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Importance: Retinopathy of prematurity (ROP) is a potentially blinding retinal disease with poorly defined epidemiology. Understanding of which infants are most at risk for developing ROP may foster targeted detection and prevention efforts. Objective: To identify changes in ROP incidence in the US from 2003 to 2019. Design, Setting, and Participants: This retrospective database cohort study used the Healthcare Cost and Utilization Project Kids' Inpatient Databases. These nationwide databases are produced every 3 years, include data from over 4000 hospitals, and are designed to generate national estimates of health care trends in the US. Participants included pediatric newborns at risk for ROP development between 2003 and 2019. Data were analyzed from September 30, 2021, to January 13, 2022. Exposures: Premature or low-birth-weight infants with relevant International Classification of Diseases, Ninth Revision or Tenth Revision codes were considered ROP candidates. Infants with ROP were identified using relevant codes. Main Outcomes and Measures: ROP incidence in selected subpopulations (based on database-reported race and ethnicity, sex, location, income) was measured. To determine whether incidences varied across time or subpopulations, χ2 tests of independence were used. Results: This study included 125â¯212 ROP discharges (64â¯715 male infants [51.7%]) from 23â¯187â¯683 births. The proportion of premature infants diagnosed with ROP increased from 4.4% (11â¯720 of 265â¯650) in 2003 to 8.1% (27â¯160 of 336â¯117) in 2019. Premature infants from the lowest median household income quartile had the greatest proportional increase of ROP diagnoses from 4.9% (3244 of 66â¯871) to 9.0% (9386 of 104â¯235; P < .001). Premature Black infants experienced the largest increase from 5.8% (2124 of 36â¯476) to 11.6% (7430 of 63â¯925; P < .001) relative to other groups (2.71%; 95% CI, 2.56%-2.87%; P < .001). Hispanic infants experienced the second largest increase from 4.6% (1796 of 39â¯106) to 8.2% (4675 of 57â¯298; P < .001) relative to other groups (-0.16%; 95% CI, -0.29% to -0.03%; P = .02). The Southern US experienced the greatest proportional growth of ROP diagnoses, increasing from 3.7% (3930 of 106â¯772) to 8.3% (11â¯952 of 144â¯013; P < .001) relative to other groups (1.61%; 95% CI, 1.51%-1.71%; P < .001). ROP diagnoses proportionally increased in urban areas and decreased in rural areas. Conclusions and Relevance: This cohort study found that ROP incidence among premature infants increased from 2003 to 2019, especially among Black and Hispanic infants. Infants from the lowest-income areas persistently had the highest proportional incidence of ROP, and all regions experienced a significant increase in ROP incidence with the most drastic changes occurring in the South. These trends suggest that ROP is a growing problem in the US and may be disproportionately affecting historically marginalized groups.
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Retinopatía de la Prematuridad , Lactante , Recién Nacido , Humanos , Masculino , Niño , Estudios de Cohortes , Incidencia , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Estudios Retrospectivos , Edad Gestacional , Factores de Riesgo , Recien Nacido PrematuroRESUMEN
PURPOSE: To report the relative incidence of excised pediatric eyelid lesions and describe the correlation between the clinical and pathology diagnosis. METHODS: This was a retrospective analysis of 137 consecutive pathology-confirmed eyelid lesions excised at a U.S. quaternary children's hospital system. Chalazion was excluded from this study. RESULTS: Benign non-cystic epithelial lesions comprised 48.2% of all excised lesions, followed by mesenchymal (14.6%) and cystic (10.2%) lesions. The most common lesions were molluscum contagiosum (21.9%) and verruca vulgaris (19.0%). Hispanic White race represented 62.0% of cases, followed by non-Hispanic White (23.3%) and Black (8.8%). There were no malignant lesions. A specific preoperative clinical diagnosis was attempted in 70.1% of cases. Of these, 60.4% had a matching histopathology. CONCLUSIONS: The authors report a higher proportion of molluscum contagiosum and verruca vulgaris when compared to the literature; these differences may suggest geographic variance, management preference, or a general increase in incidence. Correlation with pathology showed the clinical diagnosis of eyelid lesions can be challenging even for ophthalmologists. However, malignancy in pediatric eyelid lesions is rare and submission for histopathology may be safely omitted, except in cases with atypical features or suspicion for syndromic disease. The decision for surgery should be methodically approached and take into consideration the most likely diagnosis, natural history of the disease, sociopsychological impact, anesthesia risk, and resource burden. [J Pediatr Ophthalmol Strabismus. 2022;59(6):405-409.].
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Enfermedades de los Párpados , Molusco Contagioso , Verrugas , Humanos , Niño , Molusco Contagioso/patología , Molusco Contagioso/cirugía , Enfermedades de los Párpados/diagnóstico , Estudios Retrospectivos , Párpados/cirugía , Párpados/patologíaAsunto(s)
Aneurisma Falso/etiología , Arteria Carótida Interna/patología , Fístula del Seno Cavernoso de la Carótida/etiología , Diplopía/etiología , Maloclusión de Angle Clase III/cirugía , Osteotomía Le Fort/efectos adversos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/cirugía , Diplopía/diagnóstico por imagen , Diplopía/cirugía , Humanos , Masculino , Maxilar/cirugía , Tomografía Computarizada por Rayos X , Visión Binocular/fisiología , Agudeza Visual/fisiología , Adulto JovenRESUMEN
We present 5 cases of postoperative subconjunctival abscesses from two institutions and discuss their outcomes.
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Absceso/etiología , Enfermedades de la Conjuntiva/etiología , Infecciones Bacterianas del Ojo/etiología , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Estrabismo/cirugía , Infección de la Herida Quirúrgica/etiología , Absceso/diagnóstico , Niño , Preescolar , Enfermedades de la Conjuntiva/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Femenino , Humanos , Masculino , Infección de la Herida Quirúrgica/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To report a case of juvenile xanthogranuloma that simulated a chalazion and to discuss the association between juvenile xanthogranuloma and Langerhans cell histiocytosis. METHOD: Case report and review of literature. RESULTS: A 13-year-old boy with a prior history of Langerhans cell histiocytosis was referred to our clinic for a possible chalazion. The patient had undergone treatment for Langerhans cell histiocytosis 10 years prior. The patient underwent an excisional biopsy. Histopathology revealed a proliferation of histiocytes and lymphocytes with Touton giant cells, consistent with a diagnosis of juvenile xanthogranuloma. CONCLUSIONS: Though the relationship between Langerhans cell histiocytosis and juvenile xanthogranuloma has yet to be fully elucidated, juvenile xanthogranuloma should be included in the differential diagnosis for any former Langerhans cell histiocytosis patient presenting with a new cutaneous lesion.
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PURPOSE: To evaluate the role of multimodality imaging tools for intraprocedural guidance and outcome evaluation during sclerotherapy of low-flow orbital vascular malformations. MATERIALS AND METHODS: A retrospective review was performed of 17 consecutive patients with low-flow orbital malformations (14 lymphatic, two venous, and one venolymphatic) who underwent multimodality image-guided sclerotherapy between November 2012 and May 2015. Sclerotherapy technique, image guidance tools, and complications were recorded. Sclerotherapy outcome was evaluated using clinical response, magnetic resonance (MR) image-based lesion volumetry, and proptosis quantification. RESULTS: There were 22 sclerotherapy sessions performed. Intraprocedural ultrasound (US), fluoroscopy, cone-beam computed tomography (CT) and MR image fusion were used for image guidance with 100% technical success. Resolution of presenting symptoms was observed in all patients at 1-month follow-up. Four major sclerotherapy complications were successfully managed. Statistically significant reduction in lesion volume (P = .001) and proptosis (P = .0117) by MR image analysis was achieved in all patients in whom 3-month follow-up MR imaging was available (n = 13/17). There was no lesion recurrence at a median follow-up of 18 months (range, 8-38 mo). CONCLUSIONS: Multimodality imaging tools, including US, fluoroscopy, cone-beam CT, and MR fusion, during sclerotherapy of low-flow orbital malformations provide intraprocedural guidance and quantitative image-based evaluation of treatment outcome.
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Tomografía Computarizada de Haz Cónico , Imagen por Resonancia Magnética Intervencional , Imagen Multimodal/métodos , Órbita/irrigación sanguínea , Radiografía Intervencional/métodos , Escleroterapia/métodos , Ultrasonografía Intervencional , Malformaciones Vasculares/terapia , Adolescente , Adulto , Niño , Preescolar , Exoftalmia/etiología , Femenino , Fluoroscopía , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Valor Predictivo de las Pruebas , Flujo Sanguíneo Regional , Estudios Retrospectivos , Escleroterapia/efectos adversos , Texas , Resultado del Tratamiento , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/fisiopatología , Adulto JovenRESUMEN
Focal Dermal Hypoplasia (FDH) or Goltz syndrome is a rare multi-system disorder with cutaneous, ocular, dental, and skeletal anomalies due to dysplasia of mesoectodermal derived tissues. It is an X-linked inheritance syndrome caused by mutations in the PORCN gene. This study is aimed to investigate the ocular findings in patients with Goltz syndrome. To date, there have been a limited number of case reports on the ocular manifestations of FDH. This is a prospective, non-consecutive, observational case series. Prospective ophthalmologic evaluation was performed on 18 patients with confirmed genetic testing for FDH, Goltz Syndrome, as a component of a larger multi-subspecialty study to better characterize the findings of this condition. Special attention was placed on evaluating the incidence of anophthalmia, microphthalmia, colobomas (iris, optic nerve, and/or retinal), cataracts, nystagmus, and strabismus. A complete ophthalmologic exam was done on all the patients. The mean patient age was 12.8 years (1-55 years). Eighty-nine percent were female and 77% (14/18) of patients had some form of an ophthalmologic manifestation of the condition. Ophthalmological findings included chorioretinal colobomas (61%), iris colobomas (50%), microphthalmia (44%), anophthalmia (11%), cataracts (11%), and conjunctival and eyelid papillomas (5%). Nystagmus was present in 33% and strabismus in 22% of the patients. Visual acuity ranged from 20/20 to no light perception. This study demonstrates a higher incidence of ophthalmologic manifestations as previously reported (77% vs. 40%). To our knowledge, this is the largest case series reported in the literature with 18 patients.