Other than obesity, no definitive insights have been gained regarding the apparent association between mode of delivery and long-term endocrine and metabolic outcomes in the offspring. We aimed to determine whether elective cesarean delivery (CD) impacts on long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton-term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent CD and those delivered vaginally (VD). Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan–Meier survival curve was used to compare cumulative morbidity incidence. Cox and a Weibull regression models were used to control for confounders. During the study period 131,880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11,768) and 91.1% (n=120,112) were VDs. The survival curve demonstrated a significantly higher cumulative incidence of endo-metabolic morbidity in offspring born via CD (P=0.010). In the regression models, adjusted for maternal obesity, CD was not noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring while maternal obesity emerged as a strong predictor. We therefore conclude that CD per-se does not appear to increase the risk for long-term pediatric endo-metabolic morbidity of the offspring.

Purpose: Pediatric vision screening programs can detect children with amblyopic anisometropia. We aim to determine which refractive factors may be associated with the persistence of anisometropia in this population. Methods: A cohort analysis included all children aged one to six years, evaluated for refractive status between 2012 and 2022 at the Maccabi Healthcare Services. Refractive data were collected at presentation and at a subsequent follow-up visit. Logistic regression models were used to analyze relationships between baseline refractive error and anisometropia at follow-up. Results: Of 35,854 children evaluated, 6.6% ( n = 2,358) had anisometropia at presentation. Those with a baseline anisometropia of ≥ 3.0 diopters exhibited a higher prevalence of anisometropia at the last follow-up compared to those with a baseline anisometropia of a lesser magnitude; when the more ametropic eye was hyperopic (73.5% vs. 41.4%, respectively, p < 0.001) or myopic (62.5% vs. 41.8%, respectively, p = 0.009). Adjusted odds ratios for anisometropia at follow-up increased with greater levels of baseline anisometropia with the more ametropic eye being hyperopic (OR = 3.75, 95% CI 2.57 – 5.48) or myopic (OR = 2.19, 95% CI 1.11 – 4.33). A higher degree of hyperopia, myopia and astigmatism at baseline demonstrated similar patterns. Conclusion: In anisometropic preschool-aged children, higher degrees of baseline anisometropia, hyperopia, myopia and astigmatism, are associated with a higher prevalence of future anisometropia. The likelihood for later anisometropia increases with greater levels of baseline anisometropia, hyperopia, myopia and astigmatism. Key messages: What is known Higher refractive errors, lifestyle factors and educational levels have been considered as risk factors for anisometropia. Severe anisometropia at young age is more prone to persist. What is new In this cohort of 2,358 anisometropic preschool-aged children, the likelihood for anisometropia at the last follow-up has increased considerably when, at baseline, the more ametropic eye was hyperopic. It has also increased with astigmatic hyperopia, which possibly underscores the combined effect of astigmatism and hyperopia on anisometropia persistence. These findings were independent of socio-economic status, body mass index, and country of birth.

Different techniques for artificial iris implantation with or without an intraocular lens, depending on lens status, are described in the literature. We describe a surgical technique for a custom-made artificial iris and toric-intraocular lens intrascleral flange fixation. We modified the “Backpack” artificial iris implantation surgical technique to facilitate an accurate alignment of the toric-intraocular lens in a patient with aphakia, aniridia, and high asymmetric astigmatism secondary to blunt trauma. Two months after the surgery, uncorrected visual acuity was 20/30, corrected to 20/25 with a refraction of −2.00 in the diopter sphere with no residual astigmatism. The artificial iris implant and toric-intraocular lens were well-centered. The patient was satisfied with the visual and cosmetic outcomes. This procedure, however, is not complication-free as our patient developed uveitis and increased intraocular pressure during the postoperative period, which was treated successfully.

The mainstay management of progressive epithelial cysts spans from fine-needle aspiration of the cyst content to radical en bloc excision. Such a surgical approach may result in cyst rupture, recurrence, or collateral tissue damage. Based on previous experience, we aimed at evaluating the off-label use of topical brimonidine as a conservative measure for treating epithelial cysts of the iris and conjunctiva before commencing a surgical excision. We describe two different cases of epithelial cysts in which topical brimonidine was issued with successful outcome, making the more traditional surgical intervention redundant.