A Survey of Pediatric Ophthalmologists to Assess Practice Patterns for Primary Surgical Management of Nasolacrimal Duct Obstruction

PURPOSE

To survey current practice patterns of pediatric ophthalmologists regarding primary surgical management of infantile dacryostenosis.

METHODS

Responses to a five-question survey were cross-tabulated to compare surgery preferences across patient age ranges and intubation method. Surveys were submitted to members of the American Association for Pediatric Ophthalmology and Strabismus following institutional review board approval.

RESULTS

Results from 142 completed surveys were analyzed. A bimodal distribution of reported propensity to intubate the nasolacrimal duct during primary surgery for dacryostenosis was observed, with one group of ophthalmologists intubating frequently and a second group intubating rarely. For patients younger than 24 months, 33 of 142 surgeons (23%) preferred to intubate 91% or more of the time and 76 of 142 (54%) preferred to intubate 10% or less of the time. For patients older than 24 months, the overall preference for intubation increased compared to the younger patient age group (P < .0007). In older patients, 52 of 142 surgeons (37%) preferred to intubate 91% or more of the time and 45 of 142 surgeons (32%) preferred to intubate 10% or less of the time. The most common preferred intubation methods were self-threading monocanalicular stent (42%) and metal-swaged bicanalicular stent (21%). Surgeons who preferred self-threading monocanalicular stents more often also preferred intubation procedures.

CONCLUSIONS

Best practice for infantile dacryostenosis remains a surgeon preference, with some surgeons performing intubation frequently and others performing it rarely. Overall estimated intubation rates for primary surgery increased from 36% in children younger than 24 months to 50% at age 24 months or older. [J Pediatr Ophthalmol Strabismus. 2022;59(1):35-40.].

Associations between adiposity and indicators of thyroid status in children and adolescents

BACKGROUND

In adults, obesity is associated with abnormalities of thyroid function; there are fewer studies in paediatric cohorts.

OBJECTIVES

To examine associations of weight and adiposity with indices of thyroid function and thyroid-related metabolic factors in children.

DESIGN/METHODS

A sample of 1203 children without obesity (body mass index [BMI] < 95th percentile; N = 631) and with obesity (BMI ≥ 95th percentile; N = 572), age 5-18 years, had height and weight measured (to calculate BMI-Z score for age and sex) and had blood collected in the morning for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and leptin. A subset (N = 829) also underwent measurement of fat mass by dual-energy X-ray absorptiometry. Analyses examined associations of TSH and FT4 with adiposity and obesity-related conditions accounting for sociodemographic factors.

RESULTS

Thyroid-stimulating hormone was positively related to BMIz and fat mass (both p-values < 0.001). FT4 was negatively related to BMIz and fat mass (both p-values < 0.001). TSH was positively correlated to leptin (p = 0.001) even after accounting for fat mass.

CONCLUSIONS

Paediatric obesity is associated with higher TSH and lower FT4 concentrations and with a greater prevalence of abnormally high TSH. Leptin concentrations may in part explain obesity's effects on thyroid status, perhaps through leptin's effects on TSH secretion.