This workshop will discuss the unique challenges of establishing and maintaining a practice in pediatric ophthalmology in a location far from an academic center. Emphasis will be placed on clinical situations encountered in remote locations and on some of the solutions employed by a panel of experienced clinicians. Remote approaches have become especially relevant for pediatric ophthalmologists since the onset of the COVID-19 pandemic.

PURPOSE To demonstrate the benefits of using braided polyester in the management of severe or recurrent ptosis in children and young adults and to compare the efficacy of two surgical techniques. METHODS Retrospective, non-randomized record review of 30 patients (43 eyelid procedures) affected by congenital or acquired severe ptosis who underwent frontalis suspension with braided polyester from 2008 to 2016. Two surgical techniques were compared: the base-down triangle and the Fox pentagon, both of which were performed using a closed technique. Functional success was defined as clearing of the visual axis. Complications and results were examined. RESULTS Functional success was obtained in 39 eyes of 43 procedures. Marginal reflex distance increased an average of 2.51 mm with the base-down triangle technique and 1.70 mm with the Fox pentagon technique (P = .05). The vertical palpebral fissure height increased an average of 4.60 mm with the base-down triangle technique and 2.45 mm with the Fox pentagon technique (P < .001). Mean follow-up duration was 38.6 months. Complications included untied suture (n = 2), suture dehiscence (n = 1), cellulitis (n = 2), and granuloma (n = 1). CONCLUSIONS Braided polyester was found to be a safe, effective, easy-to-handle, and low-cost sling material for frontalis suspension and should be considered for clinical use, especially in developing countries where the cost and availability of other materials represents a significant barrier to treatment. In the authors' experience, the base-down triangle technique appeared superior to the Fox pentagon technique. [J Pediatr Ophthalmol Strabismus. 2018;55(4):229-233.].

Purpose of review Blepharoptosis is a common problem encountered in the pediatric ophthalmology clinic. The presentation is obvious to both parents and referring physicians and often prompts urgent consultation. The current classification and management of childhood ptosis will be reviewed. Recent findings Recent refinements in techniques utilizing new materials hold promise for better, more predictable outcomes and improved long-term results. Autogenous tensor tendon fascia lata harvested from the patient's thigh remains the gold standard for many ptosis surgeons in frontalis suspension; however, other materials are commonly utilized, including silicone rod, Gore-Tex (ePTFE; W.L. Gore & Associates, Flagstaff, Arizona, USA), Mersilene polyester fiber mesh and Ethibond braided polyester (Ethicon US LLC, Somerville, New Jersey, USA), Supramid monofilament nylon (S. Jackson, Inc, Alexandria, Virginia, USA), prolene, and banked fascia lata. Other techniques include levator resection, posterior approach levatorpexy, and Muller's muscle conjunctival resection both with and without superior tarsectomy. Recent studies suggest that ptosis repair can be effectively combined with strabismus surgery. Summary The management of ptosis in infants and children demands a structured and disciplined approach to avoid the development of amblyopia and long-term visual compromise. Underlying systemic problems must be identified and surgical planning discussed in a timely fashion with caregivers. Recent studies help to further define the proper timing of surgical intervention and the optimal techniques to provide the best long-term results for these patients.

No surgeon can completely eliminate the possibility of encountering a complication. During this symposium, experienced strabismus surgeons will share their own personal stories of complications they have experienced along with how they handled them as well as tips to decrease the chances of having them happen in the first place.

Frontalis suspension is a surgical procedure performed to address severe ptosis with poor levator function. Several different techniques and sling materials are commonly used. The purpose of this study is to demonstrate the benefits of using green braided polyester (Ethibond EXCEL- ETHICON) in the management of severe or recurrent ptosis in children and young adults.

To describe a telemedicine system for the detection of serious acute-phase ROP (e-ROP) and the implications of the study results.

Purpose of review To examine and review digital retinal imaging via telemedicine as an important screening and diagnostic tool in the management of retinopathy of prematurity (ROP). Recent findings The use of wide-angle digital retinal photography to detect clinically significant ROP has been described in numerous reports since 2000. Comparisons with the gold standard of binocular indirect ophthalmoscopy have been favorable. Digital image capture can provide more objective information for disease detection, thereby facilitating internet consultation and retrospective analysis as part of the electronic medical record. As the presence of plus disease in ROP is now the most important criteria for determining the need for laser treatment, computer-based image analysis can potentially provide additional benefit to digital retinal imaging. Telemedicine screening also allows for the extension of diagnostic expertise to underserved areas in both the developed and third world. The role of telemedicine in ROP education will impact both screening efforts and traditional fellowship training in future years. Summary As the worldwide incidence of ROP continues to rise, the use of telemedicine for screening, diagnostic and educational purposes will assume increasing importance in the delivery of healthcare for premature infants.

Pediatric ocular trauma is a major cause of ocular morbidity in children and is a leading cause of non congenital unilateral blindness in this age group. Every year a quarter of a million children present with serious ocular trauma and the vast majority of these injuries are preventable. Estimates of the incidence of serious ocular trauma varies from 8.85 to 15.2 per 100,000 per year. Extrapolation using global population data suggests that every year 160,000 to 180,000 children under 15 years sustain an ocular trauma serious enough to require hospitalization. 21% to 24% are penetrating globe injuries. Those that are less serious are more numerous: 95% of ocular injuries in this age group do not require hospitalization, suggesting that the number of eye injuries in children under 15 years of age might be as high as 3.3 to 5.7 million cases annually. Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Surv Ophthalmol 2013 Sept-Oct;58(5):476-85. Choovuthayakorn J, Patikulsila P, Patikulsila D, Watanachai N, Pimolrat W. Characteristics and outcomes of pediatric open globe injuries. Int Ophthalmol Clinics 2013 Dec 22 (Epub ahead of print).

To present our experience in the diagnosis and management of specific situations in pediatric ocular trauma.

PURPOSE To demonstrate the feasibility of telemedicine screening for retinopathy of prematurity (ROP) by summarizing the results of our experience screening premature infants at a distant hospital in a rural location.METHODS Records of all premature infants remotely screened for ROP at a neonatal intensive care unit in Great Falls, Montana, from January 1, 2007 to June 30, 2011, were retrospectively reviewed. The RetCam II imaging system was used to capture retinal images, which were posted on a secure server for evaluation by one of two pediatric ophthalmologists. Infants suspected of having ROP approaching the criteria for laser treatment were transferred to a hospital, where a diagnostic examination was performed and treatment administered when indicated. All other infants received an outpatient diagnostic examination within 2 weeks of discharge.RESULTS A total of 582 telemedicine examinations were performed on 137 infants during the study period. Of 13 infants transferred for referral-warranted ROP, 9 ultimately required laser treatment. Good outcomes were noted in all cases, with none progressing to stage 4 or 5 ROP.CONCLUSIONS Telemedicine ROP screening detected patients at a remote site in need of laser treatment, allowing prompt transfer with no poor outcomes over a 4.5-year period. Our experience demonstrates the utility of remote screening for ROP. (J AAPOS 2012;16:229-233)