Desheng Song

Accurate and objective tools for myopia screening in children and adolescents are crucial to retard progression and avert vision-endangering complications. This study aims to investigate the diagnostic performance of the axial length/corneal radius (AL/CR) ratio for myopia in children and adolescents. The literature search encompassed major electronic databases, key academic websites, and grey literature from inception to April 2025. Inclusion criteria were restricted to studies evaluating the diagnostic accuracy of AL/CR for myopia, with spherical equivalent (SE) ≤ -0.50 D as the gold standard for myopia diagnosis. The meta-analysis adhered to the Cochrane Handbook guidelines and PRISMA reporting standards. A total of 9 studies involving 24,030 children and adolescents were included in the meta-analysis. The summary sensitivity, specificity, and area under the curve of AL/CR for diagnosing myopia were 0.88 [95% CI: 0.86-0.90], 0.89 [95% CI: 0.86-0.91], and 0.93 [95% CI: 0.91-0.95], respectively. Meta-regression analysis revealed that the sensitivity of AL/CR remained independent of sample size, SE, myopia prevalence, age, or recruitment setting (school-based vs. hospital-based) (all p > 0.05). Notably, increased diagnostic specificity was significantly associated with older age (p = 0.01). The combination of AL/CR with non-cycloplegic autorefraction demonstrated significantly higher sensitivity and specificity in detecting myopia compared to AL/CR alone (Sensitivity: 0.93 [95% CI: 0.92-0.95] VS 0.88 [95% CI: 0.86-0.90]; Specificity: 0.94 [95% CI: 0.94-0.95] VS 0.89 [95% CI: 0.86-0.91]). AL/CR cut-off value exhibited significant correlations with age. AL/CR ratio demonstrates robust diagnostic efficacy for myopia in paediatric and adolescent populations, particularly when utilised in conjunction with non-cycloplegic autorefraction. However, the selection of age-specific AL/CR cut-off points is essential to maximise diagnostic precision.

Purpose Long-term surgical outcomes were compared between bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for therapy of basic type intermittent exotropia (IXT) with equal dominance. Methods Two hundred and sixty-eight subjects (3–11 years old) with basic IXT with equal dominance who underwent BLR or R&R surgery were enrolled to this study, and with a minimum follow-up period of 18 months. One hundred and fourteen patients underwent BLR surgery and 144 underwent R&R surgery at a single centre. Surgical outcomes between groups were compared. Surgery results were divided into 3 categories: undercorrection/recurrence (exotropia/phoriaå 10PD), success(esotropia/phoria ≤5PD to exotropia/phoria≤10PD), and overcorrection (esotropia/phoriaå 5 PD) according to postoperative deviation angle. Results No statistical difference was detected between BLR group and R&R group at all intervals with the exception of the last examination, demonstrating a higher success rate and a lower recurrence rate in the BLR group than R&R group at last visit (P = 0.04). Additionally, the BLR group demonstrated a smaller exodrift than the R&R group at distance and near fixation (P = 0.01; P = 0.03). Stereoacuity and exotropia control showed overall improvement following both surgeries, and this improvement had no statistical difference between groups(P > 0.05). Conclusions BLR showed better long-term results than R&R in the treatment of basic type intermittent exotropia with equal dominance given its low recurrence rate. Both BLR and R&R surgeries could improve stereoacuity function and exotropia control, and to same extents.

Background: Intermittent exotropia (IXT) is the most common type of strabismus, overminus lens (OML) therapy is frequently prescribed to treat IXT. Objectives: The purpose of this study was to compare the effectiveness of OML and observation in the treatment of IXT. Method: An exhaustive search of the literature in PubMed, Embase, Web of Science, and Cochrane Library databases was performed until July 2022. No language restrictions were used. The literature was rigorously screened according to eligibility criteria. Weighted mean differences and 95% confidence intervals (CIs) were calculated. Results: A total of 4 articles with 561 participants were included in this meta-analysis. Our pooled results showed that OML demonstrated superior outcomes compared with observation, with greater decreases in distance and near exodeviation control (MD = −1.08, 95% CI: −1.96 to −0.20, p = 0.02; MD, −0.64, 95% CI: −1.15 to −0.13, p < 0.001). Patients who received OML therapy had a greater decrease in the deviation at both distance and near (MD = −4.00, 95% CI: −7.03 to −0.98, p < 0.001; MD = −4.79, 95% CI: −6.29 to −3.30, p < 0.001). There was no statistical difference between the two groups in terms of post-treatment proximal stereopsis (MD, 0.00, 95% CI: −0.08 to 0.08, p = 1.00). Conclusions: The present meta-analysis indicated that OML therapy was effective in improving the control and decreasing exodeviation angle of IXT. However, it seemed not to be effective in improving the level of near stereopsis.

Background: To compare the effect of alternate part-time patching and pencil push-up training on control ability in patients with intermittent exotropia. Methods: Patients (3–7 years old) with previously untreated intermittent exotropia were randomly assigned to receive alternate part-time patching, pencil push-up training, or observation. Control ability was assessed using the Office Control Score. Stereoacuity at 40 cm was evaluated with Titmus. Results were compared after a 12-week follow-up. Results: Ninety-two patients (28 in patching, 30 in pencil push-ups, and 34 in observation group) completed 12-week follow-up assessments. Based on 6-point scale, the mean deviation control was significantly better in patching and pencil push-up group after 12 weeks at distance (P = 0.002 and 0.026, respectively). Furthermore, there were greater control changes in patching and pencil push-up groups in comparison with observation group from baseline to 12 weeks (PP = 0.003, respectively). After 12 weeks of treatment, stereoacuity and stereoacuity changes were not significantly different between either the intervention group or control group (P = 0.140 and 0.393, respectively). Conclusions: Based on the common office control scale, alternate part-time patching and pencil push-up training were effective treatment strategies for intermittent exotropia.

Objective To compare the effectiveness of botulinum toxin injection (BTX) and bilateral medial rectus recession (BMR) in the treatment of comitant esotropia. Methods An exhaustive search of the literature from Pubmed, EMBASE, Web of Science, and Cochrane Library databases was carried out until April 2022. No language restrictions were applied. The literature was rigorously screened against eligibility criteria. Odds ratios (ORs) and 95% confidence interval (CI) were calculated. Results A total of 9 articles with 1100 participants were included in this meta-analysis. Three studies compared the effects of BTX to BMR on infantile esotropia, five studies compared the effects of BTX to BMR on acute acquired comitant esotropia, and one study compared the therapeutic effects between BTX and BMR for partially accommodative esotropia. Our pooled results showed that BMR achieved higher overall success rate compared with BTX (OR, 0.49; 95%CI, 0.37–0.64; P < 0.001) and patients subjected to the BTX procedure had higher overall rate of undercorrection (OR, 2.27; 95%CI,1.71–3.02; P < 0.001). No statistical difference in the overall overcorrection rate was observed between the two groups (OR = 0.42, 95% CI: 0.17 ~ 1.03, P = 0.06). Further analysis found that BMR was more effective for infantile esotropia compared to botulinum toxin injections (OR, 0.40; 95%CI, 0.27–0.57; P < 0.001). Nevertheless, the same effect was observed for BMR and BTX in the treatment of acute acquired comitant esotropia (OR, 0.97; 95%CI, 0.50–1.87; P = 0.93). Conclusion The present meta-analysis indicated that the BMR procedure achieved a higher success rate and a lower undercorrection rate in patients with comitant esotropia. However, BTX demonstrated similar treatment effects to BMR surgery in the treatment of acute acquired comitant esotropia.

Intermittent exotropia (IXT) is a relatively common childhood strabismus worldwide, non-surgical treatments are sometimes administered to prevent IXT from deteriorating, which has not been widely accepted by physicians. The objective of this study is to compare the effectiveness of commonly used non-surgical treatment modalities (overminus lens therapy and part-time occlusion therapy) and observation in the treatment of intermittent exotropia. An exhaustive search of the literature in Pubmed, EMBASE, Web of Science, and Cochrane Library databases was performed until July 2022. No language restrictions were used. The literature was rigorously screened according to eligibility criteria. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated. A total of 7 articles with 1046 participants were included in this meta-analysis. Three studies compared the effects of OML and observation, three studies compared the effects of PTO and observation, and one study compared the effects of OML, PTO, and observation. Our pooled results showed that the commonly used non-surgical treatment modalities demonstrated superior outcomes compared with observation, with greater decreases in distance and near exodeviation control (OR, -0.51; 95% CI, -0.66 to -0.36, P < 0.001; OR, -0. 40; 95% CI, -0.54 to -0.25, P < 0.001). Patients who received the commonly used non-surgical treatment method had a greater decrease in the deviation at both distance and near (OR, -2.88; 95% CI, -3.75 to -2.01, P < 0.001; OR, -3.44; 95% CI, -5.34 to -1.55; P < 0.001). There was no statistical difference between the two groups in terms of post-treatment proximal stereopsis (OR=0.01, 95% CI: -0.04 to 0.05, P=0.83). Further analysis revealed that OML showed a better significant treatment effect than PTO. The present meta-analysis indicated that commonly used non-surgical treatment modalities (overminus lens therapy and part-time occlusion therapy) were effective in improving the control and decreasing exodeviation angle of intermittent exotropia, and overminus lens therapy was superior to part-time occlusion therapy.

Objective To compare the outcomes of medial rectus plication and medial rectus resection procedures in the treatment of exotropia. Methods Articles from Pubmed, EMBASE, Web of Science, and Cochrane Library databases until July 2021 with a minimum follow-up period of 1 month were retrieved. No restriction on language was applied. Eligible studies must comply with the inclusion criteria. Only studies with comparisons between unilateral medial rectus plication versus unilateral medial rectus resection, unilateral lateral rectus recession-medial rectus plication (RP) versus unilateral lateral rectus recession-medial rectus resection (RR), or bilateral medial rectus plication(BMRP) versus bilateral medial rectus resection (BMRR) would be included for subsequent analysis. Two primary outcomes were specified: success rate and mean postoperative deviation. Dichotomous data were calculated as pooled odds ratios (ORs) with 95% confidence intervals (CIs) and continuous data as weighted mean differences (WMD) with 95% CIs. Results A total of 8 studies with 557 participants were enrolled in the meta-analysis based on the inclusion criteria. Seven studies compared lateral rectus recession + medial rectus plication to unilateral lateral rectus recession + medial rectus resection and one study compared bilateral medial rectus plication to bilateral medial rectus resection. Differences in success rates between plication and resection groups were not statistically significant (OR = 0.66; 95% CI, 0.43–1.02; P = 0.06), and the unsatisfactory effects (the undercorrection and overcorrection rates) between the two groups were comparable. Additionally, there were also no significant differences in postoperative deviation and the amount of exodrift between the two groups. Conclusion This meta-analysis provides evidence that both the medial rectus plication and medial rectus resection procedures have similar efficacy in the treatment of exotropia.

Background To compare the effect of alternate part-time patching and pencil push-up training on control ability in patients with intermittent exotropia. Methods Patients (3-7 years of age) with previously untreated intermittent exotropia were randomly assigned to receive alternate part-time patching, pencil push-up training or observation. Control ability was assessed using the Office Control Score. Stereoacuity at 40cm was evaluated with Titmus. Results were compared after 12-weeks follow-up. Results Ninety-two patients (28 in patching, 30 in pencil push-up and 34 in observation group) completed baseline and 12-week follow-up assessments. On the basis of 6-point scale, the mean deviation control was significantly better in patching and pencil push-up group after 12 weeks at distance (P=0.002 and 0.026, respectively). Furthermore, there was greater control changes in patching and pencil push-up groups in comparison with observation group from baseline to 12 weeks (P༜0.001;P=0.003, respectively). After 12 weeks of treatment, stereoacuity and stereoacuity changes were not significantly different between either of the intervention group and control group (P=0.140 and 0.393, respectively). Conclusions Based on the common office control scales, alternate part-time patching and pencil push-up training were effective treatment strategies for intermittent exotropia.

Aim: To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant. Methods: Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications. Results: A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was −3.69 (95% CI: −6.70 to −0.68) at 1 month, −2.69 (−5.17 to −0.21) at 3 months, −3.67 (−6.09 to −1.25)at 6 months, −3.24 (−6.08 to −0.41) at 12 months, 1.24 (−9.43 to 11.90) at 24 months, and 1.10 (−10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10–0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications. Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01). Conclusion: Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.