An innovative era of pediatric ophthalmology and strabismus

Pediatric ophthalmology and strabismus is the oldest subspecialty in ophthalmology.[1] It is a constantly changing and evolving field. Many new advances and current concepts are developed and need to be disseminated into the ophthalmic community. This issue of Taiwan Journal of Ophthalmology reflects the enthusiastic dedication of pediatric ophthalmologists on various interesting topics.

Duane syndrome is a common form of congenital cranial dysinnervation disorders (CCDDs). The term of CCDD emerged from a multidisciplinary workshop of clinicians and researchers who studied a group of diseases characterized by abnormal eye, eyelid, and/or facial movements. The name reflects the finding that these disorders result from development errors in innervation of the ocular and facial muscles.[2] Huber[3] classified Duane syndrome into three types depending on the pattern of horizontal movement abnormality and electromyographic findings. However, there are other forms of abnormal innervation of extraocular muscles which do not fit into Huber's classification. In this issue of Taiwan Journal of Ophthalmology, Özkan[4] proposes the addition of atypical forms of Duane syndrome, including Type 4: synergic divergence, Type 5: vertical retraction syndrome, and Type 6: Y-pattern deviation. The clinical features of atypical forms of Duane syndrome are demonstrated. This article also presents a comprehensive review of treatment options for Duane syndrome. The advantages, disadvantages, and indications for each treatment option are discussed in details. The author warns that clinicians should be prepared for the low predictability of surgical outcome compared to conventional strabismus surgery.

Cyclovertical strabismus has always been a challenge to strabismologists. Among all the surgical procedures, inferior oblique muscle surgery is the most widely used procedure for treating various vertical or torsional strabismus. In this issue of Taiwan Journal of Ophthalmology, Sato[5] presents a concise historical review of this procedure. The developments of inferior oblique muscle surgery are listed chronologically, from transcutaneous approach in the 19^th century to transposition procedures nowadays. Although these techniques have a long history for treating cyclovertical deviations, the effectiveness of these procedures is still controversial. The interested readers can be referred to a recent report by the same research group, which reviewed the effectiveness of simultaneous surgery of inferior oblique myectomy and superior oblique tuck for large angle of congenital/idiopathic superior oblique palsy with a lax superior oblique tendon.[6]

Managing a swollen optic disc in a child is a crucial task to pediatric ophthalmologists due to its potentially life-threatening implications. In this issue of Taiwan Journal of Ophthalmology, McCafferty et al.[7] present a clinical algorithm for the evaluation of possible papilledema in the pediatric patients. A workup guideline at the University of Minnesota to clarify etiology is described. The authors adopt the revised diagnostic criteria proposed by Friedman et al.[8] Friedman advocated using the terms of primary and secondary pseudotumor cerebri syndromes to avoid the self-contradictory term like “secondary idiopathic intracranial hypertension.” However, many clinicians are used to the more simple division of primary and secondary idiopathic intracranial hypertension proposed by Aylward.[9] The consensus on nosology of this disease is not well established yet.[10]

With the rapid progress in diagnosis and management of pediatric ophthalmology and strabismus, our knowledge in this field is constantly revised. The pathophysiological bases behind vision and ocular motility are continuously expanded. Increasing treatment modalities have been developed to improve the outcome. We are fortunate to participate and witness the innovative era of this oldest subspecialty of ophthalmology.