicated that immature granulocyte count had the highest discriminative performance for pediatric IIH (area under the curve = 0.689). CONCLUSIONS:This study indicates that inflammatory markers, including immature neutrophil and granulocyte counts, as well as SIRI and PIV, may be elevated in pediatric IIH. Among these, immature granulocyte count showed the most consistent correlation with disease-related structural findings, suggesting its potential role as an inflammatory indicator in IIH. These results highlight possible links between systemic inflammatory parameters and IIH and related optic nerve involvement.
PURPOSE:To characterize a novel magnetic resonance imaging (MRI) finding affecting the optic chiasm in patients with optic nerve hypoplasia (ONH). METHODS:This was a retrospective case-control study including 78 patients diagnosed as having ONH at a single institution, with an average age at MRI of 2.66 years. The control group included 70 patients of similar demographics without a diagnosis of ONH or gross abnormalities on MRI. MRI images obtained on a Siemens 3T Prisma or Siemens 1.5T Aera (Siemens Healthineers) were examined for all patients by two independent graders for presence of an optic chiasm deviation termed the Y-sign. Main outcome measures were presence of the Y-sign on MRI imaging in the coronal view. RESULTS:The Y-sign was identified in 55.1% of patients with ONH and 0% of control patients. Odds of the Y-sign were significantly higher in patients younger than 1 year (odds ratio [OR]: 3.58, 95% CI: 1.4 to 9.14; P = .008) and in patients with bilateral ONH (OR: 2.82, 95% CI: 1.08 to 7.33; P = .034). No association was found between the Y-sign and visual acuity or endocrine abnormalities (P = .11 and P = .78, respectively). However, there was a moderate effect size noted between the Y-sign and absence of the septum pellucidum (P = .052). CONCLUSIONS:The authors present a novel MRI finding seen in more than half of patients with ONH that appears to be highly specific and mildly sensitive for the condition. Results indicate that the Y-sign may be a sign for absence of the septum pellucidum, but other clinical outcomes require further investigation.
PURPOSE:To investigate the supplemental role of dichoptic mobile video games in the treatment of adults with amblyopia. METHODS:Patients aged 18 to 40 years with unilateral mild to moderate amblyopia and no prior history of amblyopia treatment were recruited after 6 weeks of optimal refractive correction. Patients were randomly assigned to two groups, each comprising 15 participants. The control group was prescribed 6 hours of daily patching. The study group played dichoptic mobile video games (stereoblocks) in addition to patching. They attended 2-hour sessions weekly for 12 weeks. Follow-up assessments included best corrected visual acuity (BCVA) for distance and near, as well as stereoacuity measurements at baseline and 1, 4, 8, and 12 weeks. RESULTS:The median age of patients was 21.5 years (range: 19.5 to 26.5 years). The distance and near BCVA in the amblyopic eye showed an improvement at the final follow-up visit (12 weeks) in both groups. There was a statistically significant difference in improvement between the two groups at the final follow-up visit, with the study group performing better (P = .04). There was no significant improvement in either of the groups in terms of stereoacuity (P = .29). In intergroup and subgroup analysis, patients with anisometropia showed a significantly better improvement compared to strabismic and mixed amblyopia. CONCLUSIONS:Video games as a supplement to patching have additional benefits to patching in terms of BCVA in adults with amblyopia. Patients with anisometropic amblyopia appear to benefit more from this combined approach compared to those with strabismic or mixed amblyopia.
PURPOSE:To perform a clinical descriptive analysis of the long-term ophthalmological sequelae present in shaken baby syndrome and to evaluate a possible correlation between the grade of initial retinal hemorrhage at diagnosis and the severity of ophthalmological sequelae at school age and whether there was an association between the resorption time of initial retinal hemorrhages and ophthalmological sequelae. METHODS:Fifty-two children aged 5 to 11 years with retinal hemorrhages and confirmed shaking injury were included. Visual acuity, fundus, macular optical coherence tomography, retinal nerve fiber layer, and visual fields were evaluated and analyzed according to initial retinal hemorrhage severity. RESULTS:In the study population, 50% of children had macular impairment seen on optical coherence tomography (epiretinal membrane, retinal atrophy, internal limiting detachment, or vitreous abnormality), 42.3% had amblyopia (18% functional amblyopia and 24% organic amblyopia), 42% had strabismus, 40% had fundus abnormality (scar visible on fundus or infrared), 37% had retinal nerve fiber layer deficiency, 8% had visual field impairment (chiasmatic or retrochiasmatic impairment), and 2% had cortical blindness. Children had significantly more ophthalmological sequelae if the retinal hemorrhages were grade 3 according to the 2011 Haute Autorité de Santé (HAS) classification (French classification of retinal hemorrhages based on their number and topography). The longer the retinal hemorrhage resorption time, the more significant the ophthalmological sequelae appeared to be. CONCLUSIONS:Shaken baby syndrome is responsible for numerous ophthalmological sequelae. Some are irreversible (epiretinal membrane), whereas others are reversible and can be rehabilitated (amblyopia). Detecting ophthalmological sequelae is important to monitor for complications that may arise and also contributes to the child's integration into society.
PURPOSE:To assess macular structure and function in retinopathy of prematurity (ROP). METHODS:This was a prospective observational cohort study performed on children with laser-treated ROP (n = 32 eyes of 17 children, age 9.12 ± 2.60 years) and untreated ROP (n = 22 eyes of 12 children, age 10.40 ± 2.76 years), or premature children meeting ROP screening criteria but without ROP (immature retina) (n = 10 eyes of 6 children, age 9.00 ± 2.00 years), and full-term control patients (n = 42 eyes of 21 children, age 11.67 ± 2.87 years) comparing foveal function (logarithm of the minimum angle of resolution [logMAR] visual acuity, contrast sensitivity [CS]) and retinal morphology (central retinal thickness [CRT]). Linear mixed models were fit, followed by post-hoc comparisons using the Tukey-Kramer method. RESULTS:Visual acuity of laser-treated eyes (0.26 logMAR, 95% CI: 0.19 to 0.33) was significantly worse than that of untreated (0.06 logMAR, 95% CI: -0.02 to 0.165, P = .004) and control (-0.02 logMAR, 95% CI: -0.08 to 0.05, P < .001) eyes, but not different from immature retina eyes (0.11 logMAR, 95% CI: -0.01 to 0.22, P = .12). CS in treated eyes (1.56 log units, 95% CI: 1.48 to 1.63) was significantly worse than normal eyes (1.69 log units, 95% CI: 1.62 to 1.76, P = .05), but not different from either untreated (1.66 log units, 95% CI: 1.56 to 1.75, P = .35), or immature retina (1.65 log units, 95% CI: 1.51 to 1.78, P = .63) eyes. CRT of laser-treated eyes (330.98 µm, 95% CI: 318.18 to 343.79) was significantly greater than untreated (290.32 µm, 95% CI: 276.32 to 304.32, P < .001), immature (298.39 µm, 95% CI: 280.29 to 316.50, P = .02), and control (272.07 µm, 95% CI: 260.96 to 283.19, P < .001) eyes. In lasered-treated eyes there was a statistically significant negative correlation between logMAR and CRT (correlation = -0.39, 95% CI: -0.75 to -0.03, P = .03). CONCLUSIONS:Laser-treated eyes had abnormal macular structure and function compared to untreated eyes and normal control eyes. Further studies are needed to determine whether these abnormalities are attributable to increased severity of ROP in laser-treated patients, the effect of laser treatment, or both.
Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder caused by mutations in the NF1 gene and is commonly associated with ocular manifestations such as Lisch nodules, optic pathway gliomas, and choroidal abnormalities. Retinal structural changes are rarely reported. The authors describe a 3-year-old girl with NF1 who presented with decreased vision in her left eye. Ophthalmic imaging revealed an epiretinal fibrovascular membrane with vitreoretinal traction, cystic macular changes, and localized tractional retinal detachment (TRD) with a retinal tear. RetCam (Clarity Medical Sysetms, Inc) imaging and fluorescein angiography demonstrated vitreous opacities, fibrovascular adhesions, and vascular leakage. Systemic examination identified multiple café-au-lait spots and a plexiform neurofibroma confirmed by histopathology. The patient underwent pars plana vitrectomy with membrane removal and silicone oil tamponade, resulting in stable retinal attachment during follow-up. This case expands the spectrum of retinal manifestations associated with NF1 and highlights the importance of regular ophthalmic surveillance in affected children.
A rare case of methicillin-resistant Staphylococcus aureus (MRSA) after strabismus surgery is reported in a 7-year-old girl. The child presented with progressive pain and discharge, which was non-responsive to initial antibiotics. Surgical exploration and culture confirmed MRSA. Targeted vancomycin and linezolid led to complete resolution of the signs and symptoms. This case underscores importance of early postoperative follow-up and high clinical suspicion, coupled with prompt collaboration with microbiologists, particularly when managing unusual or drug-resistant postoperative infections.
Sinonasal myxomas are rare benign tumors that typically occur in young children, with orbital involvement in 26% of reported cases. The authors report a case manifesting solely with progressive ocular motility restrictions and diplopia. Magnetic resonance imaging revealed an expansile lesion occupying the right posterior ethmoid cavity with right orbital involvement. Surgical resection reduced the tumor size. Although rare, this case demonstrates that sinonasal myxoma should be considered in the differential diagnosis in young patients with ocular motility restrictions.
To evaluate the surgical outcomes of a combined modified Nishida's procedure with medial rectus (MR) recession augmented with lateral rectus (LR) plication in patients with long-standing complete sixth nerve palsy presenting with large-angle esotropia (ET). This retrospective interventional case series included three patients with chronic traumatic complete sixth nerve palsy and large-angle ET (70 to 75 prism diopters [PD]). Postoperatively, two patients achieved orthophoria at distance and near and one patient had a small residual ET of 5 PD at 6 months. The combination of modified Nishida's procedure with MR recession and LR plication appears to be an effective single-stage surgical approach for large-angle esotropia (approximately 70 PD) associated with complete sixth nerve palsy. The technique provides substantial alignment correction, improved abduction, resolution of diplopia, and a reduced risk of anterior segment ischemia compared to full-tendon vertical rectus transposition.
