The role of imaging in strabismus.

PURPOSE OF REVIEW: To review the most recent literature regarding the clinical experience of imaging modalities in strabismus. RECENT FINDINGS: MRI of extraocular muscles (EOMs) has elucidated the roles of variation in compartmental contraction of EOMs and further evidence of EOM pulley heterotopy in various strabismus patterns, which may contribute to the clinical and surgical management of patients as this mode of imaging becomes more readily available. Ultrasound biomicroscopy (UBM) and anterior-segment optical coherence tomography (AS-OCT) may play a role in determining the location of EOMs which could also aid in devising a preoperative surgical plan, especially in those who have had prior strabismus surgery. SUMMARY: Although MRI, UBM, and AS-OCT show promise in the formulation of a treatment plan in complex strabismus, more research regarding the role and limitations of these imaging modalities is required before they become the mainstay of strabismus evaluation.

The Effectiveness of a Mobile Clinic in Improving Follow-up Eye Care for At-Risk Children.

PURPOSE: To investigate the potential of a mobile ophthalmic unit in the schoolyard to improve the follow-up rate for children who have failed an optometric in-school screening program. Previously, the optometric program made referrals to the center and only 53% of students attended the desired ophthalmology consultation. METHODS: This was a cohort study of students conducted in elementary school lots in socioeconomically disadvantaged communities. The mobile ophthalmic unit visited schools where students with parental consent who needed examination had been identified by an in-school optometric vision care program. RESULTS: A total of 132 students were referred by the optometric program, of whom 95 (72%) had complete signed consent forms. Eighty-two patients (62%, confidence interval: 54% to 70%) were successfully seen by the mobile unit. Compared to the historical rate of successful completion of ophthalmology consultation (53%), a statistically significant improvement in follow-up was noted (P = .036). On a Likert scale of 1 to 5, the mean school nurse satisfaction rating was 4.8. CONCLUSIONS: The findings demonstrate the potential impact of mobile eye clinics at schools in connecting children with ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2016;53(6):344-348.].

Antivascular endothelial growth factor in the treatment of retinopathy of prematurity.

PURPOSE OF REVIEW: To review the most recent literature regarding the clinical experience of antivascular endothelial growth factor (anti-VEGF) therapies in the treatment of retinopathy of prematurity (ROP). RECENT FINDINGS: Anti-VEGF agents in stage 3+ and aggressive posterior ROP have been shown to induce rapid ROP regression. However, significant reoccurrence rates can require repeat injections and thus longer term and more frequent follow-up. Initial studies reflect conflicting evidence regarding significant systemic side effects of these treatments, and outcomes in these patients past the first few years of life are yet to be definitively determined. SUMMARY: Although anti-VEGF therapies show promise in the treatment of ROP, frequent reoccurrences and lack of thorough data about long-term side effects of pharmacologic intervention necessitate further research before anti-VEGF agents become the mainstay of ROP management.

Iris nevus growth into melanoma: analysis of 1611 consecutive eyes: the ABCDEF guide.

PURPOSE: To determine clinical features predictive of growth of iris nevus into melanoma. DESIGN: Retrospective, comparative case series. PARTICIPANTS: A total of 1611 consecutive patients referred to an ocular oncology center with iris nevus. INTERVENTION: Observation and photographic documentation. MAIN OUTCOME MEASURES: Growth into melanoma. RESULTS: The mean age at referral for iris nevus was 51 years (median, 54; range, <1-94 years). At presentation, the mean tumor basal diameter was 3 mm (median, 3 mm; range, <1-12 mm) and mean tumor thickness was 0.8 mm (median, 0.5 mm; range, 0-5 mm). All patients were initially diagnosed with benign iris nevus. Growth of iris nevus to melanoma was confirmed in 2% of eyes (n = 27) over a mean follow-up of 68 months (median, 46 months; range, 3-465 months). By Kaplan-Meier estimates, iris nevus growth to melanoma occurred in <1%, 3%, 4%, 8%, and 11% at 1, 5, 10, 15, and 20 years, respectively. Factors predictive of iris nevus growth to melanoma by multivariable analysis included age ≤ 40 years at presentation (hazard ratio [HR], 3), episode of hyphema (HR, 9), 4:00 to 9:00 clock hour location of tumor (HR, 9), diffuse tumor (involving entire iris surface) (HR, 14), ectropion uveae (HR, 4), and feathery tumor margins (HR, 3). Additional important factors by univariable analysis included tumor seeding on the iris or in the anterior chamber angle, feeder vessels, and nodule formation. These factors can be remembered using the mnemonic ABCDEF, representing A = age young, B = blood, C = clock hour inferior, D = diffuse, E = ectropion, and F = feathery margin. CONCLUSIONS: In an analysis of 1611 cases of iris nevus referred for evaluation at an ocular oncology center, growth into melanoma occurred in 8% by 15 years. Risk factors for growth, identified by ABCDEF included Age young, Blood (hyphema), Clock hour inferior, Diffuse configuration, Ectropion uveae, and Feathery tumor margin.

Clinical survey of 3680 iris tumors based on patient age at presentation.

OBJECTIVE: To report the spectrum of iris lesions based on patient age at presentation. DESIGN: Retrospective, nonrandomized, single-center case series. PARTICIPANTS: We included 3680 iris tumors in 3451 patients. METHODS: Chart review. MAIN OUTCOME MEASURES: Diagnostic category based on age. RESULTS: The mean age at presentation was 48 years and there were 449 (12%) tumors in children (≤20 years), 788 (21%) in young adults (21-40 years), 1308 (36%) in mid adults (41-60 years), and 1135 (31%) in senior adults (>60 years). Of 3680 tumors, the diagnostic category was cystic (n = 768; 21%) or solid (n = 2912; 79%). The cystic tumors originated from iris pigment epithelium (IPE; n = 672; 18%) or iris stroma (n = 96; 3%). The solid tumors included melanocytic (n = 2510; 68%) and nonmelanocytic (n = 402; 11%). The melanocytic tumors comprised nevus (n = 1503; 60%), melanocytoma (n = 68; 3%), melanoma (n = 645; 26%), and melanocytosis (n = 64; 3%). Of 2510 melanocytic tumors, the first and second most common diagnoses by age (children, young adult, mid adult, senior adult) were nevus (53%, 57%, 63%, and 63%, respectively) and melanoma (17%, 27%, 26%, and 27%, respectively). The nonmelanocytic tumors included categories of choristomatous (n = 4; <1%), vascular (n = 57; 2%), fibrous (n = 2; <1%), neural (n = 3; <1%), myogenic (n = 2;, <1%), epithelial (n = 35; 1%), xanthomatous (n = 8; <1%), metastasis (n = 67; 2%), lymphoid (n = 12; <1%), leukemic (n = 2; <1%), secondary (n = 12; <1%), and nonneoplastic simulators (n = 198; 5%). The median age (in years) at diagnosis included cystic (39), melanocytic (52), choristomatous (0.7), vascular (56), fibrous (53), neural (8), myogenic (42), epithelial (63), xanthomatous (1.9), metastasis (60), lymphoid (57), leukemic (25.5), secondary (59), and nonneoplastic simulators (49). Overall, the 3 most common specific diagnoses (children, young adult, mid adult, senior adult) were nevus (25%, 36%, 47%, and 47%, respectively), IPE cyst (28%, 30%, 15%, and 14%, respectively), and melanoma (8%, 16%, 20%, and 19%, respectively). CONCLUSIONS: In an ocular oncology practice, the spectrum of iris tumors includes cystic (21%) and solid (79%) tumors. The solid tumors were melanocytic (68%) or nonmelanocytic (11%). At all ages, the most common specific diagnoses were nevus (42%), IPE cyst (19%), and melanoma (17%).

Resolution of iris neovascularization following chemoreduction of retinoblastoma.

The authors report a case of advanced retinoblastoma (group E) with iris neovascularization. A 30-month-old girl was diagnosed as having group B retinoblastoma in the right eye and group E retinoblastoma and iris neovascularization with an intraocular pressure of 13 mm Hg in the left eye. The tumors were treated with six cycles of chemotherapy using vincristine (0.9 mg/m(2)), carboplatin (336 mg/m(2)), and etoposide (90 mg/m(2)). At 1 month of follow-up, there was dramatic regression of the retinoblastoma in the left eye and complete resolution of the iris neovascularization, which remained stable at 3 months of follow-up. Chemotherapy is an effective conservative treatment for advanced retinoblastoma and can successfully salvage eyes with neovascularization, particularly before the onset of glaucoma.