Ophthalmological Examination In Children Research Articles

Ophthalmological examination of children with ASD as part of a multidisciplinary approach

Ophthalmological examination of children with ASD as part of a multidisciplinary approach

Клинический случай пациентки с увеитом, ассоциированным с ювенильным идиопатическим артритом

The prevalence of juvenile idiopathic arthritis is 0.05–0.6% in different countries, and in the territory of the Russian Federation it reaches 62.3 100 thousand children. The incidence of uveitis associated with juvenile idiopathic arthritis is 10–30%. Uveitis in juvenile idiopathic arthritis occurs in 80–93% of the type of chronic iridocyclitis. In 3–19.6% of cases, recurrent macular edema develops. In order to treat uveitis associated with juvenile idiopathic arthritis, systemic immunosuppressive therapy, local and systemic administration of antiinflammatory drugs are used. Uveitis in juvenile idiopathic arthritis is asymptomatic in the early stages of the disease, so screening ophthalmological examination of children 2–4 times a year is recommended. Purpose. Description of a clinical case of a patient with uveitis associated with juvenile idiopathic arthritis. Material and methods. A clinical observation of a patient with uveitis associated with juvenile idiopathic arthritis was described. Patient Z., 10 years old, underwent a standard ophthalmological examination, ultrasound examination, optical coherence tomography. Results. The patient had a low-symptomatic course of chronic persistent anterior uveitis, the development of cystic macular edema of the left eye. Anti-inflammatory treatment was carried out in the conditions of the academician S.N. Fyodorov Federal State Institution National Medical Research Center “Intersectoral Research and Technology Complex “Eye microsurgery” Ministry of Health of the Russian Federation”, Novosibirsk Branch. The rheumatologist recommended intensification of systemic immunosuppressive therapy. The prescribed treatment made it possible to preserve visual functions, reduce the frequency and severity of the development of relapses of the disease. Conclusions.Uveitis associated with juvenile idiopathic arthritis is a serious pathology, often accompanied by the development of complications, requires a multidisciplinary approach, regular monitoring and timely adequate treatment. Key words: uveitis, macular edema, juvenile idiopathic arthritis.

Side effects of 1% cyclopentolate hydrochloride in children and adolescents attended at Centro Universitário FMABC

Introduction: It is known that vision disorders are within the context of public health problems. In childhood, during the neuropsychomotor development phase, visual changes are crucial, since there is a strong correlation between poor school performance and changes in acuity. For these reasons, ophthalmological examination in children, including refraction, is extremely important, aiming at the early diagnosis of diseases and possible refractive errors that may compromise the child's life and development. 1% cyclopentolate hydrochloride eye drops are the most used during ophthalmic clinical evaluation as a cycloplegic and mydriatic agent to assist in refractive examination. Objective: The ocular and systemic side effects of 1% cyclopentolate hydrochloride eye drops were studied in patients who underwent static refractive examination in the strabismus sector of the Ophthalmology Discipline of the Centro Universitário FMABC. Methods: A drop of 1% cyclopentolate is instilled in both eyes of each patient and the possible ocular and systemic signs and symptoms presented were observed after 40 minutes and 24 hours after instillation. Results: we expect to find ocular side effects more evident than systemic symptoms in the two evaluation times (40 minutes and 24 hours after instillation). All symptoms (ocular and systemic) are reversed spontaneously. Conclusion: The present study aims to show that the side effects observed by the topical (ocular) use of cyclopentolate eye drops 1% are few and present spontaneous reversal both from an eye point of view, as well as from a systemic point of view.

RARE-62. VISUAL FUNCTION IN CHILDREN WITH CRANIOPHARYNGIOMA AT DIAGNOSIS: A SYSTEMATIC REVIEW

Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child’s daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.

Visual functions in children with craniopharyngioma at diagnosis: A systematic review.

Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child's daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.

Ophthalmological findings in children with autism spectrum disorder.

Eye pathology could be related to atypical visual behaviours and impaired social communication through visual cues in children with autism spectrum disorder (ASD). The main purpose of this prospective study was to assess ophthalmological disorders in children with ASD and to investigate the relationships with intellectual disability (ID) and ASD severity. In this prospective study, comprehensive ophthalmological and oculomotor examinations were performed. ASD severity and verbal and performance intelligence quotients were determined using adapted scales. These clinical data were compared between groups of children based on the presence or absence of ophthalmological disorders and the achievement or not of visual acuity (VA) testing by using non-parametric statistical tests. Amongst a sample of 51 children, ophthalmological disorders were found in 39% of cases, with 35% having significant refractive errors and 10% presenting with strabismus. Children with ASD and ophthalmological disorders had significantly lower verbal (29.8 ± 14.7 compared with 44.3 ± 21.5; p = 0.010) and performance quotients (57.8 ± 18.3 compared with 67.59 ± 20; p = 0.049) but no significant result was found between the presence of ophthalmological disorders and ASD severity, level of communication and social contact, or modulating behaviour when changes occur. Children who did not achieve monocular VA testing (39%) had significantly lower verbal (25.1 ± 9.7 compared with 46.1 ± 20.9; p < 0.001) and performance quotients (52.7 ± 17 compared with 69.8 ± 18.8; p = 0.001), also presented higher social interaction impairment (p = 0.002), and expressed more important behavioural signs (p = 0.007). Ophthalmological disorders are frequently found in children with ASD, especially in those with ID. Ophthalmologists and child psychiatrists should pay attention to perform ophthalmological examination in children with ASD since eye disorders might remain undetected. A comprehensive examination by a paediatric ophthalmologist would help to improve the individual clinical description and the global intervention. Clinical trial registration number: NCT02444117.

The early diagnosis of congenital neuroinfections during ophthalmologic examination in children of the first months of life

To characterize the possibilities of early diagnosis of congenital neuroinfections during an ophthalmological examination in children in the first months of life. Five children with congenital neuroinfection, including 2 children with congenital toxoplasmosis and 3 children with congenital cytomegalovirus infection (CMVI), were studied. All babies were born prematurely (25 to 31 weeks of gestation (27.2±0.94)), with birth weight from 680 to 1610 g (1120±110.1). During the examination, binocular ophthalmoscopy and examination on a wide-field retinal pediatric camera were used. A blood testing for immunoglobulins and a polymerase chain reaction of blood were performed. To assess the state of the brain, neurosonography and magnetic resonance imaging were used. Ophthalmic signs of intrauterine infection appeared at the age of 4-5 months (at 47-51 weeks of postmenstrual age). In all children (in 4 in one eye, in 1 in both eyes), apparent exudative-proliferative changes in the retina and vitreous body appeared on the periphery with the formation of epiretinal membranes that exert a traction effect on the retina. In two children with CMVI, multiple preretinal hemorrhages in different parts of the retina in both eyes were revealed. Central chorioretinal foci in the fundus were detected in children with toxoplasmosis. A positive dynamics, such as a decrease of exudative phenomena, a partial fit of the retina, complete resorption of hemorrhages, was noted in children during treatment. It has been concluded that signs of intrauterine neuroinfection can appear delayed, only by the development of chorioretinitis, 4-5 months after birth and manifest with severe exudative-proliferative changes in the retina and vitreous body.

Evaluation of Choroidal Thickness, Choroidal Vascularity Index and Peripapillary Retinal Nerve Fiber Layer in Patients with Juvenile Systemic Lupus Erythematosus

The aim of this study was to conduct a detailed ophthalmological examination in children with systemic lupus erythematosus (jSLE), including choroidal thickness (ChT), choroidal vascularity index (CVI) and peripapillary retinal nerve fiber layer (RNFL). The study included all jSLE patients ( n = 21) diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria between January 2017 and April 2017, and an age- and gender-matched control group ( n = 21). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity. After routine eye examinations, ChT at five points (750 µ and 1500 µ from the center of the fovea both in the temporal and nasal quadrants and under the fovea), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), CVI and RNFL thickness at the optic disc were evaluated. One patient had active ocular involvement in the form of episcleritis. Another patient had corticosteroid-induced cataract. The median age of the patients was 16 years (6-19 years). ChT at five points, TCA, LA and SA were found to be higher in patients with jSLE, whereas RNFL thickness and CVI were similar to those of the healthy control individuals. No correlation was determined between optical coherence tomography findings, SLEDAI and the immunological parameters (antinuclear antibodies, anti-double-stranded DNA, complements 3 and 4, extracted nuclear antigen antibody, antiphospholipid antibody). Intraretinal and subretinal fluid was not present in any of the patients. The choroid was thicker in patients with jSLE than in the control group. The study results suggest that jSLE may affect the choroid. Ophthalmological evaluation is important in SLE patients, even in the absence of relevant complaints.

Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe

This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.

Ocular manifestations of congenital toxoplasmosis

To evaluate the ocular manifestations of congenital toxoplasmosis at the first ophthalmological examination of children up to the age of 12 months. Cross-sectional study of 44 children with a confirmed diagnosis of congenital toxoplasmosis. In all patients, complete ophthalmological examinations were performed under sedation. The patients underwent biomicroscopy of the anterior segment, skiascopy under cyclopegia, and indirect binocular ophthalmoscopy with maximum mydriasis. The mean age of patients was 4.2 months. Of the 44 children evaluated, 31 (70.4%) presented ocular involvement and 29 (65.9%) of them had retinochoroiditis lesions. The retinochoroiditis lesions were bilateral in 22 (75.8%) patients and unilateral in 7 (24.2%). The retinochoroiditis lesions were active in 8 (15.7%) eyes and had healed in 43 (84.3%). Most of the lesions were concentrated in the papillomacular area (76.3%). Other associated ocular alterations were present in 22 children, the most prevalent being cataract, microphthalmia, and strabismus. Ocular involvement in congenital toxoplasmosis might be much more frequent and occurs earlier than previously described.

Okuläre Veränderungen beim Mikrozephalie-Lymphödem-Chorioretinale-Dysplasie-Syndrom

Microcephaly-lymphoedema-chorioretinal dysplasia (MLCRD) is a rare syndrome characterized by microcephaly, chorioretinal dysplasia, lymphoedema and a characteristic facial phenotype. The exact mode of inheritance is uncertain, autosomal dominant, recessive and X-chromosomal cases have been reported. A three-month-old boy with intrauterine growth retardation and microcephaly was referred to our clinic. The ophthalmic examination revealed a left eye with a persistent hyperplastic primary vitreous. On funduscopy of the right eye pale optic disc, chorioretinal dysplasia with pigmentary and atrophic changes and falciform folds were noted. General morphological changes and ophthalmological findings led to the diagnosis of MLCRD-syndrome. Eye examinations of the parents and the grandparents did not show any retinal changes, therefore an autosomal dominant inheritance was excluded. An ophthalmological examination in children with microcephaly and facial dysmorphies is essential. Parents and grandparents should also be considered for eye examination if a child has chorioretinal dysplasia and microcephaly.

Computeranimierte Kinderbilder zur Visusbestimmung

Testing visual acuity is a very important element especially in the ophthalmological examination of children. The diagnosis and procedure of subsequent therapy depend on the results of vision testing. Some children achieve false low results in visual acuity because of reduced compliance. This can lead to incorrect diagnoses and false therapies. We developed a computer animated version of the visual acuity chart "Echelle Animaux". This new test was first performed on 16 normal adult volunteers and then on 16 children who achieved as good visual scores in conventional tests as the control group. After that we tested 25 children with low compliance. Most of the tested children were more motivated and attentive when performing the new test. In 9 out of 25 children the measured visual acuity scores were clearly better than in the conventional test. The animation of optotypes has a favourable effect on the motivation of children. The problem of reduced compliance and concentration can be reduced. The visual acuity scores can be improved by eliminating mistakes caused by low motivation.

Ophthalmologic Findings in Children With Sensorineural Hearing Loss

To determine the prevalence of refractive and nonrefractive ophthalmologic abnormalities in children with sensorineural hearing loss (SNHL) and to evaluate the overall utility of routine ophthalmological examination in children with SNHL. An institutional review board-approved retrospective analysis of ophthalmologic findings in children (18 years and younger) with SNHL seen between November 6, 2000, and June 4, 2007. Tertiary care university children's hospital. Children (18 years and younger) with SNHL. Ophthalmologic findings and SNHL. There were 226 patients with SNHL who underwent ophthalmologic examination. Of these patients, 49 (21.7%) had an ophthalmologic abnormality. Refractive errors were present in 23 patients (10.2%), whereas nonrefractive conditions were present in 29 patients (12.8%). The cause of SNHL was syndromic in 11 patients (4.9%), of whom 5 (2.2%) had syndromes with associated ophthalmologic abnormalities. No statistically significant differences were found in ophthalmologic findings based on severity or laterality of SNHL. The prevalence of ophthalmologic findings was not significantly different between patients whose conditions were diagnosed on the basis of newborn screening and other patients. Ophthalmologic abnormalities were found in 1 of 27 patients (3.7%) with biallelic GJB2 mutations and 22 of 106 patients (20.7%) without any GJB2 mutations (P = .04). In this study, the overall prevalence of ophthalmologic findings in children with SNHL was 21.7%. Ophthalmologic anomalies were present in 3.7% of children with GJB2 mutations. Routine ophthalmologic examination can be beneficial in the evaluation of children with SNHL.

Ocular manifestations of congenital Marfan syndrome with contractures (CMC syndrome)

The authors present the results of ocular examination of six children with congenital Marfan syndrome with contractures (CMC syndrome). The ocular and neuroradiological findings of the CMC syndrome are discussed with reference to the literature. The ocular findings are: blue sclerae, megalocorneas, hypoplastic irides with complete translucency, miosis, spherophakia with or without lens dislocation and severe myopia. This study demonstrates that ophthalmological examination of children with congenital contractures and arachnodactyly is very helpful for diagnosis of the CMC syndrome. The authors stressed that ophthalmologists should not only look for luxation of the lens in children who are suspected of having CMC syndrome. Spherophakia was common in the children and could easily be observed through the translucent irides. Biometric evaluation of the eyes is recommended. All of the cases in this paper and reported cases are sporadic. No conclusions have been reached in the literature on whether the CMC syndrome represents the severe expression of the classical Marfan syndrome or a distinct entity. Maybe the answer will remain difficult, until the specific molecular defects in the collagen diseases are discovered. This study demonstrates that ophthalmological examination of the children with congenital contractures and arachnodactyly is very helpful for the diagnosis of CMC syndrome.

Pediatric ophthalmology: reasons for examination and disease pictures

A representative sample of 800 patients was taken from 15,000 children treated between 1972 and 1984 in the Department of Pediatric Ophthalmology of Frankfurt University Eye Hospital. Their charts were reviewed to answer two questions: what are the most frequent reasons for ophthalmological examination in children under 15 years old and what are the most frequent diagnoses? Ophthalmological examinations were most frequently scheduled because of strabismus, errors of refraction and trauma or inflammation of the anterior segment, though also in a large number of cases because of general diseases, most often neurologic diseases such as epilepsy or elevated intracerebral pressure. The diseases diagnosed ophthalmologically were classified as congenital or acquired eye diseases and congenital or acquired general diseases with ocular symptoms. The most frequent are indicated in the text. Acquired diseases were more frequent than congenital diseases, though this group proved to be much larger in pediatric patients than in adult patients.