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Background: Amblyopia is a common cause of monocular vision impairment and disproportionally affects developmentally delayed children. Photoscreeners have been suggested as a method to detect amblyopia risk factors (ARFs) in children with developmental disabilities who may not be amenable to traditional vision screening methods. The Spot Vision Screener is a commonly used photoscreener for detecting ARF and has shown excellent sensitivity and accuracy in the general pediatric population. The purpose of this study was to evaluate its accuracy in children with Down syndrome and other special needs., Methods: Children with various disabilities or delays were recruited from outpatient clinics at the Children's Hospital of Colorado. Participants had their photograph taken with Spot before and after pupil dilation and cycloplegia. Images were compared to results of a comprehensive clinical eye examination., Results: A total of 100 children participated in the study. Images could not be obtained in 12 children; 5 children did not attend their clinical examination. The overall sensitivity of Spot was 90%, with a positive predictive value of 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% CI, 0.57-0.79), which did not differ significantly from the AUROC after dilation/cycloplegia (0.68; 95% CI, 0.54-0.81)., Conclusions: The Spot Vision Screener could be used by primary care clinics and vision screening programs with a high sensitivity to determine which patients with Down syndrome and special needs should be referred for clinical examination., (Copyright © 2023 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: Retinopathy of prematurity (ROP) screening, an integral part of pediatric ophthalmology, can be time consuming and resource intensive. The purpose of this study was to evaluate the economic landscape of ROP screening and treatment among pediatric ophthalmologists in the United States., Methods: An online survey was distributed to US pediatric ophthalmologists through a pediatric ophthalmology email listserv. Survey results were compiled, and responses were deidentified and analyzed, with particular focus on factors affecting financial compensation., Results: A total of 97 responses were collected. Almost half of respondents worked in private practice settings. Over 80% of respondents had a formal contract to perform ROP care, but only 26% enlisted the assistance of an attorney to negotiate their contract. Just over half of respondents believed themselves adequately compensated for their services. Respondents that had retained an attorney for contractual negotiations were more likely to have a higher mean annual compensation rate ($126,545 ± $145,133 vs $70,214 ± $50,671; P = 0.05). Physicians who believed themselves adequately compensated were more likely to be in academic practice settings (78% academic vs 55% combo/other vs 24% private; P < 0.001) and were more likely to have contracts to perform ROP care (68% with contracts vs 15% without; P = 0.001). Average annual compensation was $82,968 ± $84,132, approximately $24,000 higher than reported in 2013., Conclusions: More pediatric ophthalmologists among our respondents obtained contracts for their services, and compensation rates have increased since 2013. Nevertheless, concerns regarding under-compensation and time commitment persist, raising concerns about the long-term sustainability of current models for providing ROP services., (Copyright © 2021 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Blau syndrome is an early-onset granulomatous disease known to affect the skin, joints, and eyes. We report a child with diffuse rash, arthritis, and subconjunctival nodules. Biopsy of the bulbar conjunctiva revealed noncaseating lipogranulomas that lead to a diagnosis of Blau syndrome. To our knowledge, noncaseating lipogranulomas of the conjunctiva have not been reported previously as a presenting finding in Blau syndrome. Although uveitis is the classic manifestation, it is important to broaden the awareness of other ocular signs, as these variations can aid in diagnosis., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Objectives: Ketamine is one of the most commonly used procedural sedation and analgesia (PSA) agents in pediatric emergency departments (PEDs). It is considered a very safe and reliable agent, with limited respiratory suppression, hemodynamic effects, and adverse outcomes. However, physicians are often reluctant to use ketamine for patients with eye injuries due to a concern that ketamine might increase intraocular pressure (IOP). The objective was to measure IOP in previously healthy children receiving ketamine for PSA for a reason other than eye injury., Methods: This was a prospective noninferiority study of patients seen in an academic tertiary care children's hospital emergency department (ED) who required ketamine for PSA. The authors measured IOP in the right eye as soon as possible after ketamine had been administered and then at 2.5, 5, and 10 minutes after ketamine had been administered., Results: Eighty patients were enrolled (28 between 1 and 5 years of age, 26 between 6 and 10 years, 26 between 11 and 15 years); 49 (61%) were male. Procedures requiring PSA included fracture/dislocation reduction (63%), abscess incision and drainage (16%), laceration repair (11%), dental abscess incision and drainage (6%), and other (4%). The mean total ketamine dosage was 1.6 mg/kg (95% confidence interval [CI] = 1.4 to 1.7). The mean initial IOP was 17.5 mm Hg (95% CI = 16.4 to 18.6 mm Hg) and at 2.5 minutes was 18.9 mm Hg (95% CI = 17.9 to 19.9 mm Hg). The mean difference was 1.4 mm Hg (95% CI = 0.4 to 2.4 mm Hg). Using a noninferiority margin of 2.6 mm Hg (15%), noninferiority (no significant elevation in IOP) was demonstrated with 95% confidence between the first and second readings., Conclusions:  Ketamine does not significantly increase IOP in pediatric patients without eye injuries receiving typical PSA dosages in the PED. Further study should assess its safety in patients with ocular injury., (© 2012 by the Society for Academic Emergency Medicine.)

Objectives: Orbital infections caused by methicillin-resistant Staphylococcus aureus may be increasing. Because Staphylococcus aureus infections have important treatment implications, our objective was to review the microbiology and antibiotic management of children hospitalized with orbital cellulitis and abscesses., Patients and Methods: This study was a retrospective chart review of all patients admitted to a tertiary care children's hospital between 2004 and 2009 with orbital infections confirmed by a computed tomography scan. Patients with preceding surgery or trauma, anatomic eye abnormalities, malignancy, immunodeficiency, or preseptal infections were excluded., Results: There were 94 children with orbital infections. A true pathogen was recovered in 31% of patients. The most commonly identified bacteria was the Streptococcus anginosus group (14 of 94 patients [15%]). Staphylococcus aureus (1 patient with methicillin-resistant Staphylococcus aureus) was identified in 9% of patients. Combination antimicrobial agents were frequently used (62%), and vancomycin use increased from 14% to 57% during the study period. Patients treated with a single antibiotic during hospitalization (n = 32), in contrast to combination therapy (n = 58), were more likely to be discharged on a single antibiotic (P < .001). Twenty-five (27%) patients were discharged on combination antibiotics. Thirteen (14%) patients were discharged on intravenous therapy., Conclusions: The Streptococcus anginosus group is an emerging pathogen in pediatric orbital infections. Although methicillin-resistant Staphylococcus aureus was uncommon, patients frequently received vancomycin and combination antibiotics. A simplified antibiotic regimen may help limit the development of resistant organisms and facilitate transition to an oral agent.

"That tongue of yours, by which I have been tricked, shall have its power curtailed and enjoy the briefest use of speech." With these words, Hera, of Greek mythology, deprived the nymph Echo of spontaneous speech, constraining her instead to merely repeating the words of others. Echolalia, which derives from the word "echo," is disordered speech in which an individual persistently repeats what is heard. Echolalia has been described in patients with a number of neuropsychiatric illnesses including autism and Tourette's syndrome. Neuropsychiatric systemic lupus erythematosus (NPSLE) is a heterogeneous disease with protean manifestations that may occur in approximately 25% to 50% of patients with systemic lupus erythematosus (SLE). Although the most common manifestations include cognitive dysfunction (50%) and seizures (20%), NPSLE may also present as peripheral neuropathy (15%), psychosis (10%), or other central nervous system abnormalities. We report the case of a 57-year-old woman with SLE and echolalia.

We describe the case of a 3.5-year-old boy who had myelinated retinal nerve fibers and ipsilateral amblyopia refractory to occlusion therapy and simple myopic astigmatic correction. We suggest that myelinated nerve fibers may result in organic amblyopia with a resultant poor visual prognosis.

Two infants with pyogenic sacroiliitis are presented. In both babies, the clinical findings were initially attributed to septic arthritis of the ipsilateral hip. The correct diagnosis was not established in either infant until radionuclide scanning showed increased uptake in the ipsilateral sacroiliac joints. Both cases emphasize the importance of proceeding quickly to radionuclide imaging in the baby with clinical and laboratory findings of inflammation in the vicinity of the hip and a negative hip aspiration.