A Cohort Study to Evaluate the Evolution of the Optic Nerve Head Parameters and Inner Retinal Thickness During Childhood.

PURPOSE: To compare children's stereometric optic disc parameters and inner retinal thickness measured by optical coherence tomography (OCT) in two different moments in life in the same children and to establish a correlation between the optic nerve head (ONH) area and the difference of these parameters in the two observations. METHODS: In this observational cohort, children were evaluated on two occasions: at 6.7 ± 1.6 and 13.2 ± 0.7 years of age. Cup volume, neuroretinal rim (NRR) area, average cup-to-disc ratio, peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell inner plexiform layer (GCIPL) were measured by the Cirrus HD-OCT (Carl Zeiss Meditec AG). RESULTS: A total of 175 children were included, 89 boys (50.9%) and 86 girls (49.1%). There was a significant decrease of the NRR area (P < .001) and increase of the cup volume (P < .001) on the second observation. The pRNFL thickness and GCIPL thickness also decreased (P < .001 and P = .002, respectively). There was a positive correlation between the ONH area and the difference of the cup volume (P = .047; r = 0.102) and a negative correlation with the difference of the NRR area (P < .001; r = 0.237). CONCLUSIONS: During childhood, there is an increase of the cup volume, a decrease of the NRR area, and a decrease of inner retinal layer thickness (more significant in the superior and inferior quadrants) measured by OCT. This study demonstrates that in children with large discs the enlargement of the cup and decrease of the NRR is more evident. Considering these changes, the physiological enlargement of the cup in a child with a large disc can be misinterpreted as the development of a glaucomatous lesion. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Differences of a Single Injection of Botulinum Toxin A between Infantile and Nonaccommodative Esotropia.

PURPOSES: To compare the results of a single injection of botulinum toxin A (BTA) between children with infantile esotropia (IET) and nonaccommodative esotropia (NAET) during the first 2 years. METHODS: Retrospective study that included 23 children with IET and 25 with NAET. At 6 months, 1 and 2 years after treatment, the deviation and stereoacuity were evaluated. RESULTS: At 6 months and 1 year after treatment there was no difference in ocular alignment between the two groups (success criteria were achieved in 36.8% in IET group and 60.0% in NAET at 6 months p = .129, and 57.9% in IET group and 68.0% in NAET group at 1 year p = .352). Two years after treatment, there were statistical differences between motor alignment (IET group 21,1% and NAET group 60.0%, p = .007) and stereoacuity (IET group 40% and NAET group 90%, p = .004) between the two groups. Although side-effects affected most children during the first week (in the first week, overcorrection was present in 16 (84.2%) children with IET, and in 19 (76.0%) children with NAET; and ptosis affected 15 (78.9%) children with IET and 17 (68.0%) children with NAET), at 6 months all the effects have disappeared on both groups. CONCLUSIONS: We recommend BTA as an alternative, but not as definite treatment in IET if the surgeon/parents are not comfortable with an early strabismus surgery; but retreatment or surgery will have to be considered after 1 year. On the contrary, BTA may be a first-line treatment of NAET because it is an easy, safe and has a long-lasting effect.

Optical coherence tomography analysis of the inner retinal layers in children.

OBJECTIVE: The aim of this study was to determine a correlation between the optic nerve head (ONH) area, the peripapillary retinal nerve fibre layer (pRNFL), and the ganglion cell inner plexiform layer (GCIPL) thicknesses, measured by optical coherence tomography (OCT) in children. METHODS: Cross-sectional study of 358 eyes in 358 children, 187 belonging to males (52.2%), having a mean age of 6.41 ±â€…1.66 years and spherical equivalent 0.22 ±â€…0.50 D. All subjects were imaged with Cirrus HD-OCT. ONH parameters, pRNFL, and macula thicknesses maps for each subject were obtained. RESULTS: Average pRNFL thickness was 100.19 ±â€…10.10 µm and average GCIPL thickness was 85.29 ±â€…5.54 µm. Thirty-eight eyes (10.6%) had megalopapilla. A positive correlation was found between pRNFL thickness and the ONH area, GCIPL thickness and the ONH area, and pRNFL and GCIPL thicknesses. CONCLUSIONS: In children, a positive correlation was found between pRNFL and GCIPL thicknesses and the ONH area. As the ONH area increases, the pRNFL and GCIPL thicknesses measured by OCT increase, supporting the histological observations that large discs have a higher number of ganglion cells. Consequently, the fixed diameter of the OCT scan does not influence these measurements. We suggest that a future normative database of OCT measurements adapted to children adjust the pRNFL and GCIPL thicknesses with the ONH area.

Is the Sphere Value Measured by an Autorefractor Reliable in Children under Cycloplegia? Comparison with Streak Retinoscopy.

PURPOSE: To compare and repeatedly measure cycloplegic refraction in a cross-section of children using retinoscopy and automated refraction. METHODS: A total of 560 children (corresponding to 1120 eyes) ranging in age from 3 to 10 years participated in the study. Each child underwent a comprehensive eye examination, which included table mounted autorefractor evaluation (Kowa KW-2000) and streak retinoscopy, both after cycloplegia with 1% cyclopentolate hydrochloride. Data were analyzed using Fourier decomposition of the power profile. RESULTS: More positive values of M component and sphere value were given by cycloplegic autorefraction (AKW) compared with cycloplegic streak retinoscopy (RR). More negative values for the J45 vector and more positive for J0 were given AKW although this difference was not statistically significant. CONCLUSIONS: Our study shows that the table mounted autorefkeratometer Kowa KW- 2000 can be applied to young children with cycloplegia as instrument for cycloplegic refraction, and a discount of +0.67 should be applied on the sphere value. Similar care should be taken on the evaluation of the sphere and spherical equivalent values should be applied in other devices.