Reconstruction of an Eyelid Defect Associated with Congenital Coloboma in a 7-Month-Old Male Infant Using an Acellular Dermal Allograft.

BACKGROUND Congenital eyelid coloboma in children often faces complications such as keratitis, symblepharon, and amblyopia. Repairing defects involving at least 50% of the eyelid margin can be challenging. Acellular dermal allograft (ADA) has achieved excellent results as a substitute in adult eye plastic surgery, with minimal morbidity. This report describes a case of reconstruction of an eyelid defect in a 7-month-old male infant using an ADA. CASE REPORT A 7-month-old male infant was referred due to congenital eyelid coloboma in the left eye, which affected nearly one-half of the upper and lower eyelids medially, with more than 9 mm of lagophthalmos and lacrimal duct malformation inducing dacryocystitis. Under general anesthesia, A U-shaped silicone drainage tube was inserted in the nasolacrimal duct to ensure an unobstructed lacrimal duct. The symblepharon release, pseudopterygium excision, and medial canthus reconstruction were performed sequentially. Then, the upper eyelid defect was repaired through the advancement of the lateral segment of the eyelid, following lateral cantholysis. A trimmed ADA was placed as a substitute for the tarsal plate in the lower eyelid defect area and sutured with the free edge of the retractor. Finally, the lower and lateral skin orbicular muscle flap was advanced to cover the acellular dermis composite graft. The postoperative eyelid morphology was satisfactory. At 6 months after surgery, lower eyelid retraction gradually appeared. CONCLUSIONS ADA is presented as an effective solution for reconstructing significant eyelid defects of infants. However, the potential of postoperative eyelid retraction still deserves future research and refinement in surgical techniques.

A cluster randomized trial of a comprehensive intervention nesting family and clinic into school centered implementation to reduce myopia and obesity among children and adolescents in Beijing, China: study protocol.

BACKGROUND: Myopia and obesity in children and adolescents have become serious public health problems that endanger public health, especially in China. Unhealthy lifestyle behaviors are environmental drivers of both myopia and obesity. This protocol describes a study to evaluate the effectiveness of "22510SS", that is 2 h of daytime outdoor activities ('2'); Limit screen time to no more than 2 h per day ('2'); Consume at least 5 servings of fruits and vegetables daily ('5'); Attain 1 h of physical activity daily ('1'); Consume 0 sugar-sweetened beverages ('0'); Reasonable sleep duration ('S'); Regular supervision ('S'). A school-based, multifaceted intervention strategy for myopia and obesity prevention, and to assess and explore the implementation of "22510SS" with regards to acceptability, feasibility, adoption, usage and maintenance. METHODS AND ANALYSIS: This study aims to develop a comprehensive intervention strategy "22510SS" based on the socio-ecological model, and A two-arm cluster randomized trial with a parallel-group of a 1:1 allocation ratio in 36 primary and secondary schools to test its evidence-based intervention programs on the effects and implementation of myopia and obesity epidemics in children and adolescents in grades 4 and 7. The primary outcomes will include differences in visual acuity, body mass index, outdoor activity indicators, screen time, fruit and vegetable intake, high-quality protein intake, sugar-sweetened beverage intake, sleep duration, and level of monitoring among children and adolescents. Secondary outcomes will assess the acceptability, feasibility, uptake, use, and maintenance of the intervention. Effects on the primary and secondary outcomes will be analyzed using linear and logistic regression analyses, as well as difference-in-difference analysis, taking into account cluster effects and possible confounding factors. Process assessments will also be conducted through quantitative and qualitative analyses, including acceptability, feasibility, gender, adoption, implementation, and sustainability. DISCUSSION: This study will evaluate the effectiveness of "22510SS" and examine its implementation in the school-based network nesting family and clinic. Following this intervention study, the integrated intervention program focused on myopia and obesity among children and adolescents have great potential to be implemented in China to promote and support healthy lifestyle behavior change and reduce the risk of myopia and obesity in children and adolescents. TRIAL REGISTRATION: NCT05275959. Registered 23 Mach 2022.

Clinical analysis of eye movement-based data in the medical diagnosis of amblyopia.

Amblyopia is an abnormal visual processing-induced developmental disorder of the central nervous system that affects static and dynamic vision, as well as binocular visual function. Currently, changes in static vision in one eye are the gold standard for amblyopia diagnosis. However, there have been few comprehensive analyses of changes in dynamic vision, especially eye movement, among children with amblyopia. Here, we proposed an optimization scheme involving a video eye tracker combined with an "artificial eye" for comprehensive examination of eye movement in children with amblyopia; we sought to improve the diagnostic criteria for amblyopia and provide theoretical support for practical treatment. The resulting eye movement data were used to construct a deep learning approach for diagnostic and predictive applications. Through efforts to manage the uncooperativeness of children with strabismus who could not complete the eye movement assessment, this study quantitatively and objectively assessed the clinical implications of eye movement characteristics in children with amblyopia. Our results indicated that an amblyopic eye is always in a state of adjustment, and thus is not "lazy." Additionally, we found that the eye movement parameters of amblyopic eyes and eyes with normal vision are significantly different. Finally, we identified eye movement parameters that can be used to supplement and optimize the diagnostic criteria for amblyopia, providing a diagnostic basis for evaluation of binocular visual function.

Outcomes of surgery for epiblepharon accompanied with lower eyelid retraction secondary to buphthalmos in children.

IMPORTANCE: In cases of epiblepharon with lower eyelid retraction secondary to glaucoma, correcting epiblepharon alone is ineffective. Combined surgery should be performed to obtain satisfactory outcomes. OBJECTIVE: To investigate outcomes after surgery to correct epiblepharon with lower eyelid retraction secondary to buphthalmos in children. METHODS: A retrospective analysis of six eyes in four patients was performed included lower lid retractor recession combined with marginal rotation with tarsal fixation. The margin reflex distance-2, lagophthalmus, resolution of clinical symptoms, and complications were assessed during 6 to 12 months of follow-up. RESULTS: In all cases, epiblepharon and lagophthalmus were corrected, symptoms of photophobia and epiphora were relieved, and the corneal epithelium was repaired. The margin reflex distance-2 decreased and remained normal during the follow-up period, but slightly regressed within 6 months postoperatively. INTERPRETATION: Epiblepharon caused by buphthalmos in children is often associated with lower eyelid retraction. Lower lid retractor recession combined with marginal rotation with tarsal fixation fundamentally solves the problems of high eyelid tension, lower eyelid retraction, and epiblepharon and reduces the recurrence rate.

A modified Fox pentagon technique performed using a polytetrafluoroethylene sling in frontalis suspension to treat blepharophimosis syndrome.

The purpose of this study was to evaluate the functional and cosmetic outcomes of a new modified Fox pentagon technique performed using polytetrafluoroethylene in frontalis suspension surgery for blepharophimosis syndrome. This retrospective study enrolled 40 patients diagnosed with blepharophimosis syndrome from March 2016 to October 2018. All patients underwent frontalis suspension using a new modified Fox pentagon technique. The functional and cosmetic outcomes were evaluated. After the operation, the mean palpebral fissure height increased from 2.68 to 6.93 in right eyes and from 2.73 to 6.98 in left eyes. The mean MRD1 increased from 0.53 to 3.76 in right eyes and from 0.50 to 3.78 in left eyes. While preoperative to postoperative differences were statistically significant (p < 0.01), there were no significant differences between right and left eyes either before or after the surgery (p > 0.01). All patients achieved good cosmetic results with an average score of 0.6. We have experimentally created a modified Fox pentagon technique performed using a polytetrafluoroethylene sling in a frontalis suspension to treat BPES; this approach yielded favorable cosmetic and functional outcomes.

[Efficacy of surgery on congenital nystagmus with convergence damping].

OBJECTIVE: To evaluate the efficacy of surgery in the treatment of congenital nystagmus with convergence damping. METHODS: Retrospective and comparative case series. Eight patients diagnosed as congenital nystagmus with convergence damping at Beijing Children's Hospital between September 2010 and September 2012 were enrolled in this study. The ages were 9.5 (12, 6) years old, and follow-up was 9 (24, 6) months. All patients received prism induced convergence and the same surgery of bimedial rectus recession and bilateral rectus tenotomy. The best corrected visual acuity, the range of fusion and the nystagmus waveforms were analyzed before and after surgery. RESULTS: The range of fusion was -3.75±1.83° to +19.38±3.16° before surgery and -3.88±1.55° to +19.00±3.02° after surgery; there was no significant difference (t=0.24, P=0.82). The binocular visual acuity increased from 0.21±0.15 without convergence to 0.28±0.18 using convergence; there was significant difference (t=-4.43, P=0.00). The visual acuity was 0.32±0.20 after surgery, significantly different from that before surgery without convergence (t=-5.29, P=0.00), but not significantly different from that before surgery using convergence (t=-2.12, P=0.07). Patients had significant improvements in the frequency (t=3.28, 3.02, P<0.05) and intensity of the nystagmus waveforms when using convergence and postoperatively (t=3.27, 3.48; P<0.05), but there was no significant improvement in the amplitude of the waveforms (t=1.31, 1.57, 0.31, P>0.05). CONCLUSIONS: Surgery for congenital nystagmus with convergence damping can provide expectations for ocular motor and visual results. The range of fusion should be wide enough, and the effect of convergence on the frequency is greater than that on the amplitude.

[Application value of computed tomography dacryocystography in children lacrimal diseases].

OBJECTIVE: To explore the application value of computed tomography (CT) dacryocystography in children lacrimal diseases. METHODS: Retrospective case series. The results of CT dacryocystography in 300 children (395 eyes) with lacrimal diseases from October 2009 to October 2011 in Beijing Children Hospital were analyzed retrospectively. RESULTS: Among 240 children (326 eyes) with congenital nasolacrimal duct obstruction, the sites of obstruction were in the common canaliculus or upper position in 6 eyes (1.8%), in the lacrimal sac in 38 eyes (11.7%), at the borderline between lacrimal sac and nasolacrimal duct in 213 eyes (65.3%) and at the terminal of nasolacrimal duct in 69 eyes (21.2%). CT dacryocystography could display the obstruction position of lacrimal duct in congenital nasolacrimal duct obstruction. In unilateral congenital nasolacrimal duct obstruction, CT dacryocystography indicated that nasolacrimal canal in affected side were much larger than that in normal side. It could show the destruction of lacrimal soft tissue and the fossa of lacrimal sac in traumatic lacrimal duct obstruction. CT dacryocystography was also the main subsidiary method for the diagnosis of congenital dacryocystocele, congenital nasolacrimal canal agenesis and lacrimal sac diverticula. CONCLUSIONS: CT dacryocystography can provide important aspects for the diagnosis and treatment of children lacrimal diseases. Therefore, it can be used as an important image examination method in children with lacrimal diseases.

[Visual function of seven children with malignant osteopetrosis after hematopoietic stem cell transplantation].

OBJECTIVE: To detect long-term ocular alteration of children with malignant osteopetrosis after hematopoietic stem cell transplantation. METHODS: Children diagnosed as osteopetrosis from 5 months to 31 months underwent hematopoietic stem cell transplantation. Computed tomography of optic canal, FVEP, ERG and fundus examination were applied to assess the visual function. RESULTS: Bone marrow transplantation was successful. Peripheral blood test, splenohepatomegalia and osteosclerosis improved gradually. The mean optic canal diameters of right eyes before transplantation was (1.7 ± 0.4)mm. The mean optic canal diameters of right eyes was (3.2 ± 0.7)mm after transplantation. The mean optic canal diameters of left eyes before transplantation was (1.9 ± 0.5)mm . The mean optic canal diameters of left eyes was (3.1 ± 0.8)mm after transplantation. The difference between above two groups was statistically significant(t = -5.204, -4.211;P < 0.05). P2 latency period of FVEP prolonged in 7 cases before transplantation. Mean P2 latency period of FVEP decreased 21.13 ms in 5 cases after transplantation. Mean P2 latency period of FVEP prolonged 22.25 ms in 2 cases after transplantation. Under light adaptation and dark adaptation, ERG amplitude depressed obviously in 2 cases. Two cases with optic nerve atrophy did not change after transplantation. CONCLUSIONS: Hematopoietic stem cell transplantation is an effective way to deal with malignant osteopetrosis. Successful transplantation has been shown to arrest visual deterioration in some cases.

[Congenital dacryocystocele: presentation and treatment].

OBJECTIVE: To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. METHOD: We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. RESULTS: Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. CONCLUSIONS: Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.

[Factors affected therapeutic results in treatment of children congenital nasolacrimal duct obstruction by Ritleng lacrimal intubation].

OBJECTIVE: To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction (CNLDO) after failed probing and to analyze the effect of various factors that affected the recovery rate. METHODS: Retrospective noncomparative case series. The outcome of 616 cases (eyes) of silicone intubation with the Ritleng lacrimal intubation system, performed between Feb. 2008 and Oct. 2009 on 546 children with CNLDO (aged from 3 to 156 months with an average at 11 months) from Beijing Children's Hospital, was retrospectively reviewed. The follow-up period varied from 4 to 17 months (average 11 months). The effects of age, treatment history, and the type of obstruction on the recovery rate were evaluated and the complications such as epistaxis, lacrimal duct edema or silicone tube prolapse were recorded. The statistics analysis included Pearson correlation coefficient and independent-samples t-test. RESULTS: The overall recovery rate was 88% (544/616 cases). In the five sub-groups based on the age, 6 - 12 month, 12 - 24 month, 24 - 36 month, 36 - 48 month and older than 48 month age, the recovery rate was 96% (94/98); 94% (244/260); 87% (104/119); 77% (58/75) and 69% (44/64), respectively (R = -0.98, P = 0.003). According to the times of previous probing, there were three groups, once, twice, and more than twice, the recovery rate was 95% (291/304); 89% (163/184) and 70% (90/128), respectively (R = -0.99, P = 0.050). In the simple membranous obstruction group and the complex obstruction group, the recovery rate was 92% (343/374) and 83% (201/242), respectively (P = 0.000). Complications included laceration of lachrymal point (8 eyes, 1%) and false passage formation (14 eyes, 2%). The silicone tube prolapsed in 18 eyes (3%). CONCLUSIONS: The Ritleng lacrimal intubation system is an easy, effective and non-traumatic procedure for the treatment of CNLDO children after failed probing. Age of the patients, times of previous probing and type of obstruction influence the recovery rate.

[Balloon dacryocystoplasty in the treatment of congenital nasolacrimal duct obstruction after previous unsuccessful surgery].

OBJECTIVE: To introduce the procedure of balloon dacryocystoplasty and to evaluate its effectiveness and complications as the treatment of congenital nasolacrimal duct obstruction after a previous unsuccessful surgery. METHODS: Prospective case series. Balloon dacryocystoplasty was performed under general anesthesia in 50 eyes of 31 children with congenital nasolacrimal duct obstruction following previous unsuccessful surgery in Beijing Children's Hospital between May 2008 and October 2009. A probe was introduced through the punctum into the inferior meatus of the nasal cavity. A deflated balloon catheter was introduced anterogradely and the balloon was inflated several times to perform the dilation of the nasolacrimal duct. Treatment success was defined as absence of epiphora and mucous discharge, negative results of fluorescein dye disappearance test (FDDT) and the unobstructed irrigation of the lacrimal system during the follow-up period of 4 - 17 months after tube removal. RESULTS: Successful operation was reported in 44 of 50 eyes (88.0%; 95% confidence interval 85.5% - 96.9%). Forty of 50 eyes were FDDT 0 - 1(80.0%). Major complications included epistaxis (10 eyes, 20.0%) and lacrimal duct laceration (2 eyes, 4.0%). CONCLUSION: Balloon dacryocystoplasty is a safe, simple and effective procedure for congenital nasolacrimal duct obstruction following previous unsuccessful surgery without disturbing the anatomy of normal lacrimal drainage system.

[Accessory extraocular muscle-a case report and review].

OBJECTIVE: Explored the causation of a case of incomitant vertical strabismus accompanied with elevation deficit and globe retraction by surgery. METHODS: Case report. Orbital imaging study of MRI was used to discover the anatomic feature of extraocular muscle. By released the restrictive structure to treat strabismus. Histopathologic inspection was used to confirm the origin of the abnormal structure. RESULTS: Abnormal extraocular muscle that located within the cone formed by the four recti muscles was the causation of strabismus. It arose at the annulus of Zinn, passing forwards between the inferior rectus muscle and lateral rectus muscle, and insert directly on the sclera. After Released it from eyeball and recession of inferior rectus muscle the strabismus was improved. Elevation deficit was not improved. Histopathologic inspection confirmed that the structure was muscular in origin. CONCLUSION: The abnormal structure that found by MRI was the cause of elevation deficit and globe retraction. Its histopathologic inspection confirmed the muscular origin. The abnormal structure was an accessory extraocular muscle. For incomitant vertical strabismus accompanied with elevation deficit and globe retraction anomalous orbital structures maybe the causation. Orbital imaging studies should be done to explore the origin of disease.

[The transient PVEP acuity assessment for 2 to 5 years old normal children].

OBJECTIVE: To evaluate the practicality of transient PVEP (pattern visual evoked potential, PVEP) acuity assessment for 2 to 5 years old normal children from September 2007 to January 2008. METHODS: Pattern acuity and transient PVEP-A of 179 (355 eyes) normal children between 2 to 5 years were detected and analyzed. Pattern acuity data were got from test for single uncorrected eye with pattern acuity table. PVEP-A was measured by the horizontal gratings evoked potential, voyich were cognizable response. chi2 and rank tests methods were used to analysis. The value of PVEP-A was converted to international standard acuity, and then comparison to pattern acuity with Logistic regression method. RESULTS: With the growth of age, pattern acuity was gradually increased and the value was greater than 0.4. The positive correlation also existed among PVEP-A and age, PVEP-A from test children was all greater than 3.4 c/d. The analysis result of rank regression was P<0.01, that weaned PVEP-A difference among four groups had statistics significance. The correlation coefficient of PVEP-A with pattern acuity was good (r=0.673). The difference of PVEP-A and pattern acuity between two eyes was correlated(r = 0.664). The result also pointed out PVEP-A growth was earlier than pattern acuity among 179 children. CONCLUSION: Stabilization and reliability PVEP is a good objective visual assessment for younger and handicapped children.