Duane's Retraction Syndrome in a Cohort of South African Children: A 20-Year Clinic-Based Review.

PURPOSE: To describe the clinical features of Duane's retraction syndrome in a cohort of South African children and to analyze the differences between ethnic groups. METHODS: A retrospective case series of 120 patients seen between 1997 and 2017 at a tertiary referral center in Cape Town, South Africa. RESULTS: Type 2 Duane's retraction syndrome was most common in black children (54%), whereas type 1 was predominant in mixed race (68%) and white (94%) children. In this cohort, 63% of black children with Duane's retraction syndrome were boys, whereas 69% of white children and 59% of mixed race children were girls. Left eye involvement was the most common in all ethnic groups (44%), followed by right eye (41%) and bilateral (14%) involvement. The average age at presentation was 34.2 months (range: 1 to 144 months). Strabismus in primary position was present in 57 patients (46%), of whom 39% had esotropia and 61% had exotropia. A deviation in the primary position was more common in black (71%) children than in mixed race (39%) or white (41%) children. Ametropia was found in 94 patients (79%), amblyopia was present in 15 patients (13%), and 41 patients (34%) underwent surgery. CONCLUSIONS: This is the first study to provide robust data on the profile of pediatric Duane's retraction syndrome in the three main ethnic groups in South Africa, and it showed clear ethnic differences. Among black children, boys are affected more often, the proportion with type 2 Duane's retraction syndrome is more frequent, and surgery is required more often. Among white and mixed race children, girls are affected more often and type 1 Duane's retraction syndrome is predominant. [J Pediatr Ophthalmol Strabismus. 2019;56(4):248-253.].

Paralytic strabismus in South African Black and mixed race children--a 15-year clinic-based review.

PURPOSE: To describe the demographics and clinical profile of paralytic strabismus in South African black and mixed race children seen at a tertiary pediatric eye clinic. METHODS: A retrospective, descriptive case series of patients younger than 14 years diagnosed with paralytic strabismus at the Red Cross War Memorial Children's Hospital in Cape Town, between 1996 and 2010. RESULTS: A total of 166 children were studied. Of these, 74% were of mixed race descent while 26% were black. The most commonly affected cranial nerve was the fourth (52%). The sixth nerve was involved in 39% of cases, while 5% and 4% had third nerve palsy and multiple cranial palsies, respectively. The majority of mixed race children (58%) had fourth cranial nerve palsies, while 54% of black children had sixth nerve palsies. The most common cause of paralytic strabismus was congenital (55%), followed by trauma (18%). CONCLUSION: In this clinic-based study, paralytic strabismus was more common in mixed race children. Fourth nerve palsies predominated in mixed race children, whereas the majority of black children had sixth nerve palsies. Further population-based research is necessary to identify the determinants of ocular cranial nerve palsy in African children.

Comitant horizontal strabismus in South African black and mixed race children--a clinic-based study.

PURPOSE: To examine the types of comitant horizontal strabismus in children belonging to the two largest ethnic groups of the Western Cape, South Africa. METHODS: Retrospective review of 2371 children presenting with comitant horizontal strabismus to a single, large, pediatric tertiary referral center in Cape Town, South Africa, between 1997 and 2007. RESULTS: 81% of children were of mixed race and 19% were black. The overall esotropia:exotropia ratio was 73:27. For black children this was 85:15 and for mixed race, 71:29. The overwhelming majority of black children had congenital esotropias (74%), whereas accommodative esotropia was rare (9%). In mixed race children, esotopias were more equally divided between congenital (46%) and accommodative types (35%). Exotropias were uncommon in black children, and were mainly constant (61%). Intermittent exotropias predominated in mixed race children (55%). CONCLUSION: Congenital esotropia remains common in South African black children, and of the few who presented with exotropia, most had constant type. Accommodative esotropias were more prevalent in South African mixed race children, but in smaller proportions than in other studies. Exotropias were mostly intermittent in this ethnic group, and showed a similar profile to that in white American children.

Poststreptococcal syndrome uveitis in South African children.

OBJECTIVE: To describe the demographics, clinical features and management of the largest case series to date on poststreptococcal syndrome uveitis (PSU), a newly recognised immune-mediated response to group A ß-haemolytic streptococcus infection. METHODS: Case notes of all patients presenting to the Red Cross War Memorial Children's Hospital, Cape Town, with serologically confirmed PSU between 2004 and 2010, were retrospectively reviewed. RESULTS: A total of 22 cases were identified. Ages ranged from 4 to 12 years. 64% were black children and 64% were boys. Presenting visual acuities ranged from 6/6 to hand movements (median 6/24). 68% had bilateral disease. All had anterior uveitis (27% with posterior synechiae and 27% with hypopyon). 36% had vitritis and 23% had panuveitis. None had systemic illness or features of other poststreptococcal syndromes such as rheumatic fever, glomerulonephritis or polyarthritis. Anti-streptococcal titres (anti-streptolysin O and/or anti-deoxyribonuclease B) were significantly raised in all cases. Treatment comprised topical steroids and cycloplegic agents. Those with severe posterior segment involvement (41%) were treated with systemic corticosteroids. 55% received a course of oral penicillin. 82% had a single episode of uveitis. Four children had recurrences. Final visual acuities ranged from 6/6 to 6/36 (median 6/6). CONCLUSION: This case series significantly increases the evidence for PSU currently available in the world literature. The condition can manifest with the full spectrum of ocular inflammation, and most cases respond well to standard uveitis regimens. The role of antibiotic therapy remains unclear and requires further investigation.