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Altamirano-Lamarque F, Lim C, Shah AS, Vanderveen DK, Gonzalez E, Oke I. Association of Neighborhood Opportunity With Severity of Retinoblastoma at Presentation. Am J Ophthalmol 2024; 261:1-6. [PMID: 38232897 DOI: 10.1016/j.ajo.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE To examine the relationship between the Child Opportunity Index (COI) and severity of retinoblastoma at presentation. DESIGN Cross-sectional study. METHODS Children (age <18 years) treated for retinoblastoma at a tertiary care center between January 2000 and May 2023 were included. Residential census tract was used to determine the overall and domain-specific COI score for each child. Collected variables included age, sex, race/ethnicity, insurance type, and the International Classification of Retinoblastoma (ICRB) Group at initial examination. The primary outcome was Group D or E retinoblastoma at presentation. Mixed effects regression models were used to estimate the association of COI scores with disease severity at presentation. RESULTS This study included 125 children (51.2% male). Median age at diagnosis was 13 months (IQR, 5-24 months). One hundred nine (87.2%) children presented with Group D or E retinoblastoma and 33 (26.4%) resided in low or very low opportunity neighborhoods. Children residing in neighborhoods with low overall COI scores (OR, 1.62; 95% CI, 1.01-2.58; P = .044) and low education COI scores (OR, 1.77; 95% CI, 1.13-2.79; P = .013) were at increased odds of presenting with ICRB Group D or E retinoblastoma after adjusting for individual-level socioeconomic factors. CONCLUSION Children residing in low opportunity neighborhoods-particularly low education opportunity-more often presented with advanced stage retinoblastoma than children residing in neighborhoods with higher opportunity scores. Efforts to improve preventative vision care and access to eye specialty care for children residing in low-resource areas are needed to reduce existing disparities in retinoblastoma.
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Affiliation(s)
- Francisco Altamirano-Lamarque
- From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caleb Lim
- Boston University School of Medicine (C.L.), Boston, Massachusetts, USA
| | - Ankoor S Shah
- From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah K Vanderveen
- From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Efren Gonzalez
- From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isdin Oke
- From the Department of Ophthalmology (F.A.L., A.S.S., D.K.V., E.G., I.O.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Curran ALK, Stukin J, Ambrosio L, Mantagos IS, Wu C, Vanderveen DK, Hansen RM, Akula JD, Fulton AB. Electroretinographic Responses in Retinopathy of Prematurity Treated Using Intravitreal Bevacizumab or Laser. Am J Ophthalmol 2023; 252:275-285. [PMID: 37146743 PMCID: PMC10524994 DOI: 10.1016/j.ajo.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Intravitreal injection of bevacizumab (IVB) offers advantages over laser photoablation for treatment of type 1 retinopathy of prematurity (ROP). However, retinal function has not, to date, been quantitatively compared following these interventions. Therefore, electroretinography (ERG) was used compare retinal function among eyes treated using IVB or laser, and control eyes. In addition, among the IVB-treated eyes, ERG was used to compare function in individuals in whom subsequent laser was and was not required. DESIGN Prospective clinical cohort study. METHODS ERG was used to record dark- and light-adapted stimulus/response functions in 21 children treated using IVB (12 of whom required subsequent laser in at least 1 eye for persistent avascular retina [PAR]). Sensitivity and amplitude parameters were derived from the a-wave, b-wave, and oscillatory potentials (OPs), representing activity in photoreceptor, postreceptor, and inner retinal cells, respectively. These parameters were then referenced to those of 76 healthy, term-born controls and compared to those of 10 children treated using laser only. RESULTS In children with treated ROP, every ERG parameter was significantly below the mean in controls. However, these significant ERG deficits did not differ between IVB- and laser-treated eyes. Among children treated using IVB, no ERG parameter was significantly associated with dose or need for subsequent laser. CONCLUSION Retinal function was significantly impaired in treated ROP eyes. Function in IVB-treated eyes did not differ from that in laser-treated eyes. Functional differences also did not distinguish those IVB-treated eyes that would subsequently need laser for PAR.
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Affiliation(s)
| | - Justyna Stukin
- Boston Children’s Hospital, Ophthalmology
- Northeastern University, Behavioral Neuroscience
| | - Lucia Ambrosio
- University of Naples Federico II, Department of Neuroscience, Reproductive and Odontostomatological Sciences
- University of Naples Federico II, Department of Public Health
| | - Iason S. Mantagos
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - Carolyn Wu
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | | | - Ronald M. Hansen
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - James D. Akula
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - Anne B. Fulton
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
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Young AK, Vanderveen DK. Controversies in Pediatric Angle Surgery and Secondary Surgical Treatment. Semin Ophthalmol 2023; 38:248-254. [PMID: 36472368 DOI: 10.1080/08820538.2022.2152711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric glaucoma is a constellation of challenging ophthalmic conditions that, left untreated, can result in irreversible vision loss. The mainstay of treatment for primary congenital glaucoma and select secondary glaucoma subtypes is angle surgery, either trabeculotomy or goniotomy. More recently, MIGS devices have been utilized to enhance the efficacy of these procedures. Despite the high success rates of these primary surgical options, refractory cases are challenging to manage. There is no consensus on the next step of treatment following primary angle surgery. Glaucoma drainage devices and trabeculectomies have been the traditional options, with laser treatment reserved for more severe cases. The benefits and disadvantages of each of these options are discussed.
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Affiliation(s)
- Alexander K Young
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
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Bothun ED, Shainberg MJ, Christiansen SP, Vanderveen DK, Neely DE, Kruger SJ, Cotsonis G, Lambert SR. Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study. J AAPOS 2022; 26:174.e1-174.e4. [PMID: 35843488 PMCID: PMC10151123 DOI: 10.1016/j.jaapos.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS). METHODS This study was a secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who had previously been enrolled in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age. RESULTS In the IATS study, 96 of 109 children (88%) developed strabismus through age 10.5 years. Half of the 20 children who were orthophoric at distance through age 5 years maintained orthophoria at distance fixation at 10.5 years. Esotropia was the most common type of strabismus prior to age 5 years (56/109 [51%]), whereas exotropia (49/109 [45%]) was the most common type of strabismus at 10.5 years (esotropia, 21%; isolated hypertropia, 17%). Strabismus surgery had been performed on 52 children (48%), with 18 of these (35%) achieving microtropia <10Δ. Strabismus was equally prevalent in children randomized to contact lens care compared with those randomized to primary intraocular lens implantation (45/54 [83%] vs 45/55 [82%]; P = 0.8). Median visual acuity in the study eye was 0.56 logMAR (20/72) for children with orthotropia or microtropia <10Δ versus 1.30 logMAR (20/400) for strabismus ≥10Δ (P = 0.0003). CONCLUSIONS Strabismus-in particular, exotropia-is common irrespective of aphakia management 10 years following infant monocular cataract surgery. The delayed emergence of exotropia with longer follow-up indicates a need for caution in managing early esotropia in these children. Children with better visual acuity at 10 years of age are more likely to have better ocular alignment.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester Minnesota, University of Minnesota, Minneapolis, Minnesota; Department of Ophthalmology and Visual Sciences, University of Minnesota, Minneapolis, Minnesota.
| | - Marla J Shainberg
- Department of Ophthalmology, University of Tennessee, Memphis, Tennessee
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts; Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Stacey J Kruger
- Department of Ophthalmology, Zucker School of Medicine at Northwell Health, Great Neck, New York
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Palo Alto, California
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Wiecek E, Akula JD, Vanderveen DK, Mantagos IS, Wu C, Curran AL, De Bruyn H, Peterson B, Fulton AB. Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser Photocoagulation. Am J Ophthalmol 2022; 240:252-259. [PMID: 35367438 PMCID: PMC9308642 DOI: 10.1016/j.ajo.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. DESIGN Retrospective clinical cohort study. METHODS We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. RESULTS In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. CONCLUSIONS Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.
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Affiliation(s)
- Emily Wiecek
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA.
| | - James D Akula
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Deborah K Vanderveen
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Iason S Mantagos
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Carolyn Wu
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Amber-Lee Curran
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Hanna De Bruyn
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Bridget Peterson
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Anne B Fulton
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
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6
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Hartnett ME, Wallace DK, Dean TW, Li Z, Boente CS, Dosunmu EO, Freedman SF, Golden RP, Kong L, Prakalapakorn SG, Repka MX, Smith LE, Wang H, Kraker RT, Cotter SA, Holmes JM, Rhodes JE, Rogers DL, Bremer DL, Jordan CO, McGregor ML, Reem RE, Maletic SA, McMillin MC, Tobe Miller R, Bind JE, Leary JA, Mhaskar RM, Stiltner TL, Yang MB, Gray ME, Motley WW, Schwartz TL, Cobb P, Hirsch P, Reed M, Lagory D, Topmiller S, Coats DK, Bhatt AR, Demny AB, Bui VK, Lynds JL, McCartney TP, Vanderveen DK, Mantagos JS, Wu C, Yoon G, Goldstein S, Winter T, Anzaldi R, Smith HA, Haider KM, Hynes EA, Allard M, Head A, Morse D, Siatkowski RM, Collinge JE, Satnes KJ, Blunt MH, Taylor KD, Dries DC, Hoffman RO, Farnsworth KJ, Sorenson S, Austin DS, Beck RW, Boyle NM, Connelly PL, Conner CL, Chandler DL, Donahue Q, Fimbel BP, Henderson RJ, Hercinovic A, Hoepner JE, Kaplon JD, Ortiz G, Robinson JL, Stutz KM, Sutherland DR, Toro DO, Woodard VC, Wu R, Everett DF, Astle WF, Birch EE, Chen AM, Enyedi LB, Erzurum SA, Lambert SR, Lee KA, Manh VA, Manny RE, Silver JL, Weise KK, Verderber LC, Diener-West M, Baker JD, Davis BR, Phelps DL, Poff SW, Saunders RA, Tychsen L, Hartnett ME, Wallace DK, Dean TW, Li Z, Boente CS, Dosunmu EO, Freedman SF, Golden RP, Kong L, Prakalapakorn SG, Repka MX, Smith LE, Wang H, Kraker RT, Cotter SA, Holmes JM. Plasma Levels of Bevacizumab and Vascular Endothelial Growth Factor After Low-Dose Bevacizumab Treatment for Retinopathy of Prematurity in Infants. JAMA Ophthalmol 2022; 140:337-344. [PMID: 35446359 PMCID: PMC8895318 DOI: 10.1001/jamaophthalmol.2022.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Intravitreal bevacizumab effectively treats severe retinopathy of prematurity (ROP), but it enters the bloodstream and may reduce serum vascular endothelial growth factor (VEGF), potentially causing detrimental effects on developing organs in the premature infant. Objective To evaluate the association of intravitreal bevacizumab with plasma bevacizumab and VEGF concentrations at 2 and 4 weeks after predefined, de-escalating doses of intravitreal bevacizumab were administered to infants with severe ROP. Design, Setting, and Participants This phase 1 dose de-escalation case series study was conducted at 10 US hospitals of ophthalmology institutions from May 21, 2015, to May 7, 2019. Blood samples were collected 2 and 4 weeks after intravitreal bevacizumab injection. Participants included 83 premature infants with type 1 ROP in 1 or both eyes and no previous ROP treatment. Data were analyzed from April 2017 to August 2021. Interventions Study eyes received a single bevacizumab injection of 0.250 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg. When the fellow eye required treatment, one dose higher was administered. Total dose administered at baseline was defined as the sum of doses given to each eye within 3 days of initial study-eye injection. Main Outcomes and Measures Plasma bevacizumab concentration at 2 and 4 weeks after injection and the percentage change in plasma VEGF concentrations from pretreatment levels. Results A total of 83 infants (mean [SD] age, 25 [2] weeks; 48 boys [58%]) were included in this study. Higher doses of bevacizumab administered at baseline were associated with higher plasma bevacizumab concentrations at 2 weeks (ρ, 0.53; 95% CI, 0.31-0.70) and 4 weeks (ρ, 0.44; 95% CI, 0.18-0.64). Plasma VEGF concentrations decreased by 50% or more from pretreatment levels in 40 of 66 infants (61%) at 2 weeks and 31 of 61 infants (51%) at 4 weeks, but no association was observed between the total dose of bevacizumab administered at baseline and percentage change in plasma VEGF concentrations 2 weeks (ρ, -0.04; 95% CI, -0.28 to 0.20) or 4 weeks (ρ, -0.17; 95% CI, -0.41 to 0.08) after injection. Conclusions and Relevance Results of this phase 1 dose de-escalation case series study revealed that bevacizumab doses as low as 0.002 mg were associated with reduced plasma VEGF levels for most infants at 2 and 4 weeks after intravitreal administration; however, no association was observed between total bevacizumab dose administered and reductions in plasma VEGF levels from preinjection to 2 weeks or 4 weeks. Additional studies are needed to evaluate the long-term effects of low-dose bevacizumab on neurodevelopment and retinal structure.
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Affiliation(s)
| | | | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Eniolami O Dosunmu
- Cincinnati Children's Hospital Medical Center, Abrahamson Pediatric Eye Institute, Cincinnati, Ohio.,Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Lingkun Kong
- Texas Tech University Health Science Center, Lubbock
| | | | | | - Lois E Smith
- Boston Children's Hospital, Boston, Massachusetts
| | - Haibo Wang
- John A. Moran Eye Center, Salt Lake City, Utah
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson
| | - James E. Rhodes
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David L. Rogers
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Don L. Bremer
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Rachel E. Reem
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Sara Ann Maletic
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Jill E. Bind
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Julie A. Leary
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Michael B. Yang
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Michael E. Gray
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Patricia Cobb
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Patricia Hirsch
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Melissa Reed
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Denise Lagory
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Steven Topmiller
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David K. Coats
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Amit R. Bhatt
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Ann B. Demny
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Vanessa K. Bui
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | | | - Carolyn Wu
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Grace Yoon
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Tamar Winter
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Rocco Anzaldi
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Heather A. Smith
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Melissa Allard
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Annette Head
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David Morse
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Kelli J. Satnes
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Kaci D. Taylor
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - David C. Dries
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | - Susan Sorenson
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Roy W. Beck
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Nicole M. Boyle
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - Quayleen Donahue
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Brooke P. Fimbel
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Amra Hercinovic
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - James E. Hoepner
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Joseph D. Kaplon
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Gillaine Ortiz
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - David O. Toro
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Rui Wu
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - William F. Astle
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Eileen E. Birch
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Angela M. Chen
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Laura B. Enyedi
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - S. Ayse Erzurum
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Scott R. Lambert
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Katherine A. Lee
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Vivian A. Manh
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Ruth E. Manny
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Jayne L. Silver
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - John D. Baker
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Barry R. Davis
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Dale L. Phelps
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | - Stephen W. Poff
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | - Lawrence Tychsen
- Writing Committee for the Pediatric Eye Disease Investigator Group
| | | | | | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Eniolami O. Dosunmu
- Cincinnati Children’s Hospital Medical Center, Abrahamson Pediatric Eye Institute, Cincinnati, Ohio
- Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Lingkun Kong
- Texas Tech University Health Science Center, Lubbock
| | | | | | | | - Haibo Wang
- John A. Moran Eye Center, Salt Lake City, Utah
| | | | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson
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7
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Freedman SF, Beck AD, Nizam A, Vanderveen DK, Plager DA, Morrison DG, Drews-Botsch CD, Lambert SR. Glaucoma-Related Adverse Events at 10 Years in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:165-173. [PMID: 33331850 DOI: 10.1001/jamaophthalmol.2020.5664] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Glaucoma-related adverse events constitute serious complications of cataract removal in infancy, yet long-term data on incidence and visual outcome remain lacking. Objective To identify and characterize incident cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of 10.5 years and to determine whether these diagnoses are associated with optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) assessment. Design, Setting, and Participants Analysis of a multicenter randomized clinical trial of 114 infants with unilateral congenital cataract who were aged 1 to 6 months at surgery. Data on long-term glaucoma-related status and outcomes were collected when children were 10.5 years old (July 14, 2015, to July 12, 2019) and analyzed from March 30, 2019, to August 6, 2019. Interventions Participants were randomized at cataract surgery to either primary intraocular lens (IOL), or aphakia (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis. Main Outcomes and Measures Development of glaucoma and glaucoma + glaucoma suspect in operated-on eyes up to age 10.5 years, plus intraocular pressure, axial length, RNFL (by optical coherence tomography), and ONH photographs. Results In Kaplan-Meier analysis, for all study eyes combined (n = 114), risk of glaucoma after cataract removal rose from 9% (95% CI, 5%-16%) at 1 year, to 17% (95% CI, 11%-25%) at 5 years, to 22% (95% CI, 16%-31%) at 10 years. The risk of glaucoma plus glaucoma suspect diagnosis after cataract removal rose from 12% (95% CI, 7%-20%) at 1 year, to 31% (95% CI, 24%-41%) at 5 years, to 40% (95% CI, 32%-50%) at 10 years. Risk of glaucoma and glaucoma plus glaucoma suspect diagnosis at 10 years was not significantly different between treatment groups. Eyes with glaucoma (compared with eyes with glaucoma suspect or neither) had longer axial length but relatively preserved RNFL and similar ONH appearance and visual acuity at age 10 years. Conclusions and Relevance Risk of glaucoma-related adverse events continues to increase with longer follow-up of children following unilateral cataract removal in infancy and is not associated with primary IOL implantation. Development of glaucoma (or glaucoma suspect) after removal of unilateral congenital cataract was not associated with worse visual acuity outcomes at 10 years. Trial Registration ClinicalTrials.gov Identifier: NCT00212134.
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Affiliation(s)
- Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Allen D Beck
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | | | - David A Plager
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - David G Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn D Drews-Botsch
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Mantagos IS, Wu C, Griffith JF, Jastrzembski BG, Gonzalez E, Goldstein S, Pearlo L, Vanderveen DK. Retinopathy of prematurity screening and risk mitigation during the COVID-19 pandemic. J AAPOS 2021; 25:91.e1-91.e5. [PMID: 33882352 PMCID: PMC8053364 DOI: 10.1016/j.jaapos.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted the delivery of healthcare. Although most nonurgent ophthalmology visits at Boston Children's Hospital were canceled, premature infants at risk for retinopathy of prematurity (ROP) still required timely, in-person care during the initial 3-month period of the infection surge in Massachusetts. The purpose of the current study was to report our protocols for mitigating risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between infants and eye care providers and to compare examination rates and results with the same 3-month period in 2019. METHODS During the infection surge, we added new infection control measures and strengthened existing ones. Additional personal protective equipment was used, and the number of ophthalmologists rotating in the three high-capacity NICUs we service was limited. RESULTS More infants required ROP examinations during the study period in 2020 than in the same period in 2019, but fewer examinations were performed. There were no cases of missed progression to severe ROP during this time and no known transmission of SARS-CoV-2 between ROP patients and ophthalmology staff. CONCLUSIONS Overall, effective ROP care was safely provided during the COVID-19 pandemic, and contact with this vulnerable population was minimized.
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Affiliation(s)
- Iason S Mantagos
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Carolyn Wu
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Joseph F Griffith
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Benjamin G Jastrzembski
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Efren Gonzalez
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Lori Pearlo
- Boston Children's Hospital, Boston, Massachusetts
| | - Deborah K Vanderveen
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Bothun ED, Wilson ME, Yen KG, Anderson JS, Weil NC, Loh AR, Morrison D, Freedman SF, Plager DA, Vanderveen DK, Traboulsi EI, Hodge DO, Lambert SR. Outcomes of Bilateral Cataract Surgery in Infants 7 to 24 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry. Ophthalmology 2020; 128:302-308. [PMID: 32679160 DOI: 10.1016/j.ophtha.2020.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate outcomes of bilateral cataract surgery in children aged 7 to 24 months and compare rates of adverse events (AEs) with other Toddler Aphakia and Pseudophakia Study (TAPS) registry outcomes. DESIGN Retrospective clinical study at 10 Infant Aphakia Treatment Study (IATS) sites. Statistical analyses comparing this cohort with previously reported TAPS registry cohorts. PARTICIPANTS Children enrolled in the TAPS registry between 2004 and 2010. METHODS Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement at age 7 to 24 months with 5 years of postsurgical follow-up. MAIN OUTCOME MEASURES Visual acuity (VA), occurrence of strabismus, AEs, and reoperations. RESULTS A total of 40 children (76 eyes) who underwent bilateral cataract surgery with primary posterior capsulectomy were identified with a median age at cataract surgery of 11 months (7-23); 68% received a primary IOL. Recurrent visual axis opacification (VAO) occurred in 7.5% and was associated only with the use of an IOL (odds ratio, 6.10; P = 0.005). Glaucoma suspect (GS) was diagnosed in 2.5%, but no child developed glaucoma. In this bilateral cohort, AEs (8/40, 20%), including glaucoma or GS and VAO, and reoperations occurred in a similar proportion to that of the published unilateral TAPS cohort. When analyzed with children aged 1 to 7 months at bilateral surgery, the incidence of AEs and glaucoma or GS correlated strongly with age at surgery (P = 0.011/0.004) and glaucoma correlated with microcornea (P = 0.040) but not with IOL insertion (P = 0.15). CONCLUSIONS Follow-up to age 5 years after bilateral cataract surgery in children aged 7 to 24 months reveals a low rate of VAO and very rare glaucoma or GS diagnosis compared with infants with cataracts operated at < 7 months of age despite primary IOL implantation in most children in the group aged 7 to 24 months. The use of an IOL increases the risk of VAO irrespective of age at surgery.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology and Visual Neurosciences, Minneapolis, University of Minnesota, Minnesota.
| | - M Edward Wilson
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Kimberly G Yen
- Departments of Ophthalmology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Jill S Anderson
- Department of Ophthalmology and Visual Neurosciences, Minneapolis, University of Minnesota, Minnesota
| | - Natalie C Weil
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Allison R Loh
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - David Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon F Freedman
- Departments of Ophthalmology and Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - David A Plager
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana
| | | | - Elias I Traboulsi
- Department of Pediatric Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - David O Hodge
- Department Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Scott R Lambert
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Departments of Ophthalmology and Pediatrics, Stanford University Medical Center, Palo Alto, California
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Lambert SR, Vanderveen DK, Kim SJ. Reply. Ophthalmology 2020; 127:e6-e7. [DOI: 10.1016/j.ophtha.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022] Open
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Bothun ED, Wilson ME, Vanderveen DK, Plager DA, Freedman SF, Trivedi RH, Traboulsi EI, Anderson JS, Loh AR, Yen KG, Weil NC, Morrison D, Lambert SR. Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry. Ophthalmology 2019; 127:501-510. [PMID: 31987642 DOI: 10.1016/j.ophtha.2019.10.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes. DESIGN Retrospective case series review at 10 IATS sites. PARTICIPANTS The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. METHODS Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010. MAIN OUTCOME MEASURES Visual acuity (VA), strabismus, adverse events (AEs), and reoperations. RESULTS One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%). CONCLUSIONS Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.
| | - M Edward Wilson
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | | - David A Plager
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, Indiana
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Rupal H Trivedi
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Elias I Traboulsi
- Department of Pediatric Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jill S Anderson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Allison R Loh
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Kimberly G Yen
- Departments of Ophthalmology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Natalie C Weil
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - David Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott R Lambert
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Departments of Ophthalmology and Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Bothun ED, Wilson ME, Traboulsi EI, Diehl NN, Plager DA, Vanderveen DK, Freedman SF, Yen KG, Weil NC, Loh AR, Morrison D, Anderson JS, Lambert SR, Lambert S, Hutchinson A, Christiansen S, Bothun E, Wilson E, Traboulsi E, Plager D, Neely D, Vanderveen D, Buckley E, Freedman S, Wallace D, Yen K, Wheeler D, Morrison D. Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age. Ophthalmology 2019; 126:1189-1195. [DOI: 10.1016/j.ophtha.2019.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 01/22/2023] Open
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13
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Kruger SJ, Vanderveen DK, Freedman SF, Bothun E, Drews-Botsch CD, Lambert SR. Third-Party Coverage for Aphakic Contact Lenses for Children. Transl Vis Sci Technol 2019; 8:41. [PMID: 31231593 PMCID: PMC6574195 DOI: 10.1167/tvst.8.3.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stacey J Kruger
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | | | | | - Erick Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | - Scott R Lambert
- Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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Bothun ED, Lynn MJ, Christiansen SP, Kruger SJ, Vanderveen DK, Neely DE, Lambert SR. Strabismus surgery outcomes in the Infant Aphakia Treatment Study (IATS) at age 5 years. J AAPOS 2016; 20:501-505. [PMID: 27815186 PMCID: PMC5344799 DOI: 10.1016/j.jaapos.2016.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To report strabismus surgery frequency and outcomes after monocular infantile cataract surgery with or without IOL implantation. METHODS The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. This report is a secondary outcome analysis of ocular motor data from IATS patients who underwent strabismus surgery prior to age 5 years. RESULTS Strabismus surgery was performed in 45 (39%) patients (contact lens group [CL], 37%; IOL group, 42% [P = 0.70]). The indications for strabismus surgery were esotropia (62%), exotropia (33%), and hypertropia (4%). Infants who underwent cataract surgery at a younger age were less likely to undergo strabismus surgery (28-48 days, 12/50 [24%]; 49-210 days, 33/64 [52%]; P = 0.0037). Of the 42 patients who underwent strabismus surgery, 14 (33%) had a postoperative distance alignment within 8Δ of orthotropia at age 5 years. The 5-year visual acuity of children with strabismus was the same whether or not strabismus surgery had been performed (1.10 logMAR with surgery vs 1.00 without [P = 0.71]). CONCLUSIONS In this study cohort, cataract surgery performed in the first 6 weeks of life was associated with a reduced frequency of strabismus surgery. Strabismus surgery outcomes in this population are guarded. Surgical improvement of strabismus does not appear to influence long-term visual acuity.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Dan E Neely
- Department of Ophthalmology, Indiana University, Indianapolis
| | - Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, Georgia; Department of Ophthalmology, Standford University School of Medicine, Stanford, California
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15
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Bothun ED, Lynn MJ, Christiansen SP, Neely DE, Vanderveen DK, Kruger SJ, Lambert SR. Sensorimotor outcomes by age 5 years after monocular cataract surgery in the Infant Aphakia Treatment Study (IATS). J AAPOS 2016; 20:49-53. [PMID: 26917072 PMCID: PMC4869943 DOI: 10.1016/j.jaapos.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate sensorimotor outcomes among children in the Infant Aphakia Treatment Study (IATS). METHODS Secondary outcome analysis was performed in this randomized, multicenter, clinical trial comparing treatment of unilateral aphakia with a primary intraocular lens (IOL) or contact lens (CL) correction. The alignment characteristics and sensory status of children through age 5 years were evaluated. RESULTS In the IATS study, 91 of 112 children (81%) developed strabismus through age 5 years. Of 34 infants who were orthotropic at near 12 months after cataract surgery, at age 5 years 14 (41%) were orthotropic at distance, and 15 (44%) were orthotropic at near at age 5 years without strabismus surgery. Eight of 56 children (14%) in the CL group and 13 of 56 (23%) in the IOL group were orthotropic at distance (P = 0.33) at 5 years of age and had no history of strabismus surgery. Thirteen of 48 (27%) who underwent cataract surgery prior to 49 days of age compared to 8 of 64 (13%) who had surgery after 49 days were orthotropic (P = 0.085). Median visual acuity in the operative eye was 0.4 logMAR (20/50) for children with orthotropia or microtropia (<10(Δ)) versus 1.10 logMAR (20/252) for strabismus ≥10(Δ) (P = 0.0001). Stereopsis was detected in 12 of 21 children (57%) with orthotropia versus 16 of 89 (18%) children with strabismus (P = 0.0006). CONCLUSIONS IOL placement does not reduce the development of strabismus after monocular congenital cataract surgery. Improved ocular alignment by age 5 years correlated strongly with improved visual acuity and stereopsis.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Michael J Lynn
- Department of Biostatistics and Bioinformations, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Dan E Neely
- Department of Ophthalmology, Indiana University, Indianapolis, Indiana
| | | | | | - Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, Georgia
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Abstract
PURPOSE Cataract surgery in young children poses different challenges and potential complications compared to those encountered in adult populations. We performed a literature review of the complications of pediatric cataract surgery. METHODS Literature review of complications of pediatric cataract surgery. RESULTS Complications in children vary based on the age of the patient at surgery and the cause of the cataract. Common events discussed include increased inflammatory response, opacification of the posterior capsule, lens reproliferation, pupillary membrane, and amblyopia; less common events include infections, significant bleeding, and retinal detachment. CONCLUSION Complications after cataract surgery in children are often associated with a robust inflammatory reaction or secondary opacity and, in infants, glaucoma. Late complications can occur decades later, so that long-term follow-up is required. Though surgery carries significant risks, the consequences of no surgery and irreversible deprivation amblyopia in very young children should be considered.
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Affiliation(s)
- Mary C Whitman
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School , Boston, Massachusetts , USA
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17
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Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Lambert SR, DuBois L, Lambert SR, Buckley EG, Plager DA, Wilson ME, Lynn M, DuBois L, Drews-Botsch C, Hartmann EE, Everett DF, Russell B, Ward M, Hardy R, Birch E, Cheng K, Hertle R, Kollman C, Yeargin-Allsopp M, McDowell C, Everett DF, Lynn M, Bridgman B, Celano M, Cleveland J, Cotsonis G, Drews-Botsch C, Freret N, Lu L, Swanson S, Tutu-Gxashe T, Busettini C, Hayley S, Felius J, Beck A, Everett DF, Hartmann EE, Carrigan AK, Edwards C, Wilson ME, Bozic M, Vanderveen DK, Mansfield TA, Miller KB, Christiansen SP, Bothun ED, Holleschau A, Jedlicka J, Winters P, Lang J, Traboulsi EI, Crowe S, Cimino HH, Yen KG, Castanes M, Sanchez A, York S, Lambert SR, Hutchinson AK, Dubois L, Robb R, Shainberg MJ, Wheeler DT, Stout AU, Rauch P, Beaudet K, Berg P, Buckley EG, Freedman SF, Duncan L, Phillips B, Petrowski JT, Morrison D, Owings S, Biernacki R, Franklin C, Plager DA, Neely DE, Whitaker M, Bates D, Donaldson D, Kruger S, Tibi C, Vega S, Weakley DR, Stager DR, Felius J, Dias C, Sager DL, Brantley T, Orge F. Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study. Am J Ophthalmol 2014; 158:892-8. [PMID: 25077835 DOI: 10.1016/j.ajo.2014.07.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN Prospective randomized clinical trial. METHODS A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.
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Orbach DB, Vanderveen DK, Shah AS, Rodriguez-Galindo C. Blue toe syndrome: a complication of intra-arterial technique, not intra-arterial chemotherapy for retinoblastoma. JAMA Ophthalmol 2014; 132:654. [PMID: 24810697 DOI: 10.1001/jamaophthalmol.2013.6342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deborah K Vanderveen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Rodriguez-Galindo
- Division of Hematology-Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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Yonekawa Y, Vanderveen DK, Shah AS. Congenital glaucoma. J Pediatr 2013; 163:301. [PMID: 23498156 DOI: 10.1016/j.jpeds.2013.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshihiro Yonekawa
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Ramasubramanian A, Mantagos I, Vanderveen DK. Corneal endothelial cell characteristics after pediatric cataract surgery. J Pediatr Ophthalmol Strabismus 2013; 50:251-4. [PMID: 23758274 DOI: 10.3928/01913913-20130604-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 04/09/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the corneal endothelial cell characteristics after pediatric cataract surgery. METHODS Retrospective case series of 29 study eyes and 26 controls were evaluable. Specular microscopy was performed and endothelial cell features were correlated with clinical and surgical features. RESULTS Mean age at testing was 106 months in the study group and 116 months in the control group with a mean interval of 78 months after cataract surgery. Mean endothelial cell density in study eyes was 2,668 cells/mm(2) (control eyes, 3,002 cells/mm(2), P < .01). Mean coefficient of variation was 35% (control eyes, 31%, P < .01), and mean percentage of hexagonal cells was 40% (control eyes, 51%, P < .01). There was no significant difference based on age, duration since cataract surgery, contact lens use, glaucoma, number of intraocular procedures, or presence of intraocular lens. CONCLUSIONS This study demonstrates endothelial cell loss with polymegathism and pleomorphism in children undergoing cataract surgery. This poses a risk of developing long-term corneal complications and hence close monitoring of the endothelial cell count is advisable.
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Bothun ED, Cleveland J, Lynn MJ, Christiansen SP, Vanderveen DK, Neely DE, Kruger SJ, Lambert SR. One-year strabismus outcomes in the Infant Aphakia Treatment Study. Ophthalmology 2013; 120:1227-31. [PMID: 23419803 DOI: 10.1016/j.ophtha.2012.11.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation. DESIGN Secondary outcome analysis in a prospective, randomized clinical trial. PARTICIPANTS The Infant Aphakia Treatment Study is a randomized, multicenter (n = 12), clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. INTERVENTION Infants underwent cataract surgery with or without placement of an IOL. MAIN OUTCOME MEASURES The proportion of patients in whom strabismus developed during the first 12 months of follow-up was calculated using the life-table method and was compared across treatment groups and age strata using a log-rank test. RESULTS Strabismus developed within the first 12 months of follow-up in 38 pseudophakic infants (life-table estimate, 66.7%) and 42 infants (life-table estimate, 74.5%) treated with contact lenses (P = 0.59). The younger cohort (<49 days) at the time of surgery demonstrated less strabismus (29 of 50; life-table estimate, 58.0%) than the older cohort (≥ 49 days; 51 of 64; life-table estimate, 80.0%; P<0.01). CONCLUSIONS Intraocular lens placement does not prevent the early development of strabismus after congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Erick D Bothun
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Nihalani BR, Vanderveen DK. Accuracy of intraocular lens power calculation formulae in children less than two years. Am J Ophthalmol 2012; 154:759-60; author reply 760. [PMID: 22995562 DOI: 10.1016/j.ajo.2012.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 06/04/2012] [Accepted: 06/18/2012] [Indexed: 11/17/2022]
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Abstract
PURPOSE To describe our technique for secondary intraocular lens (IOL) implantation in aphakic children and report patient outcomes. PATIENTS AND METHODS In our technique for in-the-bag IOL implantion, we used a microvitreoretinal (MVR) blade to separate the capsular leaflets for aspiration of reproliferated lens material within Soemmering's ring. When sufficient capsular opening was not possible or capsular support deemed inadequate, an IOL was implanted in the sulcus. Records of patients with secondary IOL implantation between 1999 and 2009 were retrospectively reviewed with regard to intra- and postoperative complications and visual and refractive outcomes. RESULTS A total of 50 consecutive eyes of 32 patients were evaluated. Mean age at secondary IOL implantation was 9.1 years. Of these, 26 eyes had in-the-bag IOLs and 24 had sulcus IOLs. Forty-four eyes (88%) had an AcrySof IOL (Alcon Inc, Ft. Worth, TX). The prevalence of any corneal edema (54% vs 19%, P = 0.04) and uveal inflammation >2+ (92% vs 31%, P < 0.05) in immediate postoperative period was greater with sulcus IOL than in-the-bag placement. Late inflammation at 6 months developed in 1 eye, and glaucoma developed in 2 eyes with sulcus IOLs. All eyes maintained or gained lines of best-corrected visual acuity. Mean absolute prediction error was 0.9 ± 0.9 with no significant difference between in-the-bag and sulcus placement. CONCLUSIONS Eyes achieving secondary in-the-bag IOL showed less inflammation and corneal edema in the early postoperative period partly as the result of greater surgical and anatomic challenges in some eyes receiving sulcus IOL. Visual and refractive outcomes were satisfactory in eyes with secondary IOL implantation. Mean prediction error was similar for in-the-bag and sulcus IOLs.
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Hauspurg AK, Allred EN, Vanderveen DK, Chen M, Bednarek FJ, Cole C, Ehrenkranz RA, Leviton A, Dammann O. Blood gases and retinopathy of prematurity: the ELGAN Study. Neonatology 2011; 99:104-11. [PMID: 20689332 PMCID: PMC2939988 DOI: 10.1159/000308454] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 03/24/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study tested the hypothesis that preterm infants who had a blood gas derangement on at least 2 of the first 3 postnatal days are at increased risk for more severe retinopathy of prematurity (ROP). METHOD 1,042 infants born before 28 weeks' gestational age (GA) were included. An infant was considered to be exposed if his/her blood gas measure was in the highest or lowest quartile for GA on at least 2 of the first 3 postnatal days. RESULTS Multivariable models adjusting for confounders indicate that exposure to a PCO(2) in the highest quartile predicts ROP (stage 3, 4 or 5: OR = 1.6, 95% CI = 1.1-2.3); zone 1: 2.0, 1.1-3.6; prethreshold/threshold: 1.9, 1.2-3.0; plus disease: 1.8, 1.1-2.9). Estimates are similar for a low pH for zone 1 (2.1, 1.2-3.8), prethreshold/threshold (1.8, 1.1-2.8), but did not quite achieve statistical significance for ROP stage 3, 4, or 5 (1.4, 0.9-2.0) and plus disease (1.5, 0.9-2.4). A PaO(2) in the highest quartile for GA on at least 2 of the first 3 postnatal days was associated with a doubling of the risk of ROP in zone 1 (2.5, 1.4-4.4) and of prethreshold/threshold disease (2.1, 1.4-3.3), a 70% risk increase for plus disease (1.7, 1.04-2.8), while a 40% risk increase for ROP stage 3 or higher did not achieve statistical significance (1.4, 0.96-2.0). CONCLUSION Infants exposed to high PCO(2), low pH and high PaO(2) appear to be at increased risk of more severe ROP.
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Wu C, Vanderveen DK, Hellström A, Löfqvist C, Smith LEH. Longitudinal postnatal weight measurements for the prediction of retinopathy of prematurity. Arch Ophthalmol 2010; 128:443-7. [PMID: 20385939 PMCID: PMC4393744 DOI: 10.1001/archophthalmol.2010.31] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To validate longitudinal postnatal weight gain as a method for predicting severe retinopathy of prematurity (ROP) in a US cohort. METHODS Both ROP evaluations and weekly weight measurements from birth to postmenstrual week 36 for 318 infants were entered into a computer-based surveillance system, WINROP. This system signaled an alarm when the rate of weight gain decreased compared with control subjects. Infants were classified into 3 groups: (1) no alarm, (2) low-risk alarm, or (3) high-risk alarm. Maximum ROP for each infant was categorized as (1) no ROP (immature or mature vascularization), (2) mild ROP (stage 1 or 2 ROP in zone II or III, without plus disease), or (3) severe ROP (any prethreshold, any stage 3, or threshold ROP). A high-risk alarm identified infants at risk for developing severe ROP. RESULTS A high-risk alarm occurred in 81 infants (25.5%) and detected all infants who developed severe ROP a median of 9 weeks before diagnosis. The remaining infants received no alarm or a low-risk alarm. None of these infants developed more than mild ROP. CONCLUSIONS Longitudinal postnatal weight gain may help predict ROP. In a US cohort, the WINROP system had a sensitivity of 100% and identified infants early who developed severe ROP. With further validation, WINROP has the potential to safely reduce the number of ROP examinations.
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Affiliation(s)
- Carolyn Wu
- Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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Abstract
Retinopathy or prematurity (ROP) is a leading cause of potentially preventable blindness in children. With increased survival of infants born at earlier gestational ages the number of infants at risk from vision loss from ROP has increased. Current treatments consist of close monitoring of oxygen saturation levels, peripheral retinal ablation by cryotherapy or laser photocoagulation, and vitreoretinal surgery. Research in the area of angiogenesis has lead to numerous breakthroughs. Emerging treatments for ROP are targeting the Vascular Endothelial Growth Factor (VEGF) and Insulin-Like Growth Factor 1 (IGF-1) pathways, as well as dietary supplementation with omega-3-polyunsaturated fatty acids.
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Affiliation(s)
- Iason S Mantagos
- Department of Ophthalmology, Children's Hospital Boston, Boston, MA 02115, USA
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Vanderveen DK, Nihalani BR, Barron P, Anderson RL. Optic nerve sheath fenestration for an isolated optic nerve glioma. J AAPOS 2009; 13:88-90. [PMID: 18930671 DOI: 10.1016/j.jaapos.2008.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 06/17/2008] [Accepted: 07/02/2008] [Indexed: 11/27/2022]
Abstract
The treatment modalities for neurofibromatosis type 1-associated optic gliomas include chemotherapy, radiation therapy, and surgical excision. The current recommendation is to consider treatment for an optic nerve glioma only if there is clear evidence of either ophthalmologic or radiographic progression with significant visual dysfunction. We report a case of a child with neurofibromatosis type 1 and an isolated optic nerve glioma with documented progression and visual loss in which clinical signs improved and visual deterioration stabilized after optic nerve sheath fenestration.
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Vanderveen DK. Cataract update 2008: all you need to know about your pediatric cataract patients. Binocul Vis Strabismus Q 2008; 23:145-158. [PMID: 18811588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Deborah K Vanderveen
- Department of Ophthalmology, Harvard Medical School, Children's Hospital Boston, Boston, MA 02115, USA.
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Vanderveen DK, Mansfield TA, Eichenwald EC. Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity. J AAPOS 2006; 10:445-8. [PMID: 17070480 DOI: 10.1016/j.jaapos.2006.04.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 04/24/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether lowering oxygen saturation alarm limits for infants at risk for retinopathy of prematurity (ROP) reduces its incidence and/or severity. METHODS Oximetry alarm limits were lowered to 85% and 93% for all infants with a birth weight 1250 g or less and/or gestational age 28 weeks or less, and maintained until 32 weeks' postmenstrual age or until oxygen saturations were consistently greater than 93% in room air. The new policy was effective for infants born on or after June 1, 2003. ROP data were prospectively collected, and we compared the rate and severity of ROP in the year after the oximeter alarm policy change to the rates in the immediately preceding 3 years. RESULTS In the year after the oximeter alarm limit policy change, 4 of 72 infants developed prethreshold ROP compared with 44 of 251 infants in the previous 3-year epoch (17.5% vs 5.6%, p=0.01). Similarly, only 6 of 144 eyes developed prethreshold ROP in the year after the policy change, compared with 84 of 502 in the previous 3 years (16.7% vs 4.2%, p=0.001). CONCLUSIONS A simple change in oximeter alarm parameters in the first weeks of life for infants with a birth weight 1250 g or less may decrease the incidence of prethreshold ROP.
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Affiliation(s)
- Deborah K Vanderveen
- Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Gelman R, Martinez-Perez ME, Vanderveen DK, Moskowitz A, Fulton AB. Diagnosis of plus disease in retinopathy of prematurity using Retinal Image multiScale Analysis. Invest Ophthalmol Vis Sci 2006; 46:4734-8. [PMID: 16303973 PMCID: PMC1418825 DOI: 10.1167/iovs.05-0646] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate a semiautomated image analysis software package, Retinal Image multiScale Analysis (RISA), for the diagnosis of plus disease in preterm infants with retinopathy of prematurity (ROP). METHODS Digital images of the posterior pole showing both disc and macula in preterm infants with ROP were analyzed with an enhanced version of RISA. Venules (N = 106) and arterioles (N = 44) were identified, and integrated curvature, diameter, and tortuosity of the vessels were calculated. After the RISA calculations were completed, the origins of the vessels were determined to be 32 eyes in 16 infants (12 eyes with plus disease, 20 with no plus disease, as diagnosed by ophthalmic examination). Vessels were sorted into two groups-plus disease and no plus disease-and each RISA parameter was compared using the Mann-Whitney test. For each parameter, sensitivity and specificity were plotted as a function of cutoff criterion, receiver operating characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated. RESULTS For both arterioles and venules, each of the three parameters was significantly larger for the plus disease group. For instance, the median estimated arteriolar and venular diameters were approximately 12 mum greater in plus disease. Sensitivity and specificity plots indicated good accuracy of each parameter for the diagnosis of plus disease. The AUC showed that curvature had the highest diagnostic accuracy (0.911 for arterioles, 0.824 for venules). CONCLUSIONS The strong performance of RISA parameters in this sample suggests that RISA may be useful for diagnosing plus disease in preterm infants with ROP.
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Affiliation(s)
- Rony Gelman
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - M. Elena Martinez-Perez
- Department of Computer Science, Institute of Research in Applied Mathematics and Systems, Universidad Nacional Autonoma de Mexico, Circuito Escolar Ciudad Universitaria, Cuidad, Mexico
| | - Deborah K. Vanderveen
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne Moskowitz
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne B. Fulton
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
BACKGROUND Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endoscopic DCR has been successfully performed in adults and described in children. We report the success of this procedure in a series of pediatric patients. METHODS A retrospective review of all endoscopic lacrimal procedures performed in a 3-year period was undertaken. Seventeen children (22 ducts) with persistent NLDO after at least one failed probing, with or without silicone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 36 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history. RESULTS All but 2 patients (88%) with NLDO showed complete resolution of tearing and discharge. These 2 patients had recurrent symptoms after the Crawford tubes were removed and required revision endoscopic DCR. No complications from this procedure were noted. CONCLUSIONS Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple probing, intubation, or balloon procedures have failed. The team ophthalmology-otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise require an external procedure.
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Affiliation(s)
- D K Vanderveen
- Department of Ophthalmology, Children's Hospital, Boston, Massachusetts, USA.
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Fulton AB, Hansen RM, Petersen RA, Vanderveen DK. The rod photoreceptors in retinopathy of prematurity: an electroretinographic study. Arch Ophthalmol 2001; 119:499-505. [PMID: 11296015 DOI: 10.1001/archopht.119.4.499] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test the hypothesis that the more severe the acute phase retinopathy of prematurity (ROP) was in the preterm weeks, the more severely compromised is rod photoreceptor function after the ROP has resolved. METHODS Electroretinographic (ERG) responses were recorded from 25 dark-adapted children (ages 2.5 months' postterm to 14 years) categorized by maximum, acute phase ROP (None to Very Severe). From the ERG a-wave "S," a sensitivity parameter for the rod photoreceptor response, and R(mp3), the saturated amplitude of the rod photoreceptor response were calculated using a model of the activation of rod phototransduction. The patients' results were compared with those of healthy controls (n = 71). RESULTS Among those in the None, Mild, Moderate, and Severe categories, both S and R(mp3) varied significantly with severity of acute phase ROP. In the Very Severe category, ERG responses were too attenuated to calculate S and R(mp3). CONCLUSIONS The rod photoreceptors must be involved in ROP. The more severe the acute phase ROP, the more severe is the compromise of the processes involved in the activation of phototransduction in the rods.
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Affiliation(s)
- A B Fulton
- Department of Ophthalmology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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