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2.
J AAPOS ; 26(3): 145-148, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35472597

RESUMO

There is a nationwide shortage of pediatric ophthalmologists, with trends in fellowship applicants foreshadowing a continued reduction in the number of active pediatric ophthalmologists in the years ahead. In this study, we investigated whether similar fellowship applicant shortages exist in other pediatric surgical subspecialties. We compared the match statistics of six pediatric surgical fellowships from 2015 to 2020. During the 6-year interval, a median of 12.2 pediatric ophthalmology fellowship positions (IQR, 12.1-12.4) were offered per 100 graduating residents, 8.7% of ophthalmology residents (IQR, 8.3%-9.3%) pursued pediatric subspecialty training, and 72% of available pediatric fellowship positions (IQR, 69%-74%) were filled. Pediatric general surgery had the highest percentage of available fellowship positions filled, 99% (IQR, 98%-100%), which was significantly higher than for pediatric ophthalmology (P = 0.024). None of the other subspecialties had a significant difference in available positions filled compared to pediatric ophthalmology (P > 0.05).

3.
Eur J Ophthalmol ; : 11206721221094783, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35469461

RESUMO

PURPOSE: To evaluate the efficacy and safety of cenegermin 0.002% ophthalmic drops in the management of pediatric neurotrophic keratopathy (NK). METHODS: Retrospective chart review of children under the age of 18 years diagnosed with NK at Boston Children's Hospital/Massachusetts Eye and Ear Infirmary and treated with topical cenegermin 0.002% ophthalmic solution between June 2018 and June 2021 was performed. Data collection included etiology of NK, age at time of initiation of topical cenegermin, laterality, ethnicity, gender, history of previous ocular therapy, pre- and post-therapy best corrected visual acuity, pre- and post-therapy cornea examination, any adverse events from topical cenegermin, associated ocular conditions, and history of ocular surgeries. RESULTS: The current study includes four eyes of four pediatric patients with a mean age of 4.5 ± 2.0 years at the time of initiation of topical cenegermin therapy. The mean time from NK diagnosis until start of topical cenegermin drops was 5.2 ± 4.3 months and mean follow-up time was 15 ± 9.6 months. In all four patients, marked improvement in epitheliopathy was demonstrated after completion of therapy. Best corrected visual acuity was measurable in 3 eyes of 3 patients, and it improved from a mean of 0.07 ± 0.01 to a mean of 0.29 ± 0.26 (P = 0.3). No adverse events related to cenegermin therapy were noted. CONCLUSION: Topical cenegermin was effective in improving corneal healing for pediatric NK.

4.
Am J Ophthalmol ; 240: 252-259, 2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35367438

RESUMO

PURPOSE: To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. DESIGN: Retrospective clinical cohort study. METHODS: We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. RESULTS: In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. CONCLUSIONS: Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.

5.
J AAPOS ; 26(3): 117.e1-117.e6, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35398512

RESUMO

PURPOSE: To describe the etiology, clinical features, and outcomes for a large contemporary cohort of children presenting with glaucoma at a tertiary referral center. METHODS: The medical records of patients presenting to Boston Children's Hospital from January 2014 to July 2019 with a diagnosis of childhood glaucoma were retrospectively reviewed. Data regarding etiology, treatment, and visual and anatomic outcomes were collected; visual acuity outcomes were analyzed by laterality and diagnosis categories, using the Childhood Glaucoma Research Network (CGRN) classifications. RESULTS: A total of 373 eyes of 246 patients (51% males) diagnosed with glaucoma before 18 years of age were identified. Mean follow-up was 7.04 ± 5.61 years; 137 cases were bilateral. The mean age at diagnosis was 4.55 ± 5.20 years. The most common diagnoses were glaucoma following cataract surgery (GFCS, 36.5%) and primary congenital glaucoma (PCG, 29.0%). Overall, 164 eyes (44.0%) underwent at least one glaucoma surgery. Intraocular pressure (IOP) was ≤21 mm Hg with or without glaucoma medications in 300 eyes (80.4%) at the last follow-up visit. Poor final best-corrected visual acuity (≤20/200) was found in 110 eyes; patients with poor final visual acuity tended to have poor visual acuity at presentation. The most common reason for poor vision was amblyopia. Uncontrolled IOP was an uncommon cause for vision loss. CONCLUSIONS: Childhood glaucoma can be challenging to manage, but poor vision usually results from amblyopia or presence of other ocular abnormalities or syndromes rather than glaucomatous optic neuropathy.

6.
J AAPOS ; 25(5): 295-297, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34582952

RESUMO

The publication patterns of pediatric ophthalmology fellowship applicants and in particular the rates of unverifiable and incomplete publications have not been previously reported. A 5-year retrospective cross-sectional study of fellowship candidates found 2.1% of publications listed as published were unverifiable, and only 49% of manuscripts listed as pending publication were published within 5 years. There was lower likelihood to list an incomplete publication for applicants with additional degrees or prior fellowship training and higher likelihood with more manuscripts listed as in preparation. Sex, international medical graduate status, USMLE step scores, and number of publications did not corelate with unverifiable publications.


Assuntos
Internato e Residência , Oftalmologia , Criança , Estudos Transversais , Bolsas de Estudo , Humanos , Oftalmologia/educação , Estudos Retrospectivos
7.
J AAPOS ; 25(4): 217.e1-217.e6, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34246761

RESUMO

PURPOSE: To evaluate the best-corrected visual acuity and stereoacuity gains in children >7 years of age and adults with unilateral amblyopia treated with a prototype virtual reality-based binocular amblyopia therapy. METHODS: In this randomized, double masked, cross-in clinical trial, patients at Boston Children's Hospital with unilateral anisometropic and/or strabismic amblyopia and history of prior amblyopia treatment failure were randomized to either a full-treatment group (8 weeks of binocular treatment using therapeutic software application in virtual reality headset) or a sham-crossover group (4 weeks of sham treatment followed by 4 weeks of binocular treatment). Amblyopic eye visual acuity and stereoacuity were evaluated at 4, 8, and 16 weeks' follow-up. RESULTS: The study cohort included 20 participants (10 females), with a median age of 9 years (range, 7-38 years). In the full-treatment group (11 patients), the mean amblyopic eye logMAR visual acuity at 16 weeks was 0.49 ± 0.26, compared with 0.47 ± 0.20 at baseline. In the sham-crossover group, it was 0.51 ± 0.18 at 16 weeks, compared with 0.53 ± 0.21 at baseline. Stereoacuity (log arcsec) was significantly improved, from 7.3 ± 2 at baseline to 6.6 ± 2.3 at 8 weeks (P < 0.001) and 6.7 ± 2.6 at 16 weeks (P < 0.001). No significant adverse events (diplopia, asthenopia, or worsening strabismus) were noted in either group. CONCLUSIONS: Although the virtual reality-based prototype for binocular amblyopia therapy did not significantly improve visual acuity in the amblyopic eyes of older children and adults, stereoacuity did significantly improve compared with baseline; improvements were clinically minute. However, larger studies are required to confirm the results.


Assuntos
Ambliopia , Jogos de Vídeo , Realidade Virtual , Adolescente , Adulto , Ambliopia/terapia , Criança , Feminino , Humanos , Visão Binocular , Acuidade Visual , Adulto Jovem
8.
Semin Ophthalmol ; 36(4): 205-209, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-33793387

RESUMO

Purpose: Ocular findings such as retinal hemorrhages are common in abusive head trauma (AHT). Binocular indirect ophthalmoscopy has been the standard for assessing the eyes of children who are victims of AHT. However, technological advances have changed our understanding of retinal findings in AHT.Methods: Literature review on AHT - retinal findings, imaging technologies, models of representation, and telemedicine applications.Results: Many studies suggest vitreoretinal traction from repetitive acceleration-deceleration shearing forces during shaking plays an important role in the development of retinal findings in AHT. This is further supported by different imaging modalities [optical coherence tomography (OCT); magnetic resonance imaging (MRI); fluorescein angiography (FA)] and models of representation (animal and mechanical models; finite element analysis).Conclusion: Emerging technologies have augmented our diagnostic abilities, enhanced our understanding regarding the pathophysiology of retinal findings, and strengthened the link between vitreoretinal traction and ocular pathology in AHT. Telemedicine is also starting to play an important role in AHT.


Assuntos
Maus-Tratos Infantis , Traumatismos Craniocerebrais , Síndrome do Bebê Sacudido , Criança , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/etiologia , Humanos , Lactente , Retina/diagnóstico por imagem , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Síndrome do Bebê Sacudido/diagnóstico
9.
J AAPOS ; 25(2): 91.e1-91.e5, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33882352

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted the delivery of healthcare. Although most nonurgent ophthalmology visits at Boston Children's Hospital were canceled, premature infants at risk for retinopathy of prematurity (ROP) still required timely, in-person care during the initial 3-month period of the infection surge in Massachusetts. The purpose of the current study was to report our protocols for mitigating risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between infants and eye care providers and to compare examination rates and results with the same 3-month period in 2019. METHODS: During the infection surge, we added new infection control measures and strengthened existing ones. Additional personal protective equipment was used, and the number of ophthalmologists rotating in the three high-capacity NICUs we service was limited. RESULTS: More infants required ROP examinations during the study period in 2020 than in the same period in 2019, but fewer examinations were performed. There were no cases of missed progression to severe ROP during this time and no known transmission of SARS-CoV-2 between ROP patients and ophthalmology staff. CONCLUSIONS: Overall, effective ROP care was safely provided during the COVID-19 pandemic, and contact with this vulnerable population was minimized.


Assuntos
COVID-19 , Retinopatia da Prematuridade , Humanos , Lactente , Recém-Nascido , Massachusetts , Pandemias , Retinopatia da Prematuridade/epidemiologia , Fatores de Risco
10.
Am J Ophthalmol Case Rep ; 21: 101017, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33521381

RESUMO

PURPOSE: To report a case of 2-month-old boy with Stevens-Johnson syndrome (SJS)/Toxic epidermal necrolysis (TEN) and ocular involvement that was successfully treated with cryopreserved amniotic membrane transplantation (AMT). OBSERVATION: A 2-month-old otherwise healthy boy was referred to Boston Children's Hospital with extensive rash and desquamation concerning for SJS/TEN. A skin biopsy was performed which showed full-thickness epidermal necrosis. AMT was performed at the bedside under general anesthesia. A combination of tobramycin and dexamethasone ointment was prescribed four times per day. On reassessment two weeks following AMT, the entire ocular surface had healed with no signs of conjunctival and/or corneal inflammation or ulceration. CONCLUSION AND IMPORTANCE: To the best of our knowledge, our case represents the youngest patient with SJS/TEN to be managed by AMT and one of very few cases where acetaminophen is suspected to be the offending agent. This case highlights the efficacy of AMT at such a young age and feasibility of performing the procedure at bedside in these patients It also highlights that SJS/TEN can develop at such young age.

12.
J AAPOS ; 25(1): 62-64, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33348041

RESUMO

We present 2 cases of pediatric patients with reactive infectious mucocutaneous eruption with ophthalmic involvement. In both cases, the disease processes behaved similarly to that seen in patients with Mycoplasma pneumoniae-induced rash and mucositis. Visual outcomes were good.


Assuntos
Exantema , Mucosite , Pneumonia por Mycoplasma , Criança , Olho , Humanos , Mycoplasma pneumoniae
13.
Am J Ophthalmol ; 219: 351-356, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32574770

RESUMO

PURPOSE: To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm. DESIGN: Retrospective, interventional case series. METHODS: Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention. RESULTS: There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis. CONCLUSIONS: The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.


Assuntos
Âmnio/transplante , Exantema/microbiologia , Infecções Oculares Bacterianas/microbiologia , Doenças Palpebrais/microbiologia , Glucocorticoides/uso terapêutico , Mucosite/microbiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/microbiologia , Adolescente , Criança , DNA Bacteriano/genética , Exantema/diagnóstico , Exantema/terapia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/terapia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/terapia , Feminino , Seguimentos , Humanos , Imunoglobulina M/sangue , Masculino , Mucosite/diagnóstico , Mucosite/terapia , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/terapia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Acuidade Visual/fisiologia
14.
Telemed J E Health ; 26(9): 1113-1117, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32408801

RESUMO

Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and "eye contact," being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.


Assuntos
Infecções por Coronavirus/epidemiologia , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Betacoronavirus , COVID-19 , Confidencialidade/normas , Técnicas de Diagnóstico Oftalmológico/normas , Documentação , Humanos , Reembolso de Seguro de Saúde , Iluminação , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/normas , SARS-CoV-2
15.
J AAPOS ; 24(2): 113-115, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31982618

RESUMO

Lymphatic malformations are benign hamartomatous tumors present at birth but usually diagnosed in early childhood. We report a case of prenatal diagnosis of an isolated unilateral retrobulbar lymphatic malformation with fetal magnetic resonance imaging (MRI). This was first detected at 27 weeks' gestational age. Postnatal ocular examinations at 4 days and 5 weeks of age showed no signs of optic nerve compromise. Postnatal MRI at 18 days of age showed slight increase in size of the lesion, and no intracranial vascular malformations were detected.


Assuntos
Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Gravidez
16.
J AAPOS ; 23(2): 86.e1-86.e7, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885809

RESUMO

PURPOSE: To evaluate the effect of a computer-based training program-Massachusetts Eye & Ear ROP Trainer-on residents' knowledge of retinopathy of prematurity (ROP) management. METHODS: In this prospective, randomized study, ophthalmology residents from nine different training programs consented to participate. Those who completed the study were randomly assigned to either the Trainer or the control group. The ROP Trainer was created using clinical cases encompassing the stages of ROP in digital pictures and videos. It includes sections on screening decisions, examination techniques, and diagnosis, and a reference section with the expert video clips and a searchable image library. Subjects in the control group were asked to study standard print material on ROP. A pre- and post-test, consisting of theoretical and practical (diagnosis) questions, and a post-intervention satisfaction test were administered. Accuracy of ROP diagnosis was assessed. RESULTS: A total of 180 residents agreed to participate, of whom 60 completed the study. Residents in the Trainer group had statistically significant improvements (P = 0.003) in ROP knowledge and diagnostic ability (P = 0.005). Residents randomized to the Trainer group were more satisfied with the training materials than were those in the control group. There was no significant difference in improving knowledge by year of training, sex, or country. Considering all training levels, a statistically significant increase was observed in sensitivity for the diagnosis of preplus or worse, zone I or II, ROP stage, category, and aggressive posterior ROP in the Trainer group. CONCLUSIONS: In this study, the Trainer was shown to significantly improve ROP knowledge and diagnostic skills of residents, regardless of sex, year, of training, or country.


Assuntos
Competência Clínica/normas , Instrução por Computador/métodos , Internato e Residência/métodos , Oftalmologia/educação , Retinopatia da Prematuridade/diagnóstico , Retroalimentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Massachusetts , Oftalmologia/normas , Estudos Prospectivos , Retinopatia da Prematuridade/terapia
17.
J AAPOS ; 23(3): 172-174, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30710645

RESUMO

A 16-year-old boy with a history of relapsed acute myeloid leukemia and a right lower lobe lung abscess confirmed to be Aspergillus presented for a baseline eye examination prior to consideration of bone marrow transplantation. He noted double vision in up-and-left gaze, and his examination was consistent with an acquired right-sided Brown syndrome. Magnetic resonance imaging revealed a 4 mm rim-enhancing inflammatory focus in the right superior oblique muscle. His Brown syndrome resolved after treatment with systemic antimicrobials.


Assuntos
Abscesso/complicações , Aspergilose/complicações , Infecções Oculares Fúngicas/complicações , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/patologia , Abscesso/diagnóstico , Abscesso/microbiologia , Adolescente , Aspergilose/diagnóstico , Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Infecções Oculares Fúngicas/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos da Motilidade Ocular/diagnóstico , Síndrome
18.
Ophthalmology ; 125(12): 1961-1966, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29887334

RESUMO

PURPOSE: Intravitreal bevacizumab is increasingly used to treat severe retinopathy of prematurity (ROP), but it enters the bloodstream, and there is concern that it may alter development of other organs. Previously we reported short-term outcomes of 61 infants enrolled in a dose de-escalation study, and we report the late recurrences and additional treatments. DESIGN: Masked, multicenter, dose de-escalation study. PARTICIPANTS: A total of 61 premature infants with type 1 ROP. METHODS: If type 1 ROP was bilateral at enrollment, then the study eye was randomly selected. In the study eye, bevacizumab intravitreal injections were given at de-escalating doses of 0.25 mg, 0.125 mg, 0.063 mg, or 0.031 mg; if needed, fellow eyes received 1 dose level higher: 0.625 mg, 0.25 mg, 0.125 mg, or 0.063 mg, respectively. After 4 weeks, additional treatment was at the discretion of the investigator. MAIN OUTCOME MEASURES: Early and late ROP recurrences, additional treatments, and structural outcomes after 6 months. RESULTS: Of 61 study eyes, 25 (41%; 95% confidence interval [CI], 29%-54%) received additional treatment: 3 (5%; 95% CI, 1%-14%) for early failure (within 4 weeks), 11 (18%; 95% CI, 9%-30%) for late recurrence of ROP (after 4 weeks), and 11 (18%; 95% CI, 9%-30%) for persistent avascular retina. Re-treatment for early failure or late recurrence occurred in 2 of 11 eyes (18%; 95% CI, 2%-52%) treated with 0.25 mg, 4 of 16 eyes (25%; 95% CI, 7%-52%) treated with 0.125 mg, 8 of 24 eyes (33%; 95% CI, 16%-55%) treated with 0.063 mg, and 0 (0%; 95% CI, 0%-31%) of 10 eyes treated with 0.031 mg. By 6 months corrected age, 56 of 61 study eyes had regression of ROP with normal posterior poles, 1 study eye had developed a Stage 5 retinal detachment, and 4 infants had died of preexisting medical conditions. CONCLUSIONS: Retinal structural outcomes are very good after low-dose bevacizumab treatment for ROP, although many eyes received additional treatment.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Retinopatia da Prematuridade/tratamento farmacológico , Terapia Combinada , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intravítreas , Fotocoagulação a Laser , Masculino , Recidiva , Retina/fisiopatologia , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Retratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
19.
Am J Ophthalmol ; 189: 160-165, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29476725

RESUMO

PURPOSE: To determine whether botulinum toxin augments the effect of strabismus surgery in pediatric patients with large-angle infantile esotropia. DESIGN: Retrospective, comparative, case series. METHODS: Setting: Tertiary-care pediatric hospital. STUDY POPULATION: Patients with large-angle infantile esotropia. INTERVENTION: Treatment with botulinum toxin-augmented bilateral medial rectus muscle recessions ("augmented-surgery group") or traditional bilateral medial rectus muscle recessions ("surgery-only group"). MAIN OUTCOME MEASURE: The effect of surgery on ocular alignment at 4 months, measured in prism diopters of change per mm of surgery (PD/mm). RESULTS: There were 14 patients in the augmented-surgery group and 16 patients in the surgery-only group. The mean effect on alignment was significantly greater in the augmented-surgery group compared to the surgery-only group at 4 months (5.7 ± 1.3 vs 4.0 ± 1.4 PD/mm, P = .002) and at 1 year (5.4 ± 1.2 vs 3.7 ± 1.2 PD/mm, P = .002). There was a partial loss of treatment effect between 4 months and 1 year in both groups, which was similar in magnitude (P = .57). On linear regression, there was a trend toward a positive correlation between botulinum toxin dose and treatment effect, but this was not statistically significant (P = .09). CONCLUSIONS: Botulinum toxin augments the surgical effect of medial rectus muscle recession. Botulinum toxin-augmented surgery may be an alternative to traditional options for large-angle infantile esotropia. A surgical dosing table is proposed for this technique.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Esotropia/terapia , Músculos Oculomotores/efeitos dos fármacos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Terapia Combinada , Sinergismo Farmacológico , Esotropia/tratamento farmacológico , Esotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Injeções Intramusculares , Masculino , Estudos Retrospectivos , Visão Binocular/fisiologia
20.
Am J Ophthalmol ; 182: 126-132, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756152

RESUMO

PURPOSE: To establish the natural history of ophthalmic characteristics in Progeria patients and to determine incidence of ocular manifestations. DESIGN: Retrospective case series of patients with Progeria who were seen between 2007 and 2016. METHODS: Setting: Tertiary-care academic center. PATIENT POPULATION: Fourteen patients (28 eyes) with Hutchinson-Gilford Progeria syndrome were included for statistical analysis from a total of 84 patients who have been enrolled in clinical trials for Progeria at Boston Children's Hospital. Clinical treatment trial patients who were not seen at the Department of Ophthalmology at our hospital, but for whom we had detailed clinical ophthalmologic records, were also included. This essentially represents an estimated 20% of the world's known patients with Progeria. Interventions or Observation Procedures: Complete ophthalmic examination. MAIN OUTCOME MEASURES: Visual acuity, stereoacuity, refraction, clinical findings of slit-lamp and dilated fundus examinations. RESULTS: Ophthalmic manifestations noted were hyperopia and signs of ocular surface disease owing to nocturnal lagophthalmos and exposure keratopathy. Additional ophthalmic manifestations included reduced brow hair, madarosis, and reduced accommodation. Most patients had relatively good acuity; however, advanced ophthalmic disease was associated with reduced acuity. CONCLUSIONS: Children with Progeria are at risk for serious ophthalmic complications owing to ocular surface disease. Children with Progeria should have an ophthalmic evaluation at the time of diagnosis and at least yearly after that. Aggressive ocular surface lubrication is recommended, including the use of tape tarsorrhaphy at night.


Assuntos
Oftalmopatias/diagnóstico , Progéria/diagnóstico , Adolescente , Criança , Pré-Escolar , Doenças da Córnea/diagnóstico , Oftalmopatias/fisiopatologia , Oftalmopatias/terapia , Sobrancelhas/patologia , Óculos/estatística & dados numéricos , Doenças Palpebrais/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Progéria/fisiopatologia , Progéria/terapia , Refração Ocular/fisiologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
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