Evaluating Pediatric Ophthalmic Care Using Sentiment Analysis of Physician Review Sites.

PURPOSE: To assess patient satisfaction within pediatric ophthalmology and identify trends in patient sentiment. METHODS: Pediatric ophthalmologists in the United States were identified using the American Association for Pediatric Ophthalmology and Strabismus member directory. Demographic data were recorded using publicly available websites. Online written reviews and Stars ratings were obtained from Healthgrades.com. A sentiment analysis package, Valence Aware Dictionary for Sentimental Reasoning (VADER), was used to generate a compound score of reviews, and word frequency analyses were applied. RESULTS: A total of 377 pediatric ophthalmologists (2,640 online reviews) were evaluated. Physicians received an average of 4.22/5 Stars and a compound sentiment score of 0.56, indicating positive sentiment. No differences in scores were observed by gender or location, although physicians with fewer years in practice had higher Stars ratings compared to peers (P < .001). The three most common words in the word frequency analysis of all reviews were "surgery," "staff," and "time," with heavy emphasis on bedside manner and addressing patient concerns. CONCLUSIONS: This study demonstrates overall high patient satisfaction in pediatric ophthalmology care, with differences in sentiment based on physician demographic features. The study highlights that patient perspective is influenced by non-clinical features of care. These data may be used by pediatric ophthalmologists seeking to improve health care delivery. [J Pediatr Ophthalmol Strabismus. 2024;61(3):211-218.].

Iatrogenic Pseudo-Duane Retraction Syndrome Following Orbitozygomatic Craniotomy.

Restrictive strabismus is a known complication of orbitozygomatic craniotomy. However, a pseudo-Duane syndrome has not been described following this procedure. The authors describe a 58-year-old woman who after craniotomy developed incomitant left exotropia with an adduction deficit; the globe retracted and palpebral fissure narrowed with attempted ocular adduction. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e7-e10.].

Bibliometric Analysis of the Top 100 Cited Articles in Pediatric Ophthalmology.

PURPOSE: To determine and analyze the 100 most cited articles in pediatric ophthalmology. METHODS: A literature search was conducted using the ISI Web of Science database on the top 100 most cited articles in pediatric ophthalmology. RESULTS: The 100 most cited articles were published between 1941 and 2018, with the greatest number published in both 2005 and 2012. A total of 29,731 citations were generated during the study period. There has been a significant increase in citations annually since 1941, with a peak number of citations in 2021 with 2,629 citations. Myopia, retinopathy of prematurity, and other forms of refractive error were the topics most studied and cited in these articles. Most of the articles were classified as either large cohort prospective/retrospective studies (34) or randomized clinical trials (19), with case reports/series being the least frequent (7). Investigative Ophthalmology & Visual Science (23), JAMA Ophthalmology (22), and Ophthalmology (22) published the majority of the articles. Institutions that conducted the majority of the studies presented include the National Eye Institute (10), the Ohio State University College of Optometry (9), and the Oregon Health & Science University (6). CONCLUSIONS: This bibliometric analysis provides a unique historical perspective of the literature in the field of pediatric ophthalmology that has not been studied before. The research in the field of pediatric ophthalmology is advancing quickly, with most articles and citations occurring within the past 15 years. The strong focus on prospective cohort studies and clinical trials reveals the importance of advancing the treatment of critical disease within the field of pediatric ophthalmology. [J Pediatr Ophthalmol Strabismus. 2023;60(5):330-336.].

Cycloplegic Autorefraction as a Substitute for Cycloplegic Retinoscopy in the Pediatric Population.

PURPOSE: To evaluate whether cycloplegic autorefraction can provide similar results as cycloplegic retinoscopy, allowing more comprehensive ophthalmologists to be comfortable in managing pediatric refractive error and refractive amblyopia. METHODS: This retrospective chart review was performed to determine the mean difference in sphere, cylinder, and axis between cycloplegic autorefraction and retinoscopy, both of which were obtained on the same eye at least 30 minutes after cycloplegia and dilation with a mixed solution of tropicamide, cyclopentolate, and phenylephrine. RESULTS: A total of 34 eyes (18 right, 16 left) from 18 patients were included in the analysis. Mean sphere difference between cycloplegic autorefraction and retinoscopy was 0.044 ± 0.278 diopters (D) (95% CI: -1.275 to 1.363 D), mean cylinder difference was -0.081 ± 0.236 D (95% CI: -0.706 to 0.544 D), and mean axis difference was 7.059 ± 19.676 degrees (95% CI: -32.527 to 38.878 degrees). Mean differences in sphere, cylinder, and axis were not statistically significant (P = .362, .0541, and .377, respectively). CONCLUSIONS: In this small sample population, cycloplegic autorefraction was comparable to cycloplegic retinoscopy. Recognition of amblyopia should still prompt evaluation by a pediatric ophthalmologist. Further research is necessary to confirm whether uncomplicated refractive error in children may be sufficiently detected and managed by a comprehensive ophthalmologist. [J Pediatr Ophthalmol Strabismus. 2022:59(6):422-427.].

Cut and paste: sutureless conjunctival closure in strabismus surgery.

PURPOSE: This study investigated the use of fibrin glue and compared its effect with traditional sutures for conjunctival closure in strabismus surgery. METHODS: The study included 12 patients undergoing horizontal strabismus surgery, of whom 5 underwent bilateral medial rectus muscle recessions and 7 underwent bilateral lateral rectus muscle recessions. For each patient, fibrin glue was used to close the conjunctiva of one eye and 6-0 plain sutures were used to close the other. RESULTS: All eyes maintained adequate closure of the conjunctiva postoperatively and there were no intraoperative or postoperative complications for an eye. However, the average surgical time needed to apply fibrin glue was considerable less than that required for closure with sutures. Furthermore, eyes closed with fibrin glue were associated with significantly less postoperative inflammation and patient discomfort than those closed with sutures. All patients and parents reported significantly less discomfort from the eyes treated with fibrin glue. CONCLUSION: These results are promising and demonstrated a safe and effective alternative to traditional suture closure in strabismus surgery. When compared to traditional suture closure, conjunctival closure with glue includes the following advantages: less postoperative patient discomfort, diminished postoperative inflammation, and potentially reduced surgical time with corresponding reduced time under general anesthesia.

Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is one of the many significant consequences of premature birth and remains one of the leading causes of visual impairment in infants. Originally, cryotherapy was used to prevent the complications of vitreous hemorrhage and retinal detachment. Subsequently, laser photocoagulation, which is at least as effective and possibly safer than cryoretinopexy, was adopted as the primary treatment for type 1 ROP (stage 2 or 3 disease in zone II with plus disease or any stage disease in zone I with plus disease or stage 3 disease in zone I without plus disease). Laser therapy has been proven effective, and has a degree of permanence that is yet to be matched by alternative treatments, but can be associated with significant ocular side effects such as myopia. Treatment of type 1 ROP with anti-vascular endothelial growth factor (VEGF) agents seems to have fewer ocular side effects than laser ablation of the retina, particularly if used to treat type 1 ROP in zone I. However, ROP recurrence is a real threat after anti-VEGF therapy and long-term systemic side effects of this therapy remain under evaluation. This review focuses on the ophthalmic and systemic benefits and risks of anti-VEGF therapies for ROP as compared to retinal photocoagulation. Anti-VEGF therapies have dramatically altered the management of ROP and have also been shown to be beneficial with regard to the visual prognosis of patients with ROP, but patients so treated require frequent short- and long-term follow-up to detect and manage potential complications associated with this form of treatment. Such information also will allow clinicians to characterize the efficacy, side effect profile, and utility of intravitreal anti-VEGF agents for this condition. Prospective studies are needed to identify the optimum anti-VEGF drug and dose. [J Pediatr Ophthalmol Strabismus. 2020;57(6):351-362.].

Pediatric ocular inflammation.

Pediatric conjunctivitis often has a benign etiology and a self-limited course. It is common in childhood and may be infectious or noninfectious in nature and acute or chronic in presentation. Infectious causes include bacterial and viral conjunctivitis. Noninfectious causes include congenital nasolacrimal obstruction, ocular allergies, congenital glaucoma, and uveitis. This article reviews the etiology, clinical features, and treatment for pediatric conjunctivitis.

The pharmacodynamic properties of azithromycin in a kinetics-of-kill model and implications for bacterial conjunctivitis treatment.

INTRODUCTION: Antibiotics have traditionally been classified as bactericidal or bacteriostatic. Azithromycin belongs to the parent class of macrolides that are characteristically bacteriostatic. Some evidence suggests that this molecule demonstrates bactericidal kill and has concentration-dependent effects. This study tests the hypothesis that azithromycin demonstrates a bactericidal, concentration-dependent antibiotic effect at concentrations corresponding to and exceeding published tear and conjunctival levels. METHODS: The antibacterial activity of different concentrations of azithromycin 1% in DuraSite(R) (AzaSite(R); Inspire Pharmaceuticals Inc, Durham, NC, USA) was evaluated using a kinetics-of-kill model. Recent conjunctivitis isolates of Staphylococcus aureus, Streptococcus pneumoniae or Haemophilus influenzae were exposed to four concentrations of azithromycin (100, 250, 500 and 750 microg/ml). Starting concentrations were similar to the maximum concentrations (Cmax) that have been demonstrated in conjunctiva (83 microg/g) and tears (288 microg/ml) following topical ocular administration. The percentage of surviving bacteria at 30 and 60 minutes following exposure to each concentration were determined. RESULTS: Azithromycin failed to demonstrate bactericidal activity (i.e. a 3-log reduction in surviving bacteria) against S. aureus, S. pneumoniae or H. influenzae. Furthermore, the rate and extent of antibacterial activity with azithromycin did not change with higher concentrations, even at the highest tested concentration of 750 microg/ml. CONCLUSION: Similar to the parent macrolide class, azithromycin demonstrates bacteriostatic activity against common conjunctival pathogens up to the maximum tested concentration of 750 microg/ml (i.e. 2.6-times and 9-times published Cmax tear and conjunctival concentration, respectively). Azithromycin's bacteriostatic effects and prolonged elimination half-life will likely lead to a corresponding increase in the emergence of macrolide-resistant isolates.

Speed of bacterial kill with a fluoroquinolone compared with nonfluoroquinolones: clinical implications and a review of kinetics of kill studies.

It is important to rapidly eradicate bacteria in patients with bacterial conjunctivitis in order to decrease disease transmission, shorten symptom duration, and minimize the emergence of resistant bacteria. This paper presents the results of kinetics of kill studies on 3 commonly isolated pathogens in bacterial conjunctivitis. A more rapid speed of kill with moxifloxacin compared with other nonfluoroquinolone antibiotics (tobramycin, gentamicin, polymyxin B/trimethoprim, or azithromycin) was observed in Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae infections. Moxifloxacin achieved a 99.9% kill at approximately 1 h for S aureus, 2 h for S pneumoniae, and 30 min for H influenzae. In comparison, other nonfluoroquinolone therapies took longer to achieve a bactericidal (3-log) kill and some demonstrated no change or an increase in bacterial growth. Based on these findings, it is concluded that moxifloxacin kills bacteria more rapidly than nonfluoroquinolone topical ocular antibiotics.

Lymphangioma of the conjunctiva and nasal cavity in a child presenting with diffuse subconjunctival hemorrhage and nosebleeds.

A 4-year-old girl had extensive subconjunctival hemorrhage in the right eye. She had recurrent minor nosebleeds starting at 6 months. Visual acuity was 20/20. Anterior segment examination showed diffuse, blood-filled, multilobulated cystic channels in the conjunctiva. Bleeding resolved, leaving transparent cystic channels. Conjunctival lymphangioma can manifest as temporary subconjunctival lymphangioma.