Comparison of Myopia Progression among Myopic Children with Intermittent Exotropia and No Strabismus.

SIGNIFICANCE: Myopia is a highly prevalent condition in the pediatric population that is commonly comorbid with intermittent exotropia. Our study found a trend toward significance in the reduction of myopia progression with strabismus correction surgery. Further investigations characterizing the interaction between myopia and strabismus may help inform future management guidelines. PURPOSE: This study describes and compares myopic progression in the pediatric population with and without intermittent exotropia and its interaction with corrective strabismus surgery. METHODS: This study analyzed a retrospective cohort of 1239 pediatric myopic patients who were evaluated by pediatric ophthalmologists and optometrists at a tertiary care center from 2012 to 2020. The main outcome measures were the trends in refractive error over time in those with and without intermittent exotropia as well as trends in those who did and did not undergo strabismus surgery. RESULTS: A total of 275 patients (22%) were identified to have intermittent exotropia, and 12 (4.4%) from this group underwent surgical correction in the study period. No statistically significant difference was identified in myopic progression between those with intermittent exotropia and those without strabismus, and no difference was found in mean annual spherical equivalent change between intermittent exotropia patients who did not undergo surgery compared with those who did. CONCLUSIONS: Pediatric myopic patients generally experience progression in the condition for several years independent of concurrent intermittent exotropia. Corrective strabismus surgery was not found to alter the natural history of myopia in children, although a reduction in myopic progression in surgically treated patients trended toward significance. Increases in the prevalence of different treatment strategies will necessitate further studies to determine best practices for this population.

Novel mutation in CTNNB1 causes familial exudative vitreoretinopathy (FEVR) and microcephaly: case report and review of the literature.

Purpose: Neonatal retinal folds and/or vitreoretinal traction can be signs of isolated ocular or syndromic disorders. Etiologies include retinopathy of prematurity, perinatal infections or inherited vitreoretinal disorders such as familial exudative vitreoretinopathy (FEVR) or Norrie disease. We present the clinical and genetic findings of a two-month-old infant with microcephaly, mild motor developmental delay, and FEVR, who required urgent surgical interventions.Methods: The patient underwent an initial examination under anesthesia (EUA) with fluorescein angiography (FA) and subsequent medical and surgical treatments. Genetic testing was undertaken to identify the etiology.Results: Examination at 2 months of age demonstrated microcephaly with a head circumference smaller than the 1st percentile. Family history was negative for microcephaly or retinal disease. Anterior segment eye exam was normal OU. There were bilateral macular folds involving the fovea and extending from the disc to the temporal periphery. FA demonstrated bilateral incomplete vascularization of the retina most notable nasally. Indirect laser was applied to ischemic retina OU. Scleral buckling procedures were performed OU as well as a vitrectomy in the left eye. Follow-up examinations demonstrated the stable appearance of the folds and attached retinas OU. Genetic testing identified a novel dominant heterozygous c.2046_2047del [p.Phe683Glnfs*9] mutation in CTNNB1, predicted to result in a frameshift causing a truncated protein.Conclusions: CTNNB1 mutations are an uncommon cause of FEVR with microcephaly.

Cervical lymphadenopathy secondary to rhabdomyosarcoma presenting as Horner syndrome in an infant.

A 4-week-old boy with left ptosis, anisocoria, and a mass on his left hand was diagnosed with Horner syndrome. The diagnosis precipitated a work-up for a possible malignant etiology. Magnetic resonance imaging demonstrated enlarged left cervical and axillary lymph nodes. A biopsy of the hand lesion confirmed embryonal rhabdomyosarcoma, but a biopsy of the axillary lymph node was negative. Mechanical pressure by noncancerous enlarged lymph nodes is hypothesized to cause the Horner syndrome.

Botulinum toxin injection into the lacrimal gland for treatment of proximal nasolacrimal duct obstructions in children.

The authors retrospectively evaluated the use of botulinum toxin injections to treat epiphora in children secondary to proximal obstruction of the nasolacrimal drainage system. Three patients (ages 8, 9, and 16 years) received botulinum toxin injections in the palpebral portion of the lacrimal gland. Two patients experienced symptomatic relief immediately following botulinum toxin injection. Both required subsequent injections, with an average symptomatic relief lasting 7 months. The only noted side effect was papillary conjunctivitis in one patient that resolved without treatment. The third patient was lost to follow-up. Although conjunctival dacryocystorhinostomy with Jones tube is the surgical procedure of choice for treating proximal lacrimal system obstruction, complication rates in children are high. Botulinum toxin injections provide a safe and effective alternative.

Medial rectus surgery for convergence excess esotropia with an accommodative component: a comparison of augmented recession, slanted recession, and recession with posterior fixation.

UNLABELLED: Richard G. Scobee was an internationally renowned strabismologist whose life was short yet very productive. The first section of this paper describes his life and contributions to strabismology and orthoptics. The second section of this paper reports the results of our strabismological study. INTRODUCTION AND PURPOSE: Many different surgical procedures exist for the treatment of children or adults with convergence excess esotropia. We report on our results of augmented recession, slanted recession, and recession with posterior fixation of the medial rectus muscle in such situations. We also report on the incidence of induced vertical deviations. METHODS: Using a retrospective chart review of 800 patients, we excluded patients with confounding strabismus conditions and pharmacological treatments leaving 131 patients included in the study. Slanted reinsertion of medial rectus (twenty-seven patients); posterior fixation with recession of medial rectus (twenty-two patients); augmented medial rectus recession (fifty-eight patients); nonaugmented recession of medial rectus (seventy-three patients). The distance near disparity postoperatively was evaluated using a life table analysis in which all patients were grouped according to the length of time postoperatively. Induced vertical deviation was evaluated at least 6 months postoperatively. RESULTS: At all time periods postoperatively, the patients with slanted recessions showed the greatest reduction in distance near disparity and that reduction was the most stable over time. At 12- 14 months postoperatively, the range in reduction measured 7.9- 11(Δ) among all three procedures. At 15- 18 months postoperatively, the range in reduction measured 16.9- 19.3(Δ) diopters among the three procedures. At greater than 6 months postoperatively, the slanted and augmented recession groups showed up to 1(Δ) of right hypertropia and the posterior fixation and nonaugmented groups showed up to 0.6(Δ) of left hypertropia. CONCLUSIONS: All three medial rectus procedures used in our retrospective study (slanted recession, augmented recession, recession with posterior fixation) reduced the distance near disparity. The greatest and most stable reduction at all time periods postoperatively occurred with the slanted recession. The induced vertical deviation is small in all procedures and is acceptable at 1(Δ) or less. The augmented and slanted recessions are easier to perform than the posterior fixation with recession. We recommend that the slanted reinsertion of the medial rectus recession be considered as a viable option in the surgical correction of esotropia with a distance near disparity.