A Pilot Randomized Clinical Trial of Base-in Relieving Prism Spectacle Treatment of Intermittent Exotropia.

SIGNIFICANCE: This pilot randomized trial, the first to evaluate a specific base-in relieving prism treatment strategy for childhood intermittent exotropia, did not support proceeding to a full-scale clinical trial. Defining and measuring prism adaptation in children with intermittent exotropia are challenging and need further study. PURPOSE: This study aimed to determine whether to proceed to a full-scale trial of relieving base-in prism spectacles versus refractive correction alone for children with intermittent exotropia. METHODS: Children 3 years old to those younger than 13 years with distance intermittent exotropia control score of ≥2 points on the Intermittent Exotropia Office Control Scale (Strabismus 2006;14:147-150; 0 [phoria] to 5 [constant]), ≥1 episode of spontaneous exotropia, and 16 to 35∆ by prism-and-alternate-cover test, who did not fully prism adapt on a 30-minute in-office prism-adaptation test were randomized to base-in relieving prism (40% of the larger of distance and near exodeviations) or nonprism spectacles for 8 weeks. A priori criteria to conduct a full-scale trial were defined for the adjusted treatment group difference in mean distance control: "proceed" (≥0.75 points favoring prism), "uncertain" (>0 to <0.75 points favoring prism), or "do not proceed" (≥0 points favoring nonprism). RESULTS: Fifty-seven children (mean age, 6.6 ± 2.2 years; mean baseline distance control, 3.5 points) received prism (n = 28) or nonprism (n = 29) spectacles. At 8 weeks, mean control values were 3.6 and 3.3 points in prism (n = 25) and nonprism (n = 25) groups, respectively, with an adjusted difference of 0.3 points (95% confidence interval, -0.5 to 1.1 points) favoring nonprism (meeting our a priori "do not proceed" criterion). CONCLUSIONS: Base-in prism spectacles, equal to 40% of the larger of the exodeviations at distance or near, worn for 8 weeks by 3- to 12-year-old children with intermittent exotropia did not yield better distance control than refractive correction alone, with the confidence interval indicating that a favorable effect of 0.75 points or larger is unlikely. There was insufficient evidence to warrant a full-scale randomized trial.

Postnatal Pancraniosynostosis in a Patient With Infantile Hypophosphatasia.

Hypophosphatasia is a rare metabolic bone disorder that predisposes patients to craniosynostosis. Typically, patients born with hypophosphatasia will exhibit fused cranial sutures at birth. This is the first reported case of delayed onset of pancraniosynostosis in a patient with infantile hypophosphatasia. The severity of onset and delayed presentation in this patient are of interest and should give pause to those care providers who treat and evaluate patients with hypophosphatasia.

Pediatric Deep Sedation for Ophthalmology Procedures in an Outpatient Setting, Risk Evaluation.

Background: Pediatric deep sedation (PDS) performed by a dedicated pediatric sedation service has been found to be safe, convenient, and efficient for minor procedures. Major complications such as cardiopulmonary resuscitation, intubation, and death are rare. However, minor complications such as desaturation, apnea, suctioning, or laryngospasm can occur infrequently. To date, little data exist evaluating PDS use for minor ophthalmology procedures. Aims: The aim of this study was to evaluate the incidence of complications for subjects receiving PDS for minor ophthalmology procedures. Setting: Pediatric children's hospital sedation service. Materials and Methods: This was a review of a prospectively collected database between 2018 and 2020. A hundred and thirty-four subjects aged 0-18 years, who underwent PDS for minor ophthalmology procedures, were compared to 1119 subjects who received PDS for other procedures (e.g., lumbar puncture, bone marrow aspirate/biopsy, and Botox). Statistical Analysis: SAS software, version 9.4, was used to determine variables associated with deep sedation that were predictive of complications. A multiple logistic regression procedure was conducted. Statistical significance was set at the 0.05 level. Results: Subjects receiving PDS for ophthalmology procedures had a higher rate of minor complications than the control group (n = 18, 13.4%, vs. n = 58, 5.7%; P < 0001). No major complications occurred in any of the studied subjects. The ophthalmology group had a higher rate of bag-mask ventilation, airway positioning, and suctioning. Conclusions: Ophthalmology procedures using PDS have a greater occurrence of minor complications compared to other painful procedures. No major complications were noted in either group, providing evidence that PDS can be performed safely for ophthalmology procedures using the sedation team model.

Intense versus standard regimens of intermittent occlusion therapy for unilateral moderate amblyopia in children: study protocol for a randomized controlled trial.

BACKGROUND: We reported that in our previous study that wearing intermittent occlusion therapy glasses (IO-therapy) for 4 hours (h) was non-inferior to patching for 2 h in 3 to 8-year-old children with amblyopia. We hypothesize that an intense regimen of 12-h IO-therapy per day for 4 weeks could be as effective as the standard regimen of 4-h IO-therapy per day for 12 weeks in treating moderate amblyopia in 3 to 8-year-old children. METHODS/DESIGN: A total of 56 children between 3 and 8 years of age with amblyopia in association with anisometropia and/or strabismus will be enrolled. All participants will be prescribed IO-therapy glasses (Amblyz™), set at 30-s opaque/transparent intervals (i.e., occluded 50% of wear time). They will be randomized to receive the standard regimen for 12 weeks or the intense regimen for 4 weeks. Adherence to using the IO-therapy glasses will be objectively monitored in each participant by means of a microsensor dose monitor. The primary study objective is to compare the effectiveness of an intense regimen to a standard regimen of IO-therapy in 3 to 8-year-old children with moderate amblyopia. The secondary study objectives are to determine whether adherence differs between an intense regimen and a standard regimen of IO-therapy, and to determine the dose-response relationship of IO-therapy. DISCUSSION: In addition to testing the effectiveness, this study will test for the first time the association between treatment adherence and the visual outcome of IO-therapy, which will enhance our understanding of the dose-response relationship of IO-therapy. If an intense regimen is shown to be effective, it would alter amblyopia treatment strategies and improve visual outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02767856. Registered on 10 May 2016.

Systems for staging the amount of optic nerve damage in glaucoma: a critical review and new material.

The evaluation of the appearance of the optic disk is central to the diagnosis and management of patients with glaucoma. Grouping patients into categories, monitoring change, and quantitating the rate of change all require some type of quantitative staging of the amount of damage. Though the scientific literature regarding the appearance of the optic disk in glaucoma is extensive, there is remarkably little about quantitative staging of the amount of damage. We have identified eight systems, including the cup/disk ratio system of Armaly. Most of the earlier systems suffer from a failure to take into account the importance of the size of the optic disk. Furthermore, only one system includes early amounts of damage. This review is a critical appraisal of the known methods for staging optic disk damage in glaucoma, including the recent Disk Damage Likelihood Scale, which appears to offer substantial advantages over the other systems.

[Observational study about biometry in patients with cataract and synchisis scintillans]. / Studiu observational privind biometria în prezenta synchysis scintillans.

PURPOSE: to report the difficulties in biometry in patients with cataract and synchysis scintillans and the way to avoid the biometrical errors in such patients. MATERIALS AND METHODS: Observational study on 4 patients (from 3 different surgeons) with cataract and synchysis scintillans. RESULTS: In two patients, the biometry obtained an increased IOL dioptrical value (+29D, and +28D, respectively) which proved to be wrong by not obtaining the planed emmetropia postoperatively. Instead, the postoperative refraction showed increased myopia (-9D and -6.5D spherical equivalent, respectively), and explantation with re-implantation was needed. The secondary implant was chosen based on the postoperative refraction and primary implant value (+20D, and +24D respectively). In other two cases, the biometrical error was avoided by manually selecting the real antero-posterior axis value, not the mean value calculated by the computer. This method proved to be correct by obtaining near-emmetropia postoperatively. CONCLUSIONS: The association between cataract and synchysis scintillans is frequent, and the presence of synchysis scintillans could be a cause of errors in biometry. The biometrical errors could be avoided by amending the method of measurement. These observations stress the necessity of ocular echography in the case of opaque ocular media.

An explanation of transient visual loss associated with leaking filtering bleb.

PURPOSE: To report a presumed cause for the transient visual loss noted by a patient with a leaking bleb following trabeculectomy. DESIGN: Case report. METHODS: Description of an otherwise healthy woman who developed delayed-onset transient visual loss associated with a leaking filtering bleb. RESULTS: A 62-year-old woman who underwent trabeculectomy with mitomycin C in her right eye 5 years earlier (Feb 23, 1999) presented with a 3-month history of transient decreased vision. The apparent cause was a periodic gush of aqueous flowing across the surface of the cornea. CONCLUSIONS: One cause of bleb-associated transient visual loss can be aqueous leaking from the bleb on to the anterior surface of the cornea, disturbing vision as it flows past the visual axis. This is temporarily relieved by blinking.