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In This Issue of JAMA Ophthalmology
April 2017


JAMA Ophthalmol. 2017;135(4):297. doi:10.1001/jamaophthalmol.2016.3727


An indirect, noninvasive measure of intracranial pressure in children with subacute conditions, such as craniosynostosis or tumor, is judged to be of value. Swanson and coauthors evaluate what the sensitivity and specificity are for spectral-domain optical coherence tomography (SD-OCT) to diagnose intracranial hypertension in children. In a cross-sectional study that included 79 patients, SD-OCT parameters demonstrated a sensitivity of 89% and specificity of 62% for detecting intracranial hypertension in children with hydrocephalus or craniosynostosis. These findings suggest that SD-OCT shows promise as a surrogate, noninvasive measure of intracranial pressure and has the potential to advance current diagnostic and management paradigms for elevated intracranial pressure in children.

Invited Commentary

Because both maternal smoking during pregnancy and low birth weight have been implicated in impaired development of the retina, Ashina and coauthors determine the association of maternal smoking during pregnancy and low birth weight with retinal nerve fiber layer (RNFL) thickness later in a child’s life. In this population-based study of 1406 children in Denmark, children’s in utero exposure to maternal smoking and low birth weight were independently associated with the thinner RNFL observed during these children’s preadolescent years. These findings add evidence to existing recommendations for expectant mothers to avoid smoking during pregnancy and add support to other measures that promote maternal and fetal health.

Invited Commentary

Journal Club and CME

Intravitreous injections of anti–vascular endothelial growth factor agents have been associated with a sustained increase in intraocular pressure. As this sustained elevated intraocular pressure could lead to pressure-lowering glaucoma surgery, Eadie and coauthors evaluate the association of repeated intravitreous bevacizumab injections with the risk for glaucoma surgery. In a case-control study of 74 patients who underwent glaucoma surgery and 740 control participants, the adjusted rate ratio for glaucoma surgery was higher for patients who received 7 or more intravitreous bevacizumab injections per year than for those who received 3 or fewer injections annually. These results suggest that patients who receive 7 or more intravitreous bevacizumab injections per year have an increased risk for requiring glaucoma surgery.

Invited Commentary

Pyogenic granulomas, acquired vascular lesions, form on the ocular or palpebral surface related to inflammation from chalazia, trauma, or surgery, and they can be unsightly, spontaneously bleed, or cause irritation to patients. Oke and coauthors investigate whether ocular surface pyogenic granulomas resolve with topical β-blocker therapy. The investigators found that topical timolol, 0.5%, applied twice daily to ocular surface pyogenic granulomas resulted in complete resolution of the lesions in 4 children presenting consecutively to a tertiary care facility. These outcomes suggest that topical timolol, 0.5%, may be an effective alternative to topical steroids or surgical excision as a treatment for ocular surface pyogenic granulomas.