Journal Of AAPOS[JOURNAL]
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200 papers
Revisiting retinopathy of prematurity screening criteria to safely reduce infant stress and provider burden at an academic neonatal intensive care unit: a proof-of-concept study.
Donaldson RA, Freedman SF, Pittman CR … +3 more , Stinnett SS, Cotten CM, Prakalapakorn SG
J AAPOS · 2026 Jun · PMID 41881243 · Publisher ↗
BACKGROUND: Current United States retinopathy of prematurity (ROP) screening guidelines may be overly broad at the cost of undue preterm infant stress and physician workload. Our proof-of-concept study aimed to optimize...
BACKGROUND: Current United States retinopathy of prematurity (ROP) screening guidelines may be overly broad at the cost of undue preterm infant stress and physician workload. Our proof-of-concept study aimed to optimize screening criteria at our institution simply by modifying gestational age (GA) and birth weight (BW) cutoffs to examine the fewest number of infants while including all who developed stage ≥3 and/or treatment-requiring ROP (ie, "must-screen" infants). METHODS: We conducted a retrospective chart review of all infants who began ROP screening at our institution from January 21, 2014 through December 31, 2023. We collected GA, BW, highest ROP stage, and ROP treatment status, noting postmenstrual age (PMA) at first treatment. Using an iterative process, varying GA and BW cutoffs, we determined "optimized" screening criteria that minimized the number of infants examined without excluding any must-screen infants. RESULTS: Of 1,274 infants examined for ROP, 206 (16.2%) must-screen infants developed stage 3 ROP without treatment (n = 49) and/or were treated (n = 157), with maximum GA of 29.0 weeks, maximum BW of 1,360 g, and minimum PMA at first treatment of 31 weeks and 6 days. Using an iterative process, optimized screening criteria included infants with GA of ≤29.0 weeks OR BW of ≤600 g, allowing 327 infants (25.7%) to forego ROP examinations without excluding any who developed stage ≥3 or treatment-requiring ROP. CONCLUSIONS: At our institution, applying optimized screening criteria with reduced GA and BW cutoffs could have safely reduced the number of infants examined by 25.7%. This result suggests that revision of current US ROP screening guidelines is reasonable and may help optimize screening efficiency without excluding high-risk infants.
A sustained-release intracanalicular dexamethasone insert for treating ocular inflammation after intraocular surgery in children.
Morales-Mancillas NR, Trivedi RH, Wilson ME
J AAPOS · 2026 Apr · PMID 41881242 · Publisher ↗
BACKGROUND: Postoperative management in children after intraocular surgery involves steroid eye drops. However, children may be uncooperative, leading to more washout than in adults. We aimed to evaluate the clinical uti...
BACKGROUND: Postoperative management in children after intraocular surgery involves steroid eye drops. However, children may be uncooperative, leading to more washout than in adults. We aimed to evaluate the clinical utility of a 0.4 mg intracanalicular dexamethasone insert after pediatric intraocular surgery. METHODS: A retrospective chart review was conducted on all pediatric patients (≤21 years) who received a dexamethasone intracanalicular insert following intraocular surgery. The exclusion criteria included loss to follow-up, prior participation in an FDA multicenter study, and uveitic cataract. RESULTS: A total of 97 eyes received the insert (cataract, n = 68; secondary IOL, n = 27; secondary membrane removal, n = 2). The median age at surgery in the cataract subgroup was 7.2 years (range, 0.19-21.4). No inflammation was observed in 77% at 1 month. Rescue anti-inflammatory drops were used twice per day in 22%. The only complication noted was an insert that fell out at 12 days postoperatively. The median age in the secondary IOL subgroup was 6.05 years (range, 2.77-21.44). No inflammation was seen in 92% at 1 month. Rescue anti-inflammatory drops were used in 20%. Topical intraocular pressure-lowering drops were required in 12% of eyes. CONCLUSIONS: The intracanalicular dexamethasone insert offers a reliable, minimally burdensome way to reduce inflammation after pediatric intraocular surgery. It minimizes dependence on parental compliance, needing only one application by the physician instead of multiple drops daily. Combined with intracameral antibiotics, it enables dropless cataract surgery for most children undergoing intraocular anterior segment procedures.
Optic neuropathy associated with vitamin A deficiency in children: a case series.
Sharma M, Rath S, Tibrewal S … +1 more , Ganesh S
J AAPOS · 2026 Apr · PMID 41865832 · Publisher ↗
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Maxillary sinus pyogenic granuloma with orbital extension: a rare pediatric presentation mimicking malignancy.
Larsen J, Milner D, Smith C … +1 more , Vloka C
J AAPOS · 2026 Jun · PMID 41865831 · Publisher ↗
We report the case of an 11-year-old girl who presented with 2 weeks of nonspecific facial pressure and pain and who was ultimately found to have a right maxillary sinus mass with orbital invasion. Initial imaging and cl...
We report the case of an 11-year-old girl who presented with 2 weeks of nonspecific facial pressure and pain and who was ultimately found to have a right maxillary sinus mass with orbital invasion. Initial imaging and clinical features raised concern for malignancy. However, following biopsy and surgical resection, final pathology revealed a pyogenic granuloma. This benign vascular lesion has rarely been described in the maxillary sinus and, to our knowledge, has not previously been reported to involve the orbit. This case underscores the importance of maintaining a broad differential diagnosis when evaluating pediatric sinonasal masses and highlights the diagnostic challenges posed by orbital involvement.
Clinical characteristics and quality of life measures in children with glaucoma-suspect or glaucoma diagnoses in chronic, noninfectious uveitis.
Miraldi Utz V, Cassedy A, Aundhia M … +4 more , Duell A, Quinlan-Waters M, Kaufman AH, Angeles-Han S
J AAPOS · 2026 Apr · PMID 41865830 · Publisher ↗
BACKGROUND: The impact of glaucoma-suspect or glaucoma diagnoses on quality of life (QOL) outcomes in children with noninfectious uveitis (NIU) has not been well characterized. This study evaluated the impact of glaucoma...
BACKGROUND: The impact of glaucoma-suspect or glaucoma diagnoses on quality of life (QOL) outcomes in children with noninfectious uveitis (NIU) has not been well characterized. This study evaluated the impact of glaucoma-related diagnoses on vision-related QOL (VRQOL) and vision-related functioning (VRF) using the Effects of Youngsters' Eyesight on QOL (EYE-Q), overall QOL (Pediatric QOL Inventory: PedsQL), and anxiety and depression (Revised Children's Anxiety and Depression: RCAD). METHODS: Children with chronic, NIU were categorized as no glaucoma (Gla) and glaucoma-suspect or glaucoma (Gla) for QOL analysis. Demographic and clinical data were collected. Patients and parents/proxies completed the EYE-Q, PedsQL, and RCADS. Statistical analyses were performed, with significance defined at P <0.05. RESULTS: Seventy-six children (mean age, 10.7 ± 4.6 years; 71% female) were included, 36 (47%) with glaucoma-related diagnoses (Gla). Most had bilateral (82%), anterior (91%) NIU and were associated with juvenile idiopathic arthritis (JIA) (67%). Children with JIA were less likely to develop Gla. Affected eyes with glaucoma had more complications at NIU diagnosis (P = 0.003), including synechiae (P <0.001) and cataracts (P < 0.001), compared with the Gla group. While Gla children had lower QOL scores than Gla children, these differences were not statistically significant. However, parents of Gla children reported poorer VRF (P = 0.017), lower total EYE-Q scores (P = 0.013), and higher RCADS scores (P = 0.041), which persisted over time. CONCLUSIONS: Non-JIA uveitis and eyes with complications at uveitis presentation are more likely to develop glaucoma-related diagnoses. Parents/proxies of children with Gla reported lower QOL scores in both eye-specific and psychosocial functioning, highlighting the need for behavioral health interventions.
Factors associated with matching into pediatric ophthalmology and strabismus fellowship: a San Francisco Match analysis.
Khan MJ, Magan T, Shaheen A … +3 more , Kuwera E, Woreta FA, Kraus CL
J AAPOS · 2026 Apr · PMID 41861910 · Publisher ↗
PURPOSE: To identify factors associated with matching into pediatric ophthalmology and strabismus fellowships. METHODS: We analyzed deidentified San Francisco Match data from 2021-22 to 2023-24. Categorical variables wer...
PURPOSE: To identify factors associated with matching into pediatric ophthalmology and strabismus fellowships. METHODS: We analyzed deidentified San Francisco Match data from 2021-22 to 2023-24. Categorical variables were compared using χ or Fisher exact tests. Continuous variables were summarized as medians with interquartile ranges. Factors associated with match outcome were assessed with multivariable multinomial logistic regression. RESULTS: We analyzed 217 applicants, of whom 129 (59%) matched into pediatric ophthalmology, 29 (13%) matched into other ophthalmology subspecialties, and 59 (27%) did not match. Matched applicants were predominantly female (n = 89 [70.6%]) and US graduates (n = 72 [55.8%]). Applicants who matched had more interviews (median, 17 [IQR, 8-32]) than those who did not match (8 [4-16] [P < 0.001]). Underrepresented in medicine (URiM) applicants submitted fewer applications (median, 9 [1-18] [P = 0.008]) and completed fewer interviews (median, 2 [1-8] [P = 0.126]) than non-URiM applicants. Males had more interviews than females (median, 20 [10-36] vs 11 [8-23] [P = 0.003]). US graduates submitted fewer applications than international medical graduates (IMGs) (P = 0.0007) but completed more interviews (P < 0.0001). The proportion of IMG applicants varied: 61.4% in 2021-22; 54.9% in 2022-23; 75.0% in 2023-24 (P = 0.04). Being an IMG was associated with higher odds of not matching (OR = 6.99, P = 0.027). CONCLUSIONS: Across cycles, the IMG share of applicants and pediatric matches increased. Recognizing the shifting landscape in applicants is key to attracting the best candidates to pediatric ophthalmology, as well as promoting efforts to increase the appeal of pediatric subspecialty training among US residents through all pathways.
Modified suture adjustments improve the precision of surgical outcomes in acute acquired comitant esotropia.
Sun Q, Ma B, Wang Y … +3 more , Yuan Y, Yu X, Chen J
J AAPOS · 2026 Apr · PMID 41861909 · Publisher ↗
PURPOSE: To investigate whether modified postoperative suture adjustments can reduce postoperative deviation in patients with acute acquired comitant esotropia (AACE) who have significant postoperative phoria or tropia w...
PURPOSE: To investigate whether modified postoperative suture adjustments can reduce postoperative deviation in patients with acute acquired comitant esotropia (AACE) who have significant postoperative phoria or tropia within 1 week of surgery. METHODS: The medical records of patients with AACE whose deviation was ≥ 10 assessed with the single Maddox rod test (SMRT) in the early postoperative period were analyzed retrospectively. A modified adjustable suture was placed intraoperatively in all patients. Patients who underwent subsequent suture adjustments within 1 week of surgery comprised the adjustment group; the remainder formed the nonadjustment group. SMRT success was defined as elimination of diplopia and deviation ≤10 assessed using that test. RESULTS: The adjustment group included 21 patients; the nonadjustment group included 20 patients. In the early postoperative period before suture adjustment, there was no statistically significant difference in SMRT success rate between the adjustment and the nonadjustment groups (10% vs 30% [P = 0.130]); the distance deviation assessed with SMRT was greater in the adjustment group (17.76 ± 5.16) than in the nonadjustment group (13.40 ± 3.05 [P = 0.002]). At the last postoperative follow-up, the SMRT success rate was higher in the adjustment group than in the nonadjustment group (86% vs 45% [P = 0.009]); the distance deviation assessed with SMRT was lower in the adjustment group (6.05 ± 4.79 vs 13.70 ± 7.48 [P < 0.001]). CONCLUSIONS: Postoperative suture adjustments with modified technique within 1 week of surgery can further reduce postoperative deviation and improve the SMRT success rate in patients with AACE whose postoperative deviation is ≥10 assessed with SMRT.
Ocular motor atavisms: the evolutionary basis of infantile strabismus and nystagmus.
Brodsky MC
J AAPOS · 2026 Apr · PMID 41861908 · Publisher ↗
BACKGROUND: Infantile esotropia inaugurates a series of preternatural eye movements that include dissociated vertical divergence (DVD), primary oblique muscle overaction, and latent nystagmus. Congenital binocular visual...
BACKGROUND: Infantile esotropia inaugurates a series of preternatural eye movements that include dissociated vertical divergence (DVD), primary oblique muscle overaction, and latent nystagmus. Congenital binocular visual loss leads to infantile nystagmus, a seemingly unrelated condition. These disorders seem to defy clinical explanation or nosologic classification. So where do these conditions come from and why are their neurologic pathways so elusive? METHODS: Analysis of these pediatric ocular motor disorders from the perspective of evolutionary biology and its applicability to humans. RESULTS: All of these pediatric ocular motor disorders are evolutionary reversions or atavisms, characterized by the resurgence of ancestral visual reflexes under conditions that perturb early maturation of cortical binocular vision and visual motion processing. DVD and primary oblique muscle overaction originate from a primitive dorsal light reflex that is expressed when cortical binocular vision fails to develop. Latent nystagmus derives from a primitive subcortical visual motion bias that is ubiquitous in lateral-eyed afoveate animals. These atavistic ocular motor incursions originate within our ancient subcortical visuo-vestibular pathways and become incorporated into the human visual cortex when early infantile visual development is disrupted. Infantile nystagmus arises from an optokinetic "tug-of-war" between our older subcortical full-field optokinetic system and our newer cortical pursuit system. CONCLUSIONS: The infantile forms of pediatric strabismus and nystagmus can be understood only through the prism of evolutionary biology. The evolutionary basis of these disorders confers unity on a set of clinical entities that have heretofore been viewed as being disparate and unrelated.
Congenital cystic eye and coloboma with a cyst hybrid phenotype: a developmental continuum.
Farrell LC, August AH, Viaene AN … +5 more , Kim D, Shekdar K, Eagle RC, Revere K, Milman T
J AAPOS · 2026 Apr · PMID 41856268 · Publisher ↗
A 2-day-old boy presented with a large orbital mass, which showed radiological and pathological overlap between congenital cystic eye (CCE) and coloboma with cyst (CwC). Initially identified on prenatal imaging at 21 wee...
A 2-day-old boy presented with a large orbital mass, which showed radiological and pathological overlap between congenital cystic eye (CCE) and coloboma with cyst (CwC). Initially identified on prenatal imaging at 21 weeks, the patient underwent postnatal clinical and radiologic evaluation followed by histopathologic analysis of the enucleated eye. The coexistence of both anomalies within a single globe challenges the traditional view of CCE and CwC as distinct entities and supports a unifying theory of a developmental spectrum of early ocular malformations.
Trends in retinopathy of prematurity (ROP) training and future practice intentions among retina and pediatric ophthalmology fellows.
Daniel Y, Young BK, Besirli CG … +1 more , Eton EA
J AAPOS · 2026 Apr · PMID 41833658 · Publisher ↗
PURPOSE: To assess the perspectives of pediatric ophthalmology and retina fellows on retinopathy of prematurity (ROP) training in fellowship and future ROP practice intentions. METHODS: A 16-item web-based questionnaire...
PURPOSE: To assess the perspectives of pediatric ophthalmology and retina fellows on retinopathy of prematurity (ROP) training in fellowship and future ROP practice intentions. METHODS: A 16-item web-based questionnaire was administered to pediatric ophthalmology, medical retina, and vitreoretinal surgery fellows completing fellowships between 2021 and 2023. RESULTS: A total of 74 participants responded from 142 programs contacted, a 12% response rate. Sixty-three fellows (91%) received ROP training in fellowship, though the exposure to various training components differed between pediatric ophthalmology and retina fellowships (P = 0.002). Screening examinations were performed by 100% and 68% of pediatric ophthalmology and retina fellows, respectively. The most common ROP treatment modality encountered was laser/cryotherapy across both groups, but at different rates for pediatric ophthalmology (n = 18 [72%]) and retina fellowships (n = 36 [95%]). Overall, only 7 fellows (10%) had telemedicine incorporated into their training. Pediatric ophthalmology fellows were more likely than retina fellows to indicate intent to incorporate ROP care in future practice (68% vs 30% [P = 0.004]). Thirty-nine fellows (57%) were either unsure or did not plan to provide ROP care, most commonly citing liability concerns (n = 12, 28%) as the reason. CONCLUSIONS: Although most fellows are trained in some aspect of ROP care, discrepancies remain in training across subspecialties, and few trainees have exposure to telemedicine. Continued efforts should be made to improve ROP training in fellowship to reflect the changing nature of the field.
Congenital cyclic oculomotor palsy and spasms: a review of the literature and presentation of two new cases.
Chan SC, Li F, Watts P … +6 more , Harrad R, Schimansky S, Carpenter C, Monaghan M, Kawabata E, Atan D
J AAPOS · 2026 Apr · PMID 41831818 · Publisher ↗
BACKGROUND: Cyclic oculomotor palsy and spasms (COPS) is a rare neurological syndrome characterized by alternating involuntary phases of paresis and spasm of muscles supplied by the oculomotor nerve. Its etiology, manage...
BACKGROUND: Cyclic oculomotor palsy and spasms (COPS) is a rare neurological syndrome characterized by alternating involuntary phases of paresis and spasm of muscles supplied by the oculomotor nerve. Its etiology, management, and long-term prognosis are poorly understood. The purpose of this study was to provide a systematic review of the published literature and present 2 new cases. METHODS: We systematically reviewed the literature on congenital COPS following PRISMA guidelines (PROSPERO CRD42021286740). Searches were conducted in MEDLINE, EMBASE, Web of Science, KoreaMed, KMBase, KISS, KCI, CiNii, ICHUSHI, CNKI, CQVIP, African Index Medicus, African Journals Online, LILACS through September 1, 2024. RESULTS: In total, 124 congenital COPS cases were identified. Most cases developed oculomotor palsy during infancy (mean, <1 year) before later developing the cycling syndrome (range, 2 months-22 years) involving the pupil (99%), levator (86%), and extraocular muscles (57%). The results of neuroimaging were typically normal. Amblyopia was common (72%), and surgical correction of ptosis/exotropia for cosmesis had variable success and did not abolish cycling. Oral carbamazepine successfully abolished cycling in one case with no recurrences during 5 years' follow-up. CONCLUSIONS: Based on our review, we recommend a standardized nomenclature and definition of COPS. Neuroimaging is not required for diagnosis but may be indicated in cases with associated neurological morbidities or acquired cases with no clear precedent. There are similarities between COPS and other ephaptic disorders, and further research is warranted to assess the efficacy of carbamazepine in its management.
Delays and loss to follow-up in outpatient retinopathy of prematurity screening.
Daniel Y, DuPuis D, Jacobson A … +2 more , Gappy C, Jakpor O
J AAPOS · 2026 Apr · PMID 41825502 · Full text
PURPOSE: To determine the frequency and determinants of delayed and complete loss to follow-up (LTFU) for the first outpatient retinopathy of prematurity (ROP) examination after discharge at a single tertiary center. MET...
PURPOSE: To determine the frequency and determinants of delayed and complete loss to follow-up (LTFU) for the first outpatient retinopathy of prematurity (ROP) examination after discharge at a single tertiary center. METHODS: A retrospective chart review of neonates at a single institution from 2014 to 2023 who underwent inpatient ROP screening and were intended to have outpatient follow-up there within 1 month was performed. Frequency of LTFU and delayed follow-up (>3 days) were calculated, and univariate logistic regression revealed potential associations with clinical and sociodemographic factors. Qualitative themes were extracted to identify reasons for gaps. RESULTS: Of the 721 infants who met inclusion criteria, 691 (95.8%) received follow-up, although 12.9% of those receiving follow-up were delayed by a median of 9 days. Zone III ROP or retinal maturity on inpatient screening was associated with complete LTFU (OR = 0.20; 95% CI, 0.09 - 0.45). Postmenstrual age at discharge ≥40 weeks was also associated with LTFU (OR = 0.31; 95% CI, 0.14-0.65), but among those with follow-up, it was more likely to be timely (OR = 1.84; 95% CI, 1.08-3.30). Inpatient ROP treatment was associated with timeliness of follow-up (OR = 5.27; 95% CI, 1.11-94.2); Hispanic or non-White race/ethnicity was associated with delays (OR = 0.44; 95% CI, 0.28-0.69). CONCLUSIONS: Despite an overall high rate of follow-up, delays remain a challenge that may disproportionately affect Hispanic or non-White patients. ROP severity may be associated with better follow-up. Although these findings are exploratory, they may inform future research and interventions to ensure uninterrupted care for all patients.
Cooccurrence of myelinated retinal nerve fibers in pediatric unilateral persistent fetal vasculature: report of three cases.
Liu C, Lu H, Li S … +4 more , Deng G, Ma J, Dong J, Liu J
J AAPOS · 2026 Apr · PMID 41825501 · Publisher ↗
We report 3 pediatric cases of persistent fetal vasculature (PFV) and myelinated retinal nerve fibers (MRNF) coexisting in the same eye. All cases presented with congenital cataracts, vitreous strands, and an unusual axi...
We report 3 pediatric cases of persistent fetal vasculature (PFV) and myelinated retinal nerve fibers (MRNF) coexisting in the same eye. All cases presented with congenital cataracts, vitreous strands, and an unusual axial length (AL) profile-specifically, the affected eyes exhibited longer ALs than their fellow eyes, contrary to typical PFV patterns. Preoperative Color Doppler imaging consistently revealed a linear echogenic band extending from the optic disk to the posterior lens capsule. Intraoperative and postoperative fundus examinations confirmed the presence of MRNF in each case, with variable distribution and density. Our findings suggest that when axial elongation is detected preoperatively in PFV eyes with the fundus obscured by cataract, coexisting conditions such as MRNF should be considered.
Risk of neuroblastoma among patients with pediatric Horner syndrome.
Solyman O, Sallam AB, Pemberton JD … +6 more , Muayad J, Elhusseiny AM, Alaraj A, Kwok A, Phillips PH, Chauhan MZ
J AAPOS · 2026 Apr · PMID 41819444 · Publisher ↗
PURPOSE: To determine the risk of neuroblastoma in children diagnosed with Horner syndrome after infancy. METHODS: Children (<18 years of age) with an incident diagnosis of Horner syndrome were identified in the TriNetX...
PURPOSE: To determine the risk of neuroblastoma in children diagnosed with Horner syndrome after infancy. METHODS: Children (<18 years of age) with an incident diagnosis of Horner syndrome were identified in the TriNetX Research Network (January 1, 2005-January 1, 2022). Patients <1 year were excluded to minimize congenital cases. A comparison non-Horner cohort of children undergoing routine child health examinations was followed for 5 years from the index date. Neuroblastoma was identified in the record using diagnosis and oncology classification codes. Propensity score matching adjusted for age, sex, race, and ethnicity; hazard ratios (HRs) and adjusted HRs (aHRs) were calculated. Sensitivity analyses excluded patients with prior trauma, carotid dissection, or upper-lobe lung neoplasm. RESULTS: The Horner cohort included 1,331 children (56% male) from 56 health care organizations (mean age, 3.0 years) with 2,962,242 children comprising the unmatched comparison cohort. Within 5 years, 107 of 1,331 children (8.04%) with Horner syndrome and 595 of 2,962,242 controls (0.02%) developed neuroblastoma (HR = 446.90; 95% CI, 363.75-549.06; P < 0.0001). After matching (n = 1,331 per group), 5-year risk remained higher in the Horner cohort (8.03% vs 0.75%; aHR = 119.03; 95% CI, 16.61-852.79). In sensitivity analysis excluding patients with history of trauma, carotid dissection, or upper lobe lung masses, 89 of 1,148 children with incident Horner syndrome (7.75%) developed neuroblastoma. CONCLUSIONS: In our study cohort, noncongenital Horner syndrome was associated with a markedly increased risk of neuroblastoma (∼1 in 12 within 5 years). Neuroblastoma evaluation should be strongly considered for acquired or otherwise unexplained noncongenital pediatric Horner syndrome.
Retinal vasoproliferative tumors in pediatric retinal dystrophies.
Khan AO, Agarwal A
J AAPOS · 2026 Apr · PMID 41812909 · Publisher ↗
This case series documents retinal vasoproliferative tumors (RVPTs) in 3 unrelated girls (14, 14, and 13 years of age) with different genetically confirmed autosomal recessive retinal dystrophies (related to CEP290, ABCA...
This case series documents retinal vasoproliferative tumors (RVPTs) in 3 unrelated girls (14, 14, and 13 years of age) with different genetically confirmed autosomal recessive retinal dystrophies (related to CEP290, ABCA4, and MYO7A). The CEP290-related and ABCA4-related cases were both unilateral right eye lesions (inferotemporal unifocal and temporal bifocal, respectively) that were detected years after the retinal dystrophy diagnoses (Joubert syndrome and Stargardt disease, respectively) and remained asymptomatic and stable over 1 year observation. The MYO7A-related case was a left eye inferotemporal unifocal RVPT that was discovered after the child presented with left eye pain related to neovascular glaucoma in that eye in the context of exudative retinal detachment from the RVPT. She was subsequently diagnosed with Usher syndrome and later developed a RVPT in the right eye. Identification, follow-up, and appropriate management of RVPTs in children is important because some lesions have to potential to cause exudative retinal detachment with neovascular glaucoma.
Demographics and costs of pediatric blepharitis and conjunctivitis seen in California emergency departments over a 10-year period.
Morse JR, Xu A, Nesemann JM … +2 more , Keenan JD, Oatts JT
J AAPOS · 2026 Apr · PMID 41812908 · Full text
BACKGROUND: Every year, thousands of children use the emergency department (ED) for low-acuity conditions. This study aimed to determine the financial impact of ED utilization for the most common nonemergent ocular condi...
BACKGROUND: Every year, thousands of children use the emergency department (ED) for low-acuity conditions. This study aimed to determine the financial impact of ED utilization for the most common nonemergent ocular conditions, blepharitis and conjunctivitis, and to explore the demographics of patients seeking care for these conditions through the ED. METHODS: All cases of pediatric blepharitis and conjunctivitis between January 1, 2012, and December 31, 2021, were identified using the California Office of Health Care Access Information Database. Cases were analyzed under different billing structures including care rendered in the emergency department (ED) versus outpatient settings using evaluation and management (E&M) and eye visit codes. RESULTS: Blepharitis and conjunctivitis accounted for 306,417 visits, or 78.2% of all ED eye-related visits among children ≤18 years. The most common self-reported race/ethnicity was Hispanic (56.3%), followed by White (20.1%) and Black (13.0%). Most patients had public insurance (72.7%) or private insurance (19.7%). ED utilization was 17.6% higher during weekends. Estimated costs for ED visits totaled $36,567,192-$37,914,508 annually. Estimated annual outpatient costs using new patient E&M codes totaled $1,146,612- $2,303,337, and the estimated annual outpatient costs using eye visit codes totaled $1,138,339-1,525,344. This suggests the cost of ED care was 16.5-32.1 times more expensive than equivalent outpatient costs. CONCLUSIONS: Care provided in the ED for blepharitis and conjunctivitis may be 16.5-32.1 times more expensive than care rendered in outpatient settings. Non-White children and children with public insurance had higher ED utilization compared to their population-level representation. Increasing access to pediatric eye specialists and decreasing ED utilization has the potential to improve efficacy while promoting childhood health outcomes.
Management of traumatic hyphema in a patient with Glanzmann thrombasthenia using intraoperative recombinant factor VIIa.
Güleser ÜY, Usta Küçükbezirci G, Dogan C
J AAPOS · 2026 Apr · PMID 41796935 · Publisher ↗
A 14-year-old boy with known Glanzmann thrombasthenia presented with total hyphema and high intraocular pressure (IOP) of 55 mmHg in the right eye following blunt trauma. Initial management included intravenous mannitol,...
A 14-year-old boy with known Glanzmann thrombasthenia presented with total hyphema and high intraocular pressure (IOP) of 55 mmHg in the right eye following blunt trauma. Initial management included intravenous mannitol, triple antiglaucoma therapy, and platelet transfusion, resulting in partial hyphema regression and IOP reduction. However, persistent coagulated blood by day 3 necessitated surgery. Despite platelet transfusion perioperatively, anterior chamber irrigation, and anterior vitrectomy, bleeding continued until recombinant factor VIIa (rFVIIa) was administered intraoperatively. Postoperatively, visual acuity recovered to 20/20 and IOP normalized, with complete resolution and no recurrence over 1 year's follow-up.
Anesthesia exposure in unilateral retinoblastoma-comparison of enucleation and intraarterial chemotherapy.
Rodriguez A, Ha C, Abruzzo T … +1 more , Ramasubramanian A
J AAPOS · 2026 Jun · PMID 41765171 · Publisher ↗
BACKGROUND: Retinoblastoma treatment requires prolonged and repeated exposure to general anesthesia. In 2016, the FDA issued a warning that repeated or lengthy anesthesia exposures in children under 3 years of age may ca...
BACKGROUND: Retinoblastoma treatment requires prolonged and repeated exposure to general anesthesia. In 2016, the FDA issued a warning that repeated or lengthy anesthesia exposures in children under 3 years of age may cause neurodevelopmental abnormalities. The purpose of this study was to compare the mean anesthesia exposure time associated with enucleation compared with intraarterial chemotherapy (IAC) in patients treated for advanced unilateral retinoblastoma. METHODS: This retrospective study evaluated demographics, tumor features, and treatment details of unilateral intraocular retinoblastoma cases newly diagnosed at a single tertiary care children's hospital between August 2011 and March 2021. Anesthesia time was stratified by clinical characteristics and procedure type. RESULTS: A total of 25 patients (mean age at diagnosis, 26.4 months) met inclusion criteria (13 primary enucleation and 12 primary IAC), undergoing 212 tumor-directed procedures under general anesthesia. Within the first year of diagnosis, the mean total anesthesia time was 273 minutes in the enucleation group compared with 2,572 minutes in the IAC group. No anesthetic complications were noted in either group. CONCLUSIONS: In our small patient cohort, the mean total anesthesia exposure for unilateral retinoblastoma was shorter with enucleation than with IAC.
Herpetic panophthalmitis in a patient with a history of neonatal herpetic encephalitis.
Woock AE, Rowsey TG, Tauscher RG
J AAPOS · 2026 Apr · PMID 41765170 · Publisher ↗
Herpetic acute retinal necrosis (ARN) with orbital inflammation is a rare form of panophthalmitis. We report the case of a 15-year-old boy with hypoxic ischemic encephalopathy (HIE) secondary to neonatal herpetic encepha...
Herpetic acute retinal necrosis (ARN) with orbital inflammation is a rare form of panophthalmitis. We report the case of a 15-year-old boy with hypoxic ischemic encephalopathy (HIE) secondary to neonatal herpetic encephalitis who developed unilateral ocular inflammation and proptosis. Imaging and aqueous PCR confirmed orbital inflammation and active HSV infection. Given the patient's comorbidities, aggressive surgical treatment was not pursued. Treatment aimed at protecting the contralateral eye from involvement requires life-long antiviral prophylaxis.
Crizotinib-associated nodular scleritis in an adolescent.
Elfwwal M, Hawkins DS, Huang LC
J AAPOS · 2026 Apr · PMID 41763354 · Publisher ↗
We report the case of a 17-year-old girl with history of anaplastic large-cell lymphoma on crizotinib therapy who presented with pain and blurred vision in the left eye. Examination demonstrated nodular non-necrotizing a...
We report the case of a 17-year-old girl with history of anaplastic large-cell lymphoma on crizotinib therapy who presented with pain and blurred vision in the left eye. Examination demonstrated nodular non-necrotizing anterior scleritis in the left eye. The patient initially improved with oral glucocorticoid treatment until she developed nodular non-necrotizing anterior scleritis in the right eye during taper of this medication. Discontinuation of crizotinib allowed the patient to taper off glucocorticoid treatment, with subsequent resolution of scleritis.
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