Pediatric uveitis is an inflammatory ocular disease that can lead to sight-threatening complications.Pediatric patients have distinct challenges in the diagnosis and management of uveitis,secondary to difficulties in ...Pediatric uveitis is an inflammatory ocular disease that can lead to sight-threatening complications.Pediatric patients have distinct challenges in the diagnosis and management of uveitis,secondary to difficulties in performing ophthalmic examinations in young children,delayed diagnosis due to lack of adherence with recommended screening schedules,medication side-effects,and increased burden of disease into adulthood.Measurement of outcomes in pediatric uveitis has traditionally relied upon the ophthalmic examination and general quality of life(QOL)measures.However,the ophthalmic examination does not take into account the impact of uveitis on a child’s QOL and general QOL measures do not adequately assess the specific effects of vision.Several vision-related quality of life(VR-QOL)instruments have been used to measure outcomes in both adults and children including:the National Eye Institute Visual Function Questionnaire(NEI VFQ-25),Vision-related Quality of Life of Children and Young People(VQoL_CYP),the Children’s Visual Function Questionnaire(CVFQ),and the Effect of Youngsters’Eyesight on Quality of Life(EYE-Q).However,the NEI VFQ-25 is not a valid or applicable measure in children,and the VQoL_CYP and CVFQ are not uveitis specific and may not characterize disease specific burdens.The EYE-Q is the only uveitis-specific pediatric questionnaire that measures visual functioning and VR-QOL in 5-18 years old children and adolescents with uveitis.It has been shown to be a valid and reliable assessment tool in several cohorts of children with uveitis.A comprehensive assessment of the impact of uveitis on a child that includes a vision-specific measure,such as the EYE-Q,allows for better understanding of the true burden of uveitis in children.For this review,we describe traditional outcome measures in uveitis studies,general QOL measures and vision-specific measures in adults and in children.展开更多
Background: Facial nerve palsy(FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identii able cause. These children may have a variety of ocular and systemic features ass...Background: Facial nerve palsy(FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identii able cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation.Methods: This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008.Results: A total of 22 patients were included in the study. The average age at presentation was 6.08 years(range, 4 months to 16 years). Only one patient(4.54%) had bilateral FNP and 21 cases(95.45%) had unilateral FNP. Seventeen patients(77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients(22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients(36.36%). Amblyopia was seen in ten patients(45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy.Conclusions: FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Traumatic cataract is the leading cause of significant monocular </s...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Traumatic cataract is the leading cause of significant monocular </span><span style="font-family:""><span style="font-family:Verdana;">visual impairment in children. The cause of this type of cataract is preventable penetrating or blunt ocular injury. Lens extraction can improve the visual </span><span style="font-family:Verdana;">acuity but it also depends on the extent of the injury to other ocular struc</span><span style="font-family:Verdana;">ture</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To describe the features of pediatric traumatic cataract presenting at a tertiary eye center in Indonesia. </span><b><span style="font-family:Verdana;">Methods:</span></b><i> </i><span style="font-family:Verdana;">This study is a descriptive study and the data w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> collected retrospectively from the medical records of the patients who were diagnosed as pediatric traumatic cataract over the period of January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2019 to December 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2019. Demographic data, trauma characteristics, clinical features, management, and pre- and post-operative Best Corrected Visual Acuity (BCVA) were reviewed retrospectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 37 patients were diagnosed as pediatric traumatic cataract. Among these patients, 78.38% were boys, with the mean age of 9.14 </span></span><span style="font-family:""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 3.77 years old. Open globe injury was the mechanism of injury for 54.05% patients. Besides lens aspiration, additional procedures were membranectomy, anterior vitrectomy, primary posterior capsulotomy, and synechiolysis. Eighty-one percent patients had unilateral blindness preoperatively and 23.80% patients still had unilateral blindness on three months of follow</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">up. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">In pediatric patients, traumatic cataract occurred predominantly in boys while playing outside the house. The children who had ocular trauma still have the risk of blindness even after the surgery. Trauma prevention and avoidance by adult supervision when children engage in outdoor play activity </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> necessary.展开更多
Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola...Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea(POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present:(1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia;(2) Chronic or recurrent blepharitis and/or chalazia/hordeola;(3) Eyelid telangiectasia documented by an ophthalmologist;(4) Primary periorificial dermatitis and/or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.展开更多
Anophthalmia is defined as a complete absence of one eye or both the eyes,while microphthalmia represents the presence of a small eye within the orbit.The estimated birth prevalence for anophthalmia is approximately 3...Anophthalmia is defined as a complete absence of one eye or both the eyes,while microphthalmia represents the presence of a small eye within the orbit.The estimated birth prevalence for anophthalmia is approximately 3 per 100000 live births,and for microphthalmia,it is around 14 per 100000 live births.However,combined evidence suggests that the prevalence of these malformations could be as high as 30 per 100000 individuals.Microphthalmia is reported to occur in 3.2%to 11.2%of blind children.Anophthalmia and microphthalmia(A/M)are part of a phenotypic spectrum alongside ocular coloboma,hypothesized to share a com-mon genetic basis.Both A/M can occur in isolation or as part of a syndrome.Their complex etiology involves chromosomal aberrations,monogenic inheritance pattern,and the contribution of environmental factors such as gestational-acquired infections,maternal vitamin A deficiency(VAD),exposure to X-rays,solvent misuse,and thalidomide exposure.A/M exhibit significant clinical and genetic heterogeneity with over 90 genes identified so far.Familial cases of A/M have a complex genetic basis,including all Mendelian modes of inheritance,i.e.,autosomal dominant,recessive,and X-linked.Most cases arise sporadically due to de novo mutations.Examining gene expression during eye development and the effects of various environmental variables will help us better understand the phenotypic heterogeneity found in A/M,leading to more effective diagnosis and management strategies.The present review focuses on key genetic factors,developmental abnormalities,and environmental modifiers linked with A/M.It also emphasizes at potential research areas including multiomic methods and disease modeling with induced pluripotent stem cell technologies,which aim to create innovative treatment options.展开更多
AIM:To evaluate the effects of microlens design of peripheral defocus modifying spectacle lenses(PDMSLs)and non-microlens design of PDMSLs on controlling myopia progression in children and adolescents.METHODS:A system...AIM:To evaluate the effects of microlens design of peripheral defocus modifying spectacle lenses(PDMSLs)and non-microlens design of PDMSLs on controlling myopia progression in children and adolescents.METHODS:A systematic search was carried out in the PubMed,Cochrane Library,Embase,CNKI,and Web of Science databases.The search targeted randomized controlled trials(RCTs)and cohort studies(CTs)that explored the effects of PDMSLs on myopia control among children and adolescents.The Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale were employed to evaluate the risk of bias in the included studies.The published biases of the included studies were evaluated using Egger’s test.RESULTS:Nine studies(7 RCTs,2 CTs)were included,involving 4332 participants in the PDMSLs group and 7317 participants in the single vision lenses(SVLs)group.Metaanalysis showed that PDMSLs with microlens design had lower change in spherical equivalent refraction(SER)than SVLs at 6,12,18,and 24mo after wearing glasses,with reductions of 0.19 D(95%CI:0.14 to 0.24,P<0.00001),0.36 D(95%CI:0.25 to 0.46,P<0.00001),0.43 D(95%CI:0.32 to 0.55,P<0.00001),and 0.51 D(95%CI:0.33 to 0.69,P<0.00001),respectively.The changes in axial length(AL)were also lower in PDMSLs compared to SVLs,with reductions of-0.09 mm(95%CI:-0.13 to-0.04,P=0.0002),-0.15 mm(95%CI:-0.21 to-0.08,P<0.00001),-0.27 mm(95%CI:-0.34 to-0.20,P<0.00001),and-0.29 mm(95%CI:-0.38 to-0.20,P<0.00001),respectively.There was no significant difference between the non-microlens group and SVLs in controlling the changes of SER and AL in myopia(both P>0.05).CONCLUSION:The synthesized evidence indicates superior myopia management outcomes with microlens design of PDMSLs compared to both SVLs and nonmicrolens design of PDMSLs in children and adolescents.展开更多
Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cor...Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.展开更多
AIM: To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity(ROP) who were or not treated. METHODS: The clinical records of all premature infants with or wi...AIM: To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity(ROP) who were or not treated. METHODS: The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed.RESULTS: A total of 562 screened premature infants(all Chinese, 1124 eyes), were recruited with a 378:184 maleto-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55%(93/562 cases). The incidences in boys and girls were 16.14%(33/378 cases) and 17.39%(32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP(stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP(30.99%, 172/555 cases), and myopic refraction(including myopia and myopia combined with astigmatism) was more common in premature infants with ROP(48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction(including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment(63.63%, 7/11 cases). CONCLUSION: The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.展开更多
AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profile...AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.展开更多
·AIM:To evaluate the effect of 0.05%atropine on the control of myopia for 2y(phase I)and on spherical equivalent refraction(SER)progression for 1y(phase II)after its withdrawal in Chinese myopic children.·ME...·AIM:To evaluate the effect of 0.05%atropine on the control of myopia for 2y(phase I)and on spherical equivalent refraction(SER)progression for 1y(phase II)after its withdrawal in Chinese myopic children.·METHODS:Totally 142 children with myopia were randomly assigned to the 0.05%atropine group or to the placebo group.In phase I,children received 1 treatment for each eye daily.In phase II,the patients received no treatment.Axial length(AL),SER,intraocular pressure(IOP)and atropine-related side effects were assessed at 6 months’intervals.·RESULTS:During phase I,the mean change of SER was-0.46±0.30 D in the atropine group,compared to-1.72±1.12 D in the placebo group(P<0.001).The mean change of AL in the atropine group(0.26±0.30 mm)was significantly shorter than that in the placebo group(0.76±0.62 mm,P=0.002).In addition,in phase II(12mo after the withdrawal of atropine),there was no significant difference in AL change from the atropine group,when compared with that from the placebo group(0.31±0.25 mm vs 0.28±0.26 mm,P>0.05).Furthermore,the change in SER from the atropine group was 0.50±0.41 D,which was significantly lower than 0.72±0.60 D from placebo group,(P<0.05).Finally,there were no statistically significant differences in IOP between the treatment and control groups at any stages(all P>0.05).·CONCLUSION:The use of 0.05%atropine for two consecutive years may effectively control elongation of AL and thus progression of myopia,without significant SER progression 1y after atropine withdrawal.Therefore,treatment with 0.05%atropine daily for 2y is effective and safe.展开更多
Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to s...Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to significant illness including nephropathy,neuropathy,retinopathy,and macrovascular abnormalities including peripheral vasculopathy,and ischaemic heart disease.Research into diabetic retinopathy(DR),which affects one-third of persons with diabetes,has made considerable strides in recent years.In addition,it can lead to several anterior segment complications such as glaucoma,cataract,cornea,conjunctiva,lacrimal glands and other ocular surface diseases.Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells,which raises the likelihood of anterior segment diseases including corneal ulcers,dry eye disease,and chronic epithelial abnormalities.Although DR and other associated ocular complications are well-known,the complexity of its aetiology and diagnosis makes therapeutic intervention challenging.Strict glycaemic control,early detection and regular screening,and meticulous management is the key to halting the progression of the disease.In this review manuscript,we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology,epidemiology,and prospective therapeutic targets.This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes,which are often neglected.展开更多
AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral re...AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.展开更多
Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anter...Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles （EOM） and thus proved instrumental in planning and management.展开更多
Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),pr...Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),present in onethird of patients with diabetes,is a vision-threatening complication caused by uncontrolled diabetes,which greatly affects the retinal blood vessels and the lightsensitive inner retina,eventually leading to blindness.Several epidemiological studies elucidate that DR can vary by age of onset,duration,types of diabetes,and ethnicity.Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia.The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging.This review throws light on the pathological processes behind DR,the cascade of events that follow it,as well as the available and emerging treatment options.展开更多
AIM:To compare the corneal parameters of children with congenital isolated growth hormone deficiency and healthy subjects.METHODS:In this cross-sectional,prospective study,50 cases with growth hormone(GH)deficiency tr...AIM:To compare the corneal parameters of children with congenital isolated growth hormone deficiency and healthy subjects.METHODS:In this cross-sectional,prospective study,50 cases with growth hormone(GH)deficiency treated with recombinant GH and 71 healthy children underwent a complete ophthalmic examination.The corneal hysteresis(CH),corneal resistance factor(CRF),Goldmann-correlated intraocular pressure(IOPg)and corneal-compensated intraocular pressure(IOPcc)were measured with the Ocular Response Analyzer(ORA).Central corneal thickness(CCT)was measured by a ultrasonic pachymeter.RESULTS:The mean age was 13.0±3.0 years in the GH deficiency group consisting of 21 females and 29 males and 13.4±2.4 years in the healthy children group consisting of 41 females and 30 males.There was no statistically significant difference between the groups for gender or age(Chi-square test,P=0.09;independent ttest,P=0.28,respectively).The mean duration of recombinant GH therapy was 3.8±2.4y in the study group.The mean CH,CRF,IOPg and IOPcc values were 11.0±2.0,10.9±1.9,15.1±3.3,and 15.1±3.2 mm Hg respectively in the study group.The same values were 10.7±1.7,10.5±1.7,15.2±3.3,and 15.3±3.4 mm Hg respectively in the control group.The mean CCT values were 555.7±40.6,545.1±32.5μm in the study and control groups respectively.There was no statistically significant difference between the two groups for CH,CRF,IOPg,IOPcc measurements or CCT values(independent t-test,P=0.315,0.286,0.145,0.747,0.13 respectively).CONCLUSION:Our study suggests that GH deficiency does not have an effect on the corneal parameters and CCT values.This observation could be because of the duration between the beginning of disease and the diagnosis and beginning of GH therapy.展开更多
Myopia is a huge health problem due to its high frequency,vision losses and public health cost.According to the World Health Organization,at least 2.2 billion people have vision impairment.Although myopia can be contr...Myopia is a huge health problem due to its high frequency,vision losses and public health cost.According to the World Health Organization,at least 2.2 billion people have vision impairment.Although myopia can be controlled at its early and middle stages,unfortunately,no cure can be achieved so far.Among the methods to control myopia,atropine,a muscarinic receptor antagonist,is the oldest but still the most effective for retardation of myopia progression.Despite such a fact,standard protocols have not been established for clinicians to use atropine for treatment of myopia.In this article,a concise and up to date summary of myopia epidemiology and pathogenesis and summarized therapeutic effects and side effects,possible mechanisms and application methods of atropine were provided in hope for clinical doctors to effectively control this problematic disease.At present,the protocol is recommend:use higher dose(1%)of atropine intermittently to effectively slowdown myopia progression in schoolchildren for 2y,and to significantly reduce side effects of atropine by decrease of atropine frequency for 1y and inhibit myopic rebound by withdrawal of topical atropine gradually for 1y.Application of a lower dose(0.05%)atropine regime should also be considered due to its effectiveness and application at regular basis.展开更多
AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with poste...AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.展开更多
AIM： To evaluate long term follow-up （10y） of 6 muscle surgical approach in essential infantile esotropia （EIE）.METHODS： A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique...AIM： To evaluate long term follow-up （10y） of 6 muscle surgical approach in essential infantile esotropia （EIE）.METHODS： A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique （IO） hyperfunction and lateral rectus （LR） pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach： bilateral medial recti （MR） recession （4-5 mm）, bilateral LR resection （lower than 7 mm） and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥＋30 prism diopters （PD） and IO hyperfunction were selected from larger cohort of patients （n=213, 103 females and 110 males） after excluding patients with： angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package （version 9.1, SAS Institute Inc., Cary, NC, USA）.RESULTS： Ten years follow up data analysis showed the following percentage of orthotropic patients： （0 PD）： 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant （P〈0.01）, increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction （P=0.04）.CONCLUSION： Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.展开更多
基金STA His supported by Award Number R01EY030521 from the National Eye Institute。
文摘Pediatric uveitis is an inflammatory ocular disease that can lead to sight-threatening complications.Pediatric patients have distinct challenges in the diagnosis and management of uveitis,secondary to difficulties in performing ophthalmic examinations in young children,delayed diagnosis due to lack of adherence with recommended screening schedules,medication side-effects,and increased burden of disease into adulthood.Measurement of outcomes in pediatric uveitis has traditionally relied upon the ophthalmic examination and general quality of life(QOL)measures.However,the ophthalmic examination does not take into account the impact of uveitis on a child’s QOL and general QOL measures do not adequately assess the specific effects of vision.Several vision-related quality of life(VR-QOL)instruments have been used to measure outcomes in both adults and children including:the National Eye Institute Visual Function Questionnaire(NEI VFQ-25),Vision-related Quality of Life of Children and Young People(VQoL_CYP),the Children’s Visual Function Questionnaire(CVFQ),and the Effect of Youngsters’Eyesight on Quality of Life(EYE-Q).However,the NEI VFQ-25 is not a valid or applicable measure in children,and the VQoL_CYP and CVFQ are not uveitis specific and may not characterize disease specific burdens.The EYE-Q is the only uveitis-specific pediatric questionnaire that measures visual functioning and VR-QOL in 5-18 years old children and adolescents with uveitis.It has been shown to be a valid and reliable assessment tool in several cohorts of children with uveitis.A comprehensive assessment of the impact of uveitis on a child that includes a vision-specific measure,such as the EYE-Q,allows for better understanding of the true burden of uveitis in children.For this review,we describe traditional outcome measures in uveitis studies,general QOL measures and vision-specific measures in adults and in children.
文摘Background: Facial nerve palsy(FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identii able cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation.Methods: This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008.Results: A total of 22 patients were included in the study. The average age at presentation was 6.08 years(range, 4 months to 16 years). Only one patient(4.54%) had bilateral FNP and 21 cases(95.45%) had unilateral FNP. Seventeen patients(77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients(22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients(36.36%). Amblyopia was seen in ten patients(45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy.Conclusions: FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Traumatic cataract is the leading cause of significant monocular </span><span style="font-family:""><span style="font-family:Verdana;">visual impairment in children. The cause of this type of cataract is preventable penetrating or blunt ocular injury. Lens extraction can improve the visual </span><span style="font-family:Verdana;">acuity but it also depends on the extent of the injury to other ocular struc</span><span style="font-family:Verdana;">ture</span></span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To describe the features of pediatric traumatic cataract presenting at a tertiary eye center in Indonesia. </span><b><span style="font-family:Verdana;">Methods:</span></b><i> </i><span style="font-family:Verdana;">This study is a descriptive study and the data w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> collected retrospectively from the medical records of the patients who were diagnosed as pediatric traumatic cataract over the period of January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2019 to December 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2019. Demographic data, trauma characteristics, clinical features, management, and pre- and post-operative Best Corrected Visual Acuity (BCVA) were reviewed retrospectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 37 patients were diagnosed as pediatric traumatic cataract. Among these patients, 78.38% were boys, with the mean age of 9.14 </span></span><span style="font-family:""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 3.77 years old. Open globe injury was the mechanism of injury for 54.05% patients. Besides lens aspiration, additional procedures were membranectomy, anterior vitrectomy, primary posterior capsulotomy, and synechiolysis. Eighty-one percent patients had unilateral blindness preoperatively and 23.80% patients still had unilateral blindness on three months of follow</span></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">up. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">In pediatric patients, traumatic cataract occurred predominantly in boys while playing outside the house. The children who had ocular trauma still have the risk of blindness even after the surgery. Trauma prevention and avoidance by adult supervision when children engage in outdoor play activity </span></span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> necessary.
文摘Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea(POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present:(1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia;(2) Chronic or recurrent blepharitis and/or chalazia/hordeola;(3) Eyelid telangiectasia documented by an ophthalmologist;(4) Primary periorificial dermatitis and/or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.
文摘Anophthalmia is defined as a complete absence of one eye or both the eyes,while microphthalmia represents the presence of a small eye within the orbit.The estimated birth prevalence for anophthalmia is approximately 3 per 100000 live births,and for microphthalmia,it is around 14 per 100000 live births.However,combined evidence suggests that the prevalence of these malformations could be as high as 30 per 100000 individuals.Microphthalmia is reported to occur in 3.2%to 11.2%of blind children.Anophthalmia and microphthalmia(A/M)are part of a phenotypic spectrum alongside ocular coloboma,hypothesized to share a com-mon genetic basis.Both A/M can occur in isolation or as part of a syndrome.Their complex etiology involves chromosomal aberrations,monogenic inheritance pattern,and the contribution of environmental factors such as gestational-acquired infections,maternal vitamin A deficiency(VAD),exposure to X-rays,solvent misuse,and thalidomide exposure.A/M exhibit significant clinical and genetic heterogeneity with over 90 genes identified so far.Familial cases of A/M have a complex genetic basis,including all Mendelian modes of inheritance,i.e.,autosomal dominant,recessive,and X-linked.Most cases arise sporadically due to de novo mutations.Examining gene expression during eye development and the effects of various environmental variables will help us better understand the phenotypic heterogeneity found in A/M,leading to more effective diagnosis and management strategies.The present review focuses on key genetic factors,developmental abnormalities,and environmental modifiers linked with A/M.It also emphasizes at potential research areas including multiomic methods and disease modeling with induced pluripotent stem cell technologies,which aim to create innovative treatment options.
基金Supported by Sichuan Province Science and Technology Plan(No.2023YFS0506)Medical Research Project of Jinniu District,Chengdu,Sichuan Province(No.JNKY2024-94)Xinglin Scholar Program at Chengdu University of Traditional Chinese Medicine(No.ZYTS2023028).
文摘AIM:To evaluate the effects of microlens design of peripheral defocus modifying spectacle lenses(PDMSLs)and non-microlens design of PDMSLs on controlling myopia progression in children and adolescents.METHODS:A systematic search was carried out in the PubMed,Cochrane Library,Embase,CNKI,and Web of Science databases.The search targeted randomized controlled trials(RCTs)and cohort studies(CTs)that explored the effects of PDMSLs on myopia control among children and adolescents.The Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale were employed to evaluate the risk of bias in the included studies.The published biases of the included studies were evaluated using Egger’s test.RESULTS:Nine studies(7 RCTs,2 CTs)were included,involving 4332 participants in the PDMSLs group and 7317 participants in the single vision lenses(SVLs)group.Metaanalysis showed that PDMSLs with microlens design had lower change in spherical equivalent refraction(SER)than SVLs at 6,12,18,and 24mo after wearing glasses,with reductions of 0.19 D(95%CI:0.14 to 0.24,P<0.00001),0.36 D(95%CI:0.25 to 0.46,P<0.00001),0.43 D(95%CI:0.32 to 0.55,P<0.00001),and 0.51 D(95%CI:0.33 to 0.69,P<0.00001),respectively.The changes in axial length(AL)were also lower in PDMSLs compared to SVLs,with reductions of-0.09 mm(95%CI:-0.13 to-0.04,P=0.0002),-0.15 mm(95%CI:-0.21 to-0.08,P<0.00001),-0.27 mm(95%CI:-0.34 to-0.20,P<0.00001),and-0.29 mm(95%CI:-0.38 to-0.20,P<0.00001),respectively.There was no significant difference between the non-microlens group and SVLs in controlling the changes of SER and AL in myopia(both P>0.05).CONCLUSION:The synthesized evidence indicates superior myopia management outcomes with microlens design of PDMSLs compared to both SVLs and nonmicrolens design of PDMSLs in children and adolescents.
文摘Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.
基金Supported by Health and Family Planning Commission of Jiangxi Province(No.20131080)
文摘AIM: To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity(ROP) who were or not treated. METHODS: The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed.RESULTS: A total of 562 screened premature infants(all Chinese, 1124 eyes), were recruited with a 378:184 maleto-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55%(93/562 cases). The incidences in boys and girls were 16.14%(33/378 cases) and 17.39%(32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP(stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP(30.99%, 172/555 cases), and myopic refraction(including myopia and myopia combined with astigmatism) was more common in premature infants with ROP(48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction(including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment(63.63%, 7/11 cases). CONCLUSION: The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.
文摘AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.
基金Supported by the Special Fund for Young and Middle-aged Academic Technology Leaders and Reserve Talents of Yunnan Province (No.202005AC160021)the Famous Doctor of Yun Ling (No.YNWR-MY-2020-088)。
文摘·AIM:To evaluate the effect of 0.05%atropine on the control of myopia for 2y(phase I)and on spherical equivalent refraction(SER)progression for 1y(phase II)after its withdrawal in Chinese myopic children.·METHODS:Totally 142 children with myopia were randomly assigned to the 0.05%atropine group or to the placebo group.In phase I,children received 1 treatment for each eye daily.In phase II,the patients received no treatment.Axial length(AL),SER,intraocular pressure(IOP)and atropine-related side effects were assessed at 6 months’intervals.·RESULTS:During phase I,the mean change of SER was-0.46±0.30 D in the atropine group,compared to-1.72±1.12 D in the placebo group(P<0.001).The mean change of AL in the atropine group(0.26±0.30 mm)was significantly shorter than that in the placebo group(0.76±0.62 mm,P=0.002).In addition,in phase II(12mo after the withdrawal of atropine),there was no significant difference in AL change from the atropine group,when compared with that from the placebo group(0.31±0.25 mm vs 0.28±0.26 mm,P>0.05).Furthermore,the change in SER from the atropine group was 0.50±0.41 D,which was significantly lower than 0.72±0.60 D from placebo group,(P<0.05).Finally,there were no statistically significant differences in IOP between the treatment and control groups at any stages(all P>0.05).·CONCLUSION:The use of 0.05%atropine for two consecutive years may effectively control elongation of AL and thus progression of myopia,without significant SER progression 1y after atropine withdrawal.Therefore,treatment with 0.05%atropine daily for 2y is effective and safe.
文摘Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to significant illness including nephropathy,neuropathy,retinopathy,and macrovascular abnormalities including peripheral vasculopathy,and ischaemic heart disease.Research into diabetic retinopathy(DR),which affects one-third of persons with diabetes,has made considerable strides in recent years.In addition,it can lead to several anterior segment complications such as glaucoma,cataract,cornea,conjunctiva,lacrimal glands and other ocular surface diseases.Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells,which raises the likelihood of anterior segment diseases including corneal ulcers,dry eye disease,and chronic epithelial abnormalities.Although DR and other associated ocular complications are well-known,the complexity of its aetiology and diagnosis makes therapeutic intervention challenging.Strict glycaemic control,early detection and regular screening,and meticulous management is the key to halting the progression of the disease.In this review manuscript,we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology,epidemiology,and prospective therapeutic targets.This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes,which are often neglected.
文摘AIM： To study the factors affecting residual exotropia（〉10 PD） at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus（LR） recession or unilateral recess resect procedure].METHODS： A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia（〉10 PD） and successful outcome（within 10 PD of orthotropia） at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount（mm） of muscle surgery done.RESULTS： One hundred and fifty-seven patients with mean age of 14y（range 3-53y） were included. Twentyseven patients（17.2%） had residual exotropia at 4-6wk postoperative follow up. Age at surgery（P=0.009） and preoperative deviation for distance（P≤0.001） and near（P=0.001） were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done（recess-resect or bilateral LR recession）. The effect/dose ratio was more in deviations 〉40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group（1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery）.CONCLUSION： Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
文摘Anterior segment optical coherence tomography （AS-OCT） finds very few indications in the domain of strabismus surgery. Current applications remain restricted to determining limbus-muscle insertion distance and anterior segment changes after strabismus surgery. We discuss two cases of operated strabismus surgery where AS-OCT imaging helped in identifying the operated eye and/or extra ocular muscles （EOM） and thus proved instrumental in planning and management.
文摘Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),present in onethird of patients with diabetes,is a vision-threatening complication caused by uncontrolled diabetes,which greatly affects the retinal blood vessels and the lightsensitive inner retina,eventually leading to blindness.Several epidemiological studies elucidate that DR can vary by age of onset,duration,types of diabetes,and ethnicity.Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia.The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging.This review throws light on the pathological processes behind DR,the cascade of events that follow it,as well as the available and emerging treatment options.
文摘AIM:To compare the corneal parameters of children with congenital isolated growth hormone deficiency and healthy subjects.METHODS:In this cross-sectional,prospective study,50 cases with growth hormone(GH)deficiency treated with recombinant GH and 71 healthy children underwent a complete ophthalmic examination.The corneal hysteresis(CH),corneal resistance factor(CRF),Goldmann-correlated intraocular pressure(IOPg)and corneal-compensated intraocular pressure(IOPcc)were measured with the Ocular Response Analyzer(ORA).Central corneal thickness(CCT)was measured by a ultrasonic pachymeter.RESULTS:The mean age was 13.0±3.0 years in the GH deficiency group consisting of 21 females and 29 males and 13.4±2.4 years in the healthy children group consisting of 41 females and 30 males.There was no statistically significant difference between the groups for gender or age(Chi-square test,P=0.09;independent ttest,P=0.28,respectively).The mean duration of recombinant GH therapy was 3.8±2.4y in the study group.The mean CH,CRF,IOPg and IOPcc values were 11.0±2.0,10.9±1.9,15.1±3.3,and 15.1±3.2 mm Hg respectively in the study group.The same values were 10.7±1.7,10.5±1.7,15.2±3.3,and 15.3±3.4 mm Hg respectively in the control group.The mean CCT values were 555.7±40.6,545.1±32.5μm in the study and control groups respectively.There was no statistically significant difference between the two groups for CH,CRF,IOPg,IOPcc measurements or CCT values(independent t-test,P=0.315,0.286,0.145,0.747,0.13 respectively).CONCLUSION:Our study suggests that GH deficiency does not have an effect on the corneal parameters and CCT values.This observation could be because of the duration between the beginning of disease and the diagnosis and beginning of GH therapy.
基金Supported by the Basic Research Fund for Science and Technology Department of Yunnan Province and Kunming Medical University(No.202401AY070001-289).
文摘Myopia is a huge health problem due to its high frequency,vision losses and public health cost.According to the World Health Organization,at least 2.2 billion people have vision impairment.Although myopia can be controlled at its early and middle stages,unfortunately,no cure can be achieved so far.Among the methods to control myopia,atropine,a muscarinic receptor antagonist,is the oldest but still the most effective for retardation of myopia progression.Despite such a fact,standard protocols have not been established for clinicians to use atropine for treatment of myopia.In this article,a concise and up to date summary of myopia epidemiology and pathogenesis and summarized therapeutic effects and side effects,possible mechanisms and application methods of atropine were provided in hope for clinical doctors to effectively control this problematic disease.At present,the protocol is recommend:use higher dose(1%)of atropine intermittently to effectively slowdown myopia progression in schoolchildren for 2y,and to significantly reduce side effects of atropine by decrease of atropine frequency for 1y and inhibit myopic rebound by withdrawal of topical atropine gradually for 1y.Application of a lower dose(0.05%)atropine regime should also be considered due to its effectiveness and application at regular basis.
文摘AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.
文摘AIM： To evaluate long term follow-up （10y） of 6 muscle surgical approach in essential infantile esotropia （EIE）.METHODS： A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique （IO） hyperfunction and lateral rectus （LR） pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach： bilateral medial recti （MR） recession （4-5 mm）, bilateral LR resection （lower than 7 mm） and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥＋30 prism diopters （PD） and IO hyperfunction were selected from larger cohort of patients （n=213, 103 females and 110 males） after excluding patients with： angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package （version 9.1, SAS Institute Inc., Cary, NC, USA）.RESULTS： Ten years follow up data analysis showed the following percentage of orthotropic patients： （0 PD）： 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant （P〈0.01）, increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction （P=0.04）.CONCLUSION： Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.
