Pediatric Ocular Disease Research Articles

Part-Time Monocular 1% Atropine Therapy for Intermittent Exotropia Control in Young Children

Intermittent exotropia (IXT), a common pediatric ocular disease, lacks defined treatment. Suggested treatments like part-time patching show results similar to observation, and over-minus therapy increases the risk of myopia progression.1,2,3 Often, physicians seek to improve control until children are old enough for viable options like surgery and/or exercises. This retrospective chart review assesses the effectiveness of 1% atropine applied to the dominant eye for 2 consecutive days per week for IXT in children younger than 8 years.

Long-term Prognosis of Pediatric Ocular Disease.

Several problems differentiate the treatment of children, especially those with congenital ocular disease, from adults, including the absence of complaints and the complication of systemic diseases. However, the most challenging is the continuing developing anatomical and functional development and immaturity in children. Consequently, the timing of disease onset and treatment can greatly affect the prognosis, and the prognosis cannot be confirmed without long-term follow-up periods. The prognosis for unilateral congenital cataract is very poor. However, some cases achieved good vision with successful refractive correction and amblyopia therapy, suggesting that long-term parental enthusiasm and adherence are important for the visual prognosis. Penetrating keratoplasty is rarely performed in children, and outcomes at our hospital have been extremely poor for congenital corneal opacity over the past 28 years. The visual prognosis is also poor for large limbal dermoids approaching the center of the cornea, which did not respond to preoperative amblyopia therapy. Consequently, early excision, lamellar keratoplasty, wearing of hard contact lenses, and amblyopia therapy were considered necessary. Treatment of pediatric ocular disease should consider the pros and cons, methods, and timing, especially the development of the pediatric eye and the time of onset of the disease.

Anterior segment optical coherence tomography in pediatric ocular pathology: imaging study of 115 eyes

ABSTRACT Objective To assess the pediatric anterior segment characteristics in ocular pathology using spectral domain optical coherence tomography (SD-OCT). Methods This case series follows 115 eyes of 78 children (2–17 years) with anterior segment pathology in an academic facility. The anterior segment OCT (AS-OCT) analysis was done using the Optopol Revo 80 high-resolution SD-OCT using an imaging adapter. All pathological features visible on imaging were observed, studied, tabulated, and analyzed. Results The average age was 11.84 years, with 44 males and 34 females. The primary clinical diagnosis was cataract in 40 (34.8%) eyes, followed by corneal disease in 28 (24.3%) eyes, glaucoma in 18 (15.7%) eyes, and trauma in 15 (13%) eyes. Systemic diseases were associated with 20.9% of the cases. The commonest imaging pathology observed was lens opacification in 43 (37.4%), increased reflectivity of the cornea in 31 (28.2%), corneal stromal thinning in 34 (29.6%), increased corneal thickness in 28 (24.3%), a shallow anterior chamber in 17 (14.8%), and cells in the anterior chamber in 18 (15.7%) eyes, along with a multitude of other findings. Conclusion This study demonstrates that anterior segment OCT is a useful non-contact technique for the detailed anatomic and pathologic assessment of pediatric ocular diseases.

Imaging of Pediatric Ocular Globe Pathologies

The spectrum of ocular diseases encountered in the pediatric population is different from that in adults. Recognition of the normal embryologic development and anatomy is crucial to understand various ocular pathologies. Cross-sectional imaging supplements the clinical evaluation in establishing an accurate diagnosis, guiding management and monitoring diseases of the ocular globe. CT is mostly reserved for evaluation of acute processes in the setting of trauma or infection. MR imaging is the technique of choice for most other ocular conditions, given its high soft-tissue resolution. This article highlights the relevant embryologic developmental stages and normal anatomy and provides a review of various pediatric orbital pathologies and their key imaging features.Learning Objective: To recognize the normal embryologic development, anatomy, and key imaging features of common ocular pathologies in the pediatric population to aid the neuroradiologist in promptly detecting and confidently establishing the diagnosis of pediatric ocular disease

Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases.

Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.

Prevalence of pediatric ocular morbidity in tertiary care hospital in Lucknow District

Globally as of mid-2020, about 26% of the world's population was under 15 years old .1 Ocular morbidity in children is a global problem being faced today that has a tremendous influence on the society. This was a cross sectional, observational study in a tertiary care hospital in Lucknow, UttarPradeshwhich was carried out for 12 months i.e. from September 2019 to august 2020 on1 to 15 years old patients . Maximum burden i.e. ≥90% of pediatric ocular disease is from refractory error, allergic conjunctivitis, computer vision syndrome, congenital NLD block, few infective diseases and ocular trauma so the managing these diseases only can help ≥90% pediatric ocular problems. For ≤ 10% diseases like ROP, retinal disease, cataract , glaucoma needs advanced diagnostic and therapeutic measures so for that after screening these patients in satellite centre these can be referred to tertiary care hospital.. focus on setting up peripheral eye care centre/ satellite eye care centre where a ophthalmology resident and paramedical staff can be appointed on rotatory basis will be helpful. Thus we can save few more precious eyes.

Single vesicle analysis of aqueous humor in pediatric ocular diseases reveals eye specific CD63‐dominant subpopulations

Aqueous humor (AH), the clear fluid in front of the eye, maintains the pressure and vitality of ocular tissues. This fluid is accessible via the clear cornea which enables use of AH as a liquid biopsy source of biomarkers for intraocular disease. Extracellular vesicles are detectable in the AH and small extracellular vesicles (sEVs) are present in the AH from adults. However, EVs in AH from pediatric eyes in vivo have never previously been explored. We know very little about the heterogeneity of AH EV populations in ocular disease. Twenty-seven processing-free AH samples from 19 patients across four different pediatric ocular diseases were subjected to Nanoparticle Tracking Analysis (NTA) and Single Particle-Interferometric Reflectance Imaging Sensor (SP-IRIS) analysis. NTA demonstrated the concentration of AH EV/EPs is 3.11 × 109-1.38 × 1010 particles/ml; the majority sized 76.8-103 nm. SP-IRIS revealed distinct patterns of tetraspanin expression of AH sEVs. An enriched mono-CD63+ sEV subpopulation identified in AH indicates this is a potential AH-specific biomarker. In the setting of retinoblastoma there was a more heterogeneous population of sEVs which normalized with treatment. This suggests a potential clinical application of direct measurement of sEV subpopulations in AH samples to monitor successful tumor response to therapy.

Incidence of pediatric eye morbidity

Globally as of mid-2020, about 26% of the world's population was under 15 years old .1 Ocular morbidity in children is a global problem being faced today that has a tremendous influence on the society. This was a cross sectional, observational study in a tertiary care hospital in UttarPradesh which was carried out for 12 months i.e. from September 2019 to august 2020 on1 to 15 years old patients. Maximum burden i.e. ≥90% of pediatric ocular disease is from refractory error, allergic conjunctivitis, computer vision syndrome, congenital NLD block, few infective diseases and ocular trauma so the managing these diseases only can help ≥90% pediatric ocular problems. For ≤ 10% diseases like ROP, retinal disease, cataract, glaucoma needs advanced diagnostic and therapeutic measures so for that after screening these patients in satellite centre these can be referred to tertiary care hospital.. focus on setting up peripheral eye care centre/ satellite eye care centre where a ophthalmology resident and paramedical staff can be appointed on rotatory basis will be helpful. Thus we can save few more precious eyes.

Genetic analysis of children with congenital ocular anomalies in three ecological regions of Nepal: a phase II of Nepal pediatric ocular diseases study

BackgroundGenetic eye diseases constitute a large and heterogeneous group of childhood ocular morbidity. Individual diseases may cause multiple structural anomalies and developmental features. Nepal Pediatric Ocular Disease Study (NPODS) was a population-based epidemiological study conducted across three ecological regions of Nepal to determine the prevalence and etiology of childhood ocular morbidity and blindness. In Phase II of this study, genetic analysis was performed for children who were found to have congenital ocular anomalies.MethodIt was a cross sectional descriptive study. A total of 10,270 children across three different ecological regions in Nepal (Low lands, hills, and mountains) underwent ocular examinations in NPODS. Out of 374 (3.6%) of children with ocular abnormalities, 30 were thought to be congenital in nature. Targeted genetic analysis, including genotyping for genes specific to presenting phenotype, was performed for 25 children using serum samples.ResultsOut of 25 children, 18 had meaningful genetic results. Analysis revealed one missense alteration G12411T of Zinc Finger Homeobox 4 (ZFHX4) gene in one participant among 10 with congenital ptosis and another missense variation T > C P. Y374 C of Signaling Receptor and Transporter Retinol 6 (STRA6) gene in one participant among 3 with microphthalmos.ConclusionThe study is first of its kind from Nepal and mutant genes were unique to Nepalese Population. Further analysis of genetic factors is crucial to better understand genetic association with ocular diseases and conditions. This helps further in genetic counseling and probably gene therapy to prevent blindness from these conditions.

Pediatric ocular surface disease associated with suspected abuse

PurposeTo describe one of the largest case series of children whose ocular surface disease was strongly suspicious for nonaccidental injury (NAI). MethodsThis multicenter retrospective case series includes 4 patients whose presentations were concerning for anterior segment NAI. The history, examination, treatment, and outcomes of these patients is presented, along with a brief review of case reports in the literature. ResultsA broad spectrum of anterior segment findings was noted in our case series and in cases previously reported in the literature. NAI appears to be associated with bilateral and recurrent disease as well as improvement during hospitalization that is better than initially expected. ConclusionsOcular surface NAI is a diagnosis of exclusion and necessitates a thorough history and examination. Clinician concern for ocular NAI should prompt examination or referral for signs of other bodily injuries, especially in young children. Siblings of patients who have received the diagnosis of NAI may also be at risk.

Pediatric ocular disease in an ophthalmic surgical mission trip to belize: A 7-year review

Purpose: The purpose is to identify the various causes of ocular disease and surgical interventions undertaken in children (0–18 years of age) seen during an annual ophthalmic surgical trip to Belize. Methods: A retrospective, cross-sectional review of records from seven annual surgical trips conducted by the World Pediatric Project providing pediatric ophthalmologic clinical and surgical care to Belize from 2013 to 2019 was performed. Results: The charts of 313 patients who received care during the surgical mission trips were examined. From these 313 patients, there were 545 independent clinical encounters, yielding 405 diagnoses. Patients aged 6–10 years were most commonly seen (32.1%) followed by those 2–5 years old (28.1%). The most common pathophysiology seen was strabismus/ocular motility disorder (151 diagnoses; 37.4%), followed by refractive issues (69 diagnoses; 17.1%), eyelids and/or lacrimal system disorders (53 diagnoses; 13.1%), disorders of the retina/vitreous (30 diagnoses; 7.4%), lens abnormalities/cataract (28 diagnoses; 6.9%), amblyopia (23 diagnoses; 5.7%), disorders of the cornea/conjunctiva (23 diagnoses; 5.7%), trauma (13 cases; 3.2%), conditions affecting the globe/orbit (7 diagnoses; 1.7%), other (6 diagnoses; 1.5%), and glaucoma (1 diagnoses, 0.2%). Conclusion: This study identified the most frequently diagnosed ocular conditions encountered during annual surgical mission trips to Belize. The most prevalent pathophysiology encountered was strabismus/ocular motility disorders, followed by refractive issues. The most common refractive issues encountered were myopia and astigmatism. This is the first study detailing pediatric ocular disease in Belize.

Prognostic importance of congenital cataract morphology: A case report

Congenital cataract (CC) has an important place in pediatric ocular diseases. CCs are different from senile nuclear cataracts in terms of their etiologic, clinic and morphological characteristics. CCs occur many different forms such as non-hereditary isolated cases or autosomal dominant bilateral cases. In addition, many of ocular and systemic diseases can be associated with CC and ophthalmologist should be aware of these potential risks. In this article, we questioned whether the different morphological features of CC have prognostic importance or effect decision of surgery by considering a case of CC.

Anti-VEGF for ROP and Pediatric Retinal Diseases.

Vascular endothelial growth factor (VEGF) is an important mediator of the pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. In retinopathy of prematurity (ROP), the role of VEGF in pathogenesis has been well recognized and the use of anti-VEGF treatment in phase 2 ROP has demonstrated promising results, particularly in severe cases of posterior disease. This has made VEGF an established target in the treatment of pediatric retinal diseases known to have abnormal vascular activity. However, questions remain about late systemic and neurodevelopmental effects after anti-VEGF therapy for children because intravitreal injection of anti-VEGF may result in systemic circulation of anti-VEGF agent and a corresponding suppression of systemic VEGF. We do not currently know whether the short-term suppression of systemic VEGF affects long-term neurodevelopmental outcomes because VEGF is a vital supporting factor during neurodevelopment. This review article focuses on the evidence for the use of anti-VEGF treatment in certain pediatric ocular diseases, including ROP, Coats disease, and retinoblastoma. More extensive and prospective studies are warranted to further elucidate the role of anti-VEGF therapy in these diseases and illustrate how we can optimally use these agents in pediatric patients.

Causes of visual impairment and blindness in children in three ecological regions of Nepal: Nepal Pediatric Ocular Diseases Study.

PurposeTo study the causes of blindness and visual impairment in children in three ecologically diverse regions of Nepal.Materials and methodsThis is a baseline survey report of a 3-year longitudinal population-based study. One district each from the three ecological regions – Terai, Hills, and Mountains – was selected for the study. Village Development Committees from each district were selected by random sampling. Three community health workers were given training on vision screening and identification of abnormal ocular conditions in children. Health workers who examined children and collected data using pretested questionnaire performed house-to-house surveys. Children with abnormal vision or ocular conditions were referred to and examined by pediatric ophthalmologists.ResultsA total of 10,950 children aged 0–10 years, 5,403 from Terai, 3,204 from Hills, and 2,343 from Mountains, were enrolled in the study. Of them, 681 (6.2%) were nonresponders. The ratio of boys to girls was 1.03:1. Prevalence of blindness was 0.068% (95% confidence interval [CI] 0.02%–0.12%) and visual impairment was 0.097% (95% CI 0.04%–0.15%). Blindness was relatively more prevalent in Terai region (0.08%, 95% CI 0.02%–0.13%). The most common cause of blindness was amblyopia (42.9%) followed by congenital cataract. Corneal opacity (39%) was the most common cause of unilateral blindness.ConclusionMore than two-thirds of the causes that lead to blindness and visual impairment were potentially preventable. Further, nutritional and genetic studies are needed to determine the factors associated with ocular morbidity and blindness in these regions.

Keeping an eye on SOXC proteins.

The formation of a mature, functional eye requires a complex series of cell proliferation, migration, induction among different germinal layers, and cell differentiation. These processes are regulated by extracellular cues such as the Wnt/BMP/Hh/Fgf signaling pathways, as well as cell intrinsic transcription factors that specify cell fate. In this review article, we provide an overview of stages of embryonic eye morphogenesis, extrinsic and intrinsic factors that are required for each stage, and pediatric ocular diseases that are associated with defective eye development. In addition, we focus on recent findings about the roles of the SOXC proteins in regulating vertebrate ocular development and implicating SOXC mutations in human ocular malformations.

Factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal: Nepal pediatric ocular disease study.

BackgroundNepal Pediatric Ocular Diseases Study is a three year longitudinal population based study. Here we present the baseline survey report which aims to investigate various risk factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal.MethodThis baseline survey is a population based cross sectional study. The investigation was conducted in a district from each of the following regions: Terai, Hill and Mountain. The Village Development Committees (VDCs) from each district were selected by random sampling. Three Community health workers were given training on vision screening and identification of abnormal ocular signs in children. They conducted a house to house survey in their respected districts examining the children and gathering a standardized set of data variables. Children with abnormal vision or ocular signs were then further examined by pediatric ophthalmologists.ResultsA total of 10950 children aged 0–10 years (5403 from Terai, 3204 from the hills, 2343 from the mountains) were enrolled in the study. However 681 (6.2%) were non responders. The male to female ratio was 1.03. The overall prevalence of ocular morbidity was 3.7% (95% CI of 3.4%-4%) and blindness was 0.07% (95% CI of 0.02%-0.12%). Ocular morbidity was more prevalent in the mountain region whereas blindness was more prevalent in the Terai region.Children from the Terai region were more likely to suffer from congenital ocular anomalies compared to the other regions. Children whose mother smoked, drank alcohol, or was illiterate were significantly afflicted with ocular diseases (p < 0.05). In addition,a higher prevalence of ocular disease was related to children with past medical history of systemic illnesses, abnormal postnatal period or missing childhood vaccinations. Blindness was more prevalent in children who suffered from a systemic illness. Females and under-nourished children were more likely to have ocular morbidity and blindness.ConclusionIt was found that childhood blindness was more prevalent in the Terai region, the undernourished, females and in those with co-morbid systemic illnesses. This study strongly suggests that prevention of childhood blindness requires additional resources to address these disparity.

An Evidence-Based Review of Vascular Endothelial Growth Factor Inhibition in Pediatric Retinal Diseases: Part 2. Coats’ Disease, Best Disease, and Uveitis With Childhood Neovascularization

Vascular endothelial growth factor (VEGF) is an important factor in the pathogenesis of multiple retinal neovascular disorders. This report focuses on the quality and depth of new evidence for the use of VEGF inhibitors in selected pediatric ocular diseases, including Coats' disease, Best disease, and childhood uveitis. Because much of the literature comprises case reports and retrospective case series, the level of evidence supporting its use as a primary treatment option, or even as adjuvant therapy, is low. The standard of care is treatment of the underlying disorder to prevent neovascularization (retinal or subretinal), vitreous hemorrhage, or subsequent retinal detachment. However, these complications may not present until late in the disease course. It may then be useful to treat with these agents. Prospective studies are warranted to further elucidate the role of anti-VEGF therapy in these diseases.

Retinoblastoma With Coats’ Response

Although it is well known that a variety of pediatric ocular diseases may clinically resemble retinoblastoma, perhaps of more concern is when the actual tumor mimics seemingly benign ocular lesions. The authors present two cases of retinoblastoma with a Coats' response as evidence of the challenge often encountered in evaluating intraocular malignancies. The cases further emphasize the need for retaining a high level of clinical suspicion for more malicious diseases, often using repeated fundus evaluations when a diagnosis remains ambiguous.

Bilateral Primary Congenital Glaucoma in Monozygotic Twins

Primary congenital glaucoma is an uncommon pediatric ocular disease contributing to a disproportionately high percentage of childhood blindness worldwide. This case report describes bilateral primary congenital glaucoma in monozygotic twins who first presented to an ophthalmologist in Ethiopia at 6 years of age. Both had severe, protracted disease, with only moderate improvement after surgical intervention.

Etiological analysis on pediatric bacterial ocular disease

目的 回顾分析14岁以下儿童的眼部标本培养细菌的菌属分布.方法对1989～2000年送检的798份14岁以下儿童的眼部细菌培养标本,进行革兰(G)染色分布、细菌菌属分布及随年龄变化规律进行分析.结果培养阳性的细菌250株,12年平均培养阳性率为31.3%,其中G+球菌127株,占50.8%;G+杆菌35株,占14%;G-球菌30株,占12%;G-杆菌53株,占21.2%.放线菌5株,占2%.培养阳性菌中凝固酶阴性葡萄球菌(主要为表皮葡萄球菌)的比例最高,为18.0%,其次为棒状杆菌为12.4%,肠杆菌科为11.6%,微球菌属为9.6%,假单孢菌属为9.2%,淋病奈瑟氏菌为9.2%.结论儿童结膜标本细菌G染色特点及细菌菌属分布与全体人群差异较大,儿童结膜淋病奈瑟菌阳性率远高于一般人群,应该引起临床医生重视。