Adult Versus Pediatric Relapse and Recurrence in Orbital Inflammatory Syndrome.

PURPOSE: Orbital inflammatory syndrome (OIS) is a diagnosis of exclusion that has a variable presentation and unpredictable course. Many studies report incomplete or lack of OIS resolution with high recurrence and relapse rates. No studies to date have investigated the characteristics of both recurrence and relapse in OIS. We sought to determine this in both pediatric and adult patients. METHODS: A retrospective chart review of 56 patients with OIS was performed between 2004 and 2018. Forty-one patients were identified as adults greater than 18 years of age and 15 were identified as pediatric patients less than 18 years of age. RESULTS: Among 56 (41 adult and 15 pediatric) cases of OIS, 18 cases of recurrent disease (32.1%) were identified and 15 (26.8%) patients experienced relapses. All 6 (100%) pediatric patients that had recurrent disease initially suffered from relapses. In contrast, only 1 of the 12 (8.3%) recurrent adult cases initially experienced relapse. Of the 18 patients with recurrent disease, 9 (50%) had multiple recurrences. Underlying etiologies were confirmed in 5 of 18 recurrent cases (27.8%) and 5 of 38 (13.2%) non-recurrent cases. Of the 5 patients with recurrent OIS and an identified etiology, all 5 (100%) demonstrated multiple recurrences. CONCLUSIONS: In pediatric cases, relapse was more common and prior episodes of relapse were predictive of later recurrence. Recurrence was relatively common in both groups with half of the patients having multiple recurrences. Identifiable underlying etiologies were more common in patients with recurrent OIS and those cases all demonstrated multiple recurrences.

Ahmed Valve Tube Extension in Pediatric Glaucoma.

PRéCIS:: Ahmed valve tube extender showed good long-term outcomes for retracted tubes in pediatric glaucoma. The procedure is safe with limited complications. PURPOSE: To analyze the long-term outcomes of Ahmed valve tube extension in pediatric glaucoma patients. PATIENTS AND METHODS: This study analyzed the records of all children who underwent surgery involving extension of a pediatric Ahmed valve tube, treated at a tertiary medical center between 2007 and 2018. Surgical success was defined as intraocular pressure between 6 and 22 mm Hg and reduced by at least 20% from its preoperative value, with or without intraocular pressure lowering medications, without additional surgical procedures and without vision loss. RESULTS: Fourteen eyes of 11 children were treated with the Ahmed tube extender during the study period. Mean age of all children was 5.7±4.7 years (range, 3 mo to 16 y). The most common type of glaucoma was congenital glaucoma (n=6, 42.9%). The mean age at the time of initial valve implant was 2.39±3.89 years and the mean duration from initial insertion to the extension was 3.39±2.95 years. The mean follow-up was 72.8±43.3 months (range, 12 to 140 mo), with 85.7% followed for >2 years. The mean survival was 34.1±37.2 months after the extension. Three surgeries (21.4%) were primary failures, 8 patients (57.1%) failed during follow-up (mean, 40.6±44.4 mo after the extension; range, 1 to 125 mo), whereas 3 patients (21.4%) maintained the successful outcome until their last follow-up visit (mean, 37.7±24.1 mo; range, 12 to 70 mo). CONCLUSIONS: The Ahmed valve extender can often save a retracted or obstructed tube. The procedure has limited complications and long-term efficacy in one third of the patients.

Masked bilateral superior oblique palsy in children.

PURPOSE: Following surgery on an eye for unilateral superior oblique palsy, it is a well-recognized postoperative occurrence for the unoperated eye to develop superior oblique palsy, commonly referred to as masked bilateral superior oblique palsy. The purpose of this study was to describe this postoperative finding in children following unilateral inferior oblique weakening surgery. METHODS: A retrospective review of records of children who underwent unilateral inferior oblique weakening surgery at Children's Hospital of Michigan, Detroit, Michigan, from 1987 to 2005, including information on the development of masked bilateral superior oblique palsy with contralateral inferior oblique overaction requiring a second surgical intervention. RESULTS: Of 50 children (25 boys and 25 girls, mean age: 5.6 years) who underwent unilateral inferior oblique weakening surgery (47 recessions and 3 myectomies), 9 (18%) manifested masked bilateral superior oblique palsy postoperatively, requiring subsequent surgical weakening of the inferior oblique muscle in the unoperated eye. Preoperative primary position hypertropia in children who were eventually diagnosed as having masked bilateral superior oblique palsy (5.56±4.22 prism diopters [PD]) was significantly smaller compared to children with unilateral superior oblique palsy (10.4±6.5 PD, P=.012), and preoperative primary position hypertropia of less than 5 PD was associated with an odds ratio of 8.2 (95% confidence interval: 1.7 to 38.5, P=.008) for requiring reoperation. CONCLUSIONS: Masked bilateral superior oblique palsy is a possible outcome after surgery for the correction of pediatric unilateral superior oblique palsy. Parents should be informed of this possible outcome, especially when primary position hypertropia is less than 5 PD.

The role of the random dot Stereo Butterfly test as an adjunct test for the detection of constant strabismus in vision screening.

BACKGROUND: A goal of vision screening is the detection of amblyopia risk factors, including strabismus. The random dot Stereo Butterfly test requires no instruction, has a simple pass/fail response with no monocular clues, and is easily administered. The purpose of this study was to determine whether this test could be used as a cost-effective and reliable component of preschool vision screening. METHODS: The Stereo Butterfly was presented to children with no previous history of ocular problems or treatment. The test was presented with the use of polarized glasses at a 16-inch testing distance. A "pass" was recorded if the patient reported seeing a butterfly; a "refer" was denoted otherwise. Vision and motility measurements were recorded, and the patient underwent a complete eye examination with cycloplegic refraction. RESULTS: A total of 281 children 3 to 6 years of age were tested: 221 children passed the test. Of those who passed, 7 (3.2%) had intermittent strabismus, 1 had a small-angle constant strabismus, 60 failed screening for constant strabismus (of whom 24 [40%] had constant strabismus), and 6 were false-negative results. The sensitivity of the Stereo Butterfly for detecting constant strabismus was 96%; the specificity, 86%. CONCLUSIONS: The Stereo Butterfly test may be a valuable adjunctive tool in vision screening programs for the detection of manifest strabismus because it is easy to administer and effectively detects constant strabismus. It has a high specificity for detection of constant strabismus but, if used alone, the low positive predictive value would allow for many false-positive results.

Phakomatous choristoma: a rare orbital tumor presenting as an eyelid mass with obstruction of the nasolacrimal duct.

We describe a case of phakomatous choristoma presenting as a lower eyelid mass with nasolacrimal duct obstruction. The literature is reviewed and the unique aspects of the case are discussed.

Efficacy of brinzolamide and levobetaxolol in pediatric glaucomas: a randomized clinical trial.

PURPOSE: To describe the safety and clinical response on elevated intraocular pressure (IOP) of brinzolamide and levobetaxolol in pediatric patients under 6 years of age. METHODS: A double-masked, randomized design. Pediatric patients were randomized to brinzolamide suspension, 1%, or levobetaxolol suspension, 0.5%, both dosed twice daily. IOPs at 9 AM were taken at screening, baseline, and weeks 2, 6, and 12. A descriptive study with mean change from baseline IOP, the primary efficacy parameter. RESULTS: Seventy-eight evaluable patients (32 brinzolamide and 46 levobetaxolol). Patients on no prestudy IOP-lowering therapy randomized to brinzolamide had mean IOP change from baseline ranging from -4.1 mm Hg (week 2) to -5.0 mm Hg (week 6). When all brinzolamide patients are considered, there was little mean change from baseline IOP due to the large number of patients enrolled without a washout of prior IOP-lowering therapy. Levobetaxolol patients had mean change from baseline, ranging from -1.8 mm Hg (week 6) to -2.9 mm Hg (week 2). Levobetaxolol patients on no prestudy therapy had mean IOP change from baseline ranging from -2.9 mm Hg (week 12) to -4.0 mm Hg (week 2). Brinzolamide was more efficacious for glaucoma associated with systemic or ocular abnormalities and less efficacious for primary congenital glaucoma. Levobetaxolol was most efficacious for primary congenital glaucoma. Adverse events were predominantly nonserious and did not interrupt patient continuation in the study. CONCLUSIONS: Both brinzolamide and levobetaxolol were well tolerated. Both drugs provided clinically relevant IOP reductions for patients not on a previous medication, although efficacy is, in part, contingent upon diagnosis.