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Shu Q, Pang J, Liu Z, Liang X, Chen M, Tao Z, Liu Q, Guo Y, Yang X, Ding J, Chen R, Wang S, Li W, Zhai G, Xu J, Li L. Artificial Intelligence for Early Detection of Pediatric Eye Diseases Using Mobile Photos. JAMA Netw Open 2024; 7:e2425124. [PMID: 39106068 PMCID: PMC11304122 DOI: 10.1001/jamanetworkopen.2024.25124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/31/2024] [Indexed: 08/07/2024] Open
Abstract
IMPORTANCE Identifying pediatric eye diseases at an early stage is a worldwide issue. Traditional screening procedures depend on hospitals and ophthalmologists, which are expensive and time-consuming. Using artificial intelligence (AI) to assess children's eye conditions from mobile photographs could facilitate convenient and early identification of eye disorders in a home setting. OBJECTIVE To develop an AI model to identify myopia, strabismus, and ptosis using mobile photographs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at the Department of Ophthalmology of Shanghai Ninth People's Hospital from October 1, 2022, to September 30, 2023, and included children who were diagnosed with myopia, strabismus, or ptosis. MAIN OUTCOMES AND MEASURES A deep learning-based model was developed to identify myopia, strabismus, and ptosis. The performance of the model was assessed using sensitivity, specificity, accuracy, the area under the curve (AUC), positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (P-LR), negative likelihood ratios (N-LR), and the F1-score. GradCAM++ was utilized to visually and analytically assess the impact of each region on the model. A sex subgroup analysis and an age subgroup analysis were performed to validate the model's generalizability. RESULTS A total of 1419 images obtained from 476 patients (225 female [47.27%]; 299 [62.82%] aged between 6 and 12 years) were used to build the model. Among them, 946 monocular images were used to identify myopia and ptosis, and 473 binocular images were used to identify strabismus. The model demonstrated good sensitivity in detecting myopia (0.84 [95% CI, 0.82-0.87]), strabismus (0.73 [95% CI, 0.70-0.77]), and ptosis (0.85 [95% CI, 0.82-0.87]). The model showed comparable performance in identifying eye disorders in both female and male children during sex subgroup analysis. There were differences in identifying eye disorders among different age subgroups. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the AI model demonstrated strong performance in accurately identifying myopia, strabismus, and ptosis using only smartphone images. These results suggest that such a model could facilitate the early detection of pediatric eye diseases in a convenient manner at home.
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Affiliation(s)
- Qin Shu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiali Pang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Zijia Liu
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Liang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Moxin Chen
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Zhuoran Tao
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qianwen Liu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yonglin Guo
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefeng Yang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jinru Ding
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Ruiyao Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Sujing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Lin Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Shu Q, Xiao Z, Peng X, Liang X, Chen M, Tao Z, Liu Q, Guo Y, Yang X, Nie W, Chen R, Yang L, Li J, Xu J, Li L. Influencing factors for pediatric eye disorders and health related quality of life: a cross-sectional study in Shanghai, China. Front Med (Lausanne) 2024; 11:1420848. [PMID: 39139792 PMCID: PMC11319247 DOI: 10.3389/fmed.2024.1420848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
Background Myopia, strabismus, and ptosis are common pediatric eye diseases, which have a negative impact on children and adolescents in terms of visual function, mental health, and health-related quality of life (HRQoL). Therefore, this study focused on those pediatric eye diseases by analyzing their risk factors and HRQoL for the comprehensive management of myopia, strabismus, and ptosis. Methods A total of 363 participants (2-18 years old) were included in this study for risk factors analysis of myopia, strabismus, and ptosis. We collected demographic characteristics, lifestyle habits and eye care habits of these children and analyzed them by using univariable and multivariable logistic regression. In addition, we applied the Chinese version of Pediatric Quality of Life Inventory-Version 4.0 (PedsQL 4.0) to assess HRQoL in 256 children with strabismus and ptosis. Univariable and multivariable linear regression models were applied to evaluate potential influencing factors of HRQoL. Results Of all the participants, 140 had myopia, 127 had strabismus, and 145 had ptosis. Based on the multivariable logistic regression analysis model, we found that the history of parental myopia and daily average near-distance eye usage time were risk factors for myopia, and increased body mass index (BMI) was identified as a risk factor for strabismus and ptosis. Individuals with ptosis possessed decreased HRQoL. The multivariable linear regression model suggested that daily average near-distance eye usage time, light intensity during visual tasks, and daily average sleep duration had potential influences on HRQoL. Conclusion This is the first study to assess the risk factors and HRQoL of myopia, strabismus, and ptosis together. We identified risk factors for these common pediatric eye diseases to help doctors, parents, and teachers better manage them. Our study discovered that children with eye disorders exhibit a notably diminished HRQoL. Consequently, it emphasizes the necessity for increased social attention and mental health assistance for these children.
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Affiliation(s)
- Qin Shu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Zhongzhou Xiao
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Xinwei Peng
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Xiaoyi Liang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Moxin Chen
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Zhuoran Tao
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qianwen Liu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yonglin Guo
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefeng Yang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Wanqin Nie
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ruiyao Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Liya Yang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Jin Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Lin Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Jeong JH, Park CS. Evaluating the Correlation between Ptosis Improvement and Immediate Postoperative Lagophthalmos following Blepharoptosis Surgery under General Anesthesia in Pediatric Patients. J Clin Med 2024; 13:1173. [PMID: 38398487 PMCID: PMC10889339 DOI: 10.3390/jcm13041173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/17/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The objective of this study is to establish a potential correlation between postoperative improvement in upper eyelid ptosis, measured by the marginal reflex distance 1 (MRD1), and the immediate postoperative degrees of lagophthalmos (IPDL). The established correlation is then used to assess whether IPDL can be used as a reliable indicator of successful treatment of eyelid ptosis. Methods: This retrospective study involved 19 patients, aged 1 to 11, with a total of 28 eyes affected by ptosis, who underwent surgery under general anesthesia at Seoul National University Bundang Hospital from January 2018 to December 2022. We monitored the MRD1 of the patients for over six months postoperatively and measured the IPDL. Results: After ptosis correction surgery, no statistically significant correlation was observed between the improvement in MRD1 and IPDL. Furthermore, the degree of postoperative eyelid ptosis improvement was found to vary and was not consistently sustained, attributable to a range of factors. Conclusions: Our study did not establish a statistically significant correlation between IPDL and ptosis improvement as measured by MRD1. Further research is needed to draw definitive conclusions about their correlation.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chong Soo Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Yan Y, Gan C. Using the "Frontalis-Free Orbital Septum-Complex Flap" in the Correction of Unilateral Congenital Ptosis. J Craniofac Surg 2023; 34:e602-e604. [PMID: 37394700 DOI: 10.1097/scs.0000000000009533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Congenital ptosis has deleterious effects on the appearance and vision-related function. Patients need timely and effective treatments. A new surgical practice was performed using the discarded fibrous and thickened orbital septum to prolong the advanced frontalis muscular flap and reduce iatrogenic injuries in the frontalis. A 5-year-old boy with severe unilateral congenital ptosis was enrolled and got satisfactory surgical effects without complication. The "frontalis-free orbital septum-complex flap" is a new and relatively ideal method. The purpose of this paper is to demonstrate this surgical practice and provide a new idea for correcting congenital ptosis with the thickened and fibrotic orbital septum.
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Affiliation(s)
- Yucheng Yan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road, Shijingshan District, Beijing, China
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Horner's Syndrome and Lymphocele Following Thyroid Surgery. J Clin Med 2023; 12:jcm12020474. [PMID: 36675400 PMCID: PMC9865845 DOI: 10.3390/jcm12020474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid−related HS represents an unusual entity underling thyroid nodules/goiter/cancer−HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2−6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.
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Traylor KS, Branstetter BF. Cranial Nerve Anatomy. Neuroimaging Clin N Am 2022; 32:565-576. [PMID: 35843663 DOI: 10.1016/j.nic.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 12 cranial nerves (CNs) all have important functions. All, except the accessory nerve, arise solely within the cranial vault. We will discuss each CN function along with its entire CN course. The modality of choice for evaluation of the CN itself is typically MRI, however, CT is very important to access the bony foramina and CN boundaries..
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Affiliation(s)
- Katie Suzanne Traylor
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA.
| | - Barton F Branstetter
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA
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Hsia NY, Wen LY, Chou CY, Lin CL, Wan L, Lin HJ. Increased Risk of Refractive Errors and Amblyopia among Children with Ptosis: A Nationwide Population-Based Study. J Clin Med 2022; 11:jcm11092334. [PMID: 35566461 PMCID: PMC9100637 DOI: 10.3390/jcm11092334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to investigate the risk of refractive errors (astigmatism, myopia, and hyperopia) and amblyopia in children with ptosis and association between age at diagnosis of ptosis and subsequent risks of vision problems. Methods: Retrospective claims data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. We identified 1799 children aged 0−18 years who were newly diagnosed with ptosis between 2000 and 2012 and 7187 individuals without the disease. Both cohorts were followed up until 2013 to estimate the incidence of refractive errors and amblyopia. Results: Children with ptosis had 5.93-fold, 3.46-fold, 7.60-fold, and 13.45-fold increases in the risk of developing astigmatism, myopia, hyperopia, and amblyopia, respectively, compared with the control cohort (astigmatism: adjusted hazard ratio, aHR = 5.93, 95% confidence interval, CI = 5.16−6.82; myopia: aHR = 3.46, 95% CI = 3.13−3.83; hyperopia: aHR = 7.60, 95% CI = 5.99−9.63; amblyopia: aHR = 13.45, 95% CI = 10.60−17.05). Children diagnosed with ptosis at an age older than 3 years old had a higher risk of myopia than patients diagnosed with ptosis before age 3. There was no significant difference of the risk of astigmatism, amblyopia, and hyperopia between age groups. Conclusions: Children with ptosis may exhibit a higher risk of astigmatism, myopia, hyperopia, and amblyopia than children without ptosis. The risk of myopia is higher in children with ptosis diagnosed at >3 years than those diagnosed at ≤3 years.
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Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Li-Yen Wen
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Ching-Ying Chou
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan;
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: (L.W.); (H.-J.L.)
| | - Hui-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Correspondence: (L.W.); (H.-J.L.)
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8
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Garanto A, Ferreira CR, Boon CJF, van Karnebeek CDM, Blau N. Clinical and biochemical footprints of inherited metabolic disorders. VII. Ocular phenotypes. Mol Genet Metab 2022; 135:311-319. [PMID: 35227579 PMCID: PMC10518078 DOI: 10.1016/j.ymgme.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022]
Abstract
Ocular manifestations are observed in approximately one third of all inherited metabolic disorders (IMDs). Although ocular involvement is not life-threatening, it can result in severe vision loss, thereby leading to an additional burden for the patient. Retinal degeneration with or without optic atrophy is the most frequent phenotype, followed by oculomotor problems, involvement of the cornea and lens, and refractive errors. These phenotypes can provide valuable clues that contribute to its diagnosis. In this issue we found 577 relevant IMDs leading to ophthalmologic manifestations. This article is the seventh of a series attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnoses according to system involvement.
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Affiliation(s)
- Alejandro Garanto
- Department of Pediatrics, Amalia Children's Hospital Radboud Center for Mitochondrial and Metabolic Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands and Amsterdam University Medical Centers, Academic Medical Center, Department of Ophthalmology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Clara D M van Karnebeek
- Department of Pediatrics, Amalia Children's Hospital Radboud Center for Mitochondrial and Metabolic Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Departments of Pediatrics and Human Genetics, Emma Children's Hospital, Amsterdam Reproduction and Development, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital, Zürich, Switzerland.
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Adducchio S, Reyes I, Chikkannaiah M, Rasch M, Kumar G. Bilateral Ptosis, Zosteriform Rash and Flaccid Bladder in a 10-Year-old boy. Child Neurol Open 2022; 9:2329048X221079429. [PMID: 35174255 PMCID: PMC8841934 DOI: 10.1177/2329048x221079429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
We present a case report of a 10-year-old completely immunized boy presenting with a 2-week history of bilateral eyelid drooping, fatigue followed by bladder and bowel paralysis. This was followed by the appearance of a vesicular painful and itchy rash which directed further diagnosis and treatment as it was consistent with a varicella reactivation rash. This case is a very important addition to the current body of literature on varicella-related neurological complications. It outlines that varicella reactivation can present in completely vaccinated, immunocompetent young children as a neurological syndrome affecting the autonomic nervous system primarily and the rash can occur a few weeks later after presentation of the neurological symptoms.
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Affiliation(s)
| | - Irma Reyes
- Dayton Children’s Hospital, Dayton, Ohio, USA
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Mahesh Chikkannaiah
- Dayton Children’s Hospital, Dayton, Ohio, USA
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Matthew Rasch
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Gogi Kumar
- Dayton Children’s Hospital, Dayton, Ohio, USA
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Igde M, Yilmaz M, Gungor Y, Saglam ME, Salman N, Tapan M, Comert E, Comert A. Neurovascular anatomy of pronator quadratus for reanimation of blepharoptosis. Surg Radiol Anat 2022; 44:207-213. [DOI: 10.1007/s00276-022-02882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
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Jones DL, Ma J, Yang M, Duong A, Richani K. Pediatric Ptosis: A Review of Less Common Causes. Int Ophthalmol Clin 2022; 62:177-202. [PMID: 34965234 DOI: 10.1097/iio.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Treatment of Severe Ptosis by Conjoint Fascial Sheath Suspension. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1837458. [PMID: 34840967 PMCID: PMC8626196 DOI: 10.1155/2021/1837458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
Objective To explore the role of conjoint fascial sheath (CFS) suspension in the treatment of severe ptosis. Methods A total of 110 patients with severe ptosis who were admitted to our hospital from May 2018 to December 2020 were included. Fifty-seven patients treated with frontalis suspension were assigned into group A, and the remaining 53 patients treated with CFS suspension were assigned into group B. The curative effect, ocular surface alterations, complications, and satisfaction in the two groups were compared. Results Patients in group B suffered from severe upper eyelid retraction and lid lag than those in group A, as well as more limited range of motion (ROM) (P < 0.05). The curative effect and patient satisfaction in group B were higher than those in group A (P < 0.05). Postsurgical complications in group B were fewer than those in group A (P < 0.05). Conclusion CFS suspension is effective in the treatment of severe ptosis.
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Owji N, Khalili MR, Bazrafkan H, Heydari M. Long-term outcome of refractive errors in patients with congenital blepharoptosis who have undergone ptosis surgery. Clin Exp Optom 2021; 105:715-720. [PMID: 34538220 DOI: 10.1080/08164622.2021.1973344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. BACKGROUND The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. METHODS Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. RESULTS The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2-10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48º vs. 0.45*53º, respectively). CONCLUSION Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery.
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Affiliation(s)
- Naser Owji
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Bazrafkan
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Atypical Horner's syndrome: frequency, features and aetiology in a paediatric population. Eye (Lond) 2020; 35:811-816. [PMID: 32424330 DOI: 10.1038/s41433-020-0967-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Paediatric Horner's syndrome (HS) may present atypically with incomplete or intermittent clinical features, yet could represent sinister pathology including neuroblastoma. We aim to report the frequency and features with which atypical HS presents in our population (Northern Ireland) and to propose an investigation algorithm to aid diagnosis in these challenging cases. SUBJECTS/METHODS Retrospective chart review of all paediatric anisocoria and HS cases presenting to Belfast, Northern Ireland, between 2012 and 2018, identified through searching our paediatric ophthalmology database. RESULTS Sixty-one eligible cases of anisocoria or HS were analysed. Ten cases of HS were identified, four (40%) of which presented atypically with incomplete or intermittent features. Two of these four atypical cases were secondary to neuroblastoma. Overall incidence of paediatric HS in Northern Ireland during the study period was at least 2.54 per 100,000. CONCLUSIONS Paediatric HS may present atypically in a significant number of cases. Accordingly, clinicians should consider HS in children with a history of anisocoria or ptosis and have a low threshold for use of pharmacological tests to aid diagnosis.
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Aagaard Nolting L, Brasch-Andersen C, Cox H, Kanani F, Parker M, Fry AE, Loddo S, Novelli A, Dentici ML, Joss S, Jørgensen JP, Fagerberg CR. A new 1p36.13-1p36.12 microdeletion syndrome characterized by learning disability, behavioral abnormalities, and ptosis. Clin Genet 2020; 97:927-932. [PMID: 32170730 DOI: 10.1111/cge.13739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
Two 1p36 contiguous gene deletion syndromes are known so far: the terminal 1p36 deletion syndrome and a 1p36 deletion syndrome with a critical region located more proximal at 1p36.23-1p36.22. We present even more proximally located overlapping deletions from seven individuals, with the smallest region of overlap comprising 1 Mb at 1p36.13-1p36.12 (chr1:19077793-20081292 (GRCh37/hg19)) defining a new contiguous gene deletion syndrome. The characteristic features of this new syndrome are learning disability or mild intellectual disability, speech delay, behavioral abnormalities, and ptosis. The genes UBR4 and CAPZB are considered the most likely candidate genes for the features of this new syndrome.
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Affiliation(s)
| | | | - Helen Cox
- Clinical Genetics Unit, West Midlands Regional Clinical Genetics Unit Birmingham U.K., Birmingham, UK
| | - Farah Kanani
- Sheffield Clinical Genetics Service, Northern General Hospital, Sheffield, UK
| | - Michael Parker
- Sheffield Clinical Genetics Service, Northern General Hospital, Sheffield, UK
| | - Andrew E Fry
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Sara Loddo
- Laboratory of Medical Genetics, Bambino Gesù Childrens' Hospital, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Childrens' Hospital, Rome, Italy
| | | | - Shelagh Joss
- Clinical Genetics, West of Scotland Genetic Services, the Queen Elisabeth University Hospital, Glasgow, UK
| | - Joan P Jørgensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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