Safety and efficacy of intravitreal anti vascular endothelial growth factor for severe posterior retinopathy of prematurity with flat fibrovascular proliferation

BACKGROUND Intravitreal anti-vascular endothelial growth factor(IVA)injection is known to cause contraction of fibrovascular proliferation(FVP),when present in severe retinopathy of prematurity(ROP).AIM To assess the structural outcomes of IVA injection in the treatment of severe posterior ROP with significant FVP.METHODS It was a retrospective study in which 36 eyes of 18 preterm babies who developed>4 clock hours of FVP in zone I or posterior zone II,were treated with either intravitreal 0.625 mg bevacizumab or intravitreal 0.2 mg of ranibizumab.Favorable structural outcome included resolution of plus disease and FVP without the development of tractional retinal detachment.Secondary outcome measure included either full retinal maturation at follow-up or development of recurrent disease requiring additional treatment.Adverse outcomes included progression to retinal detachment.RESULTS The mean gestational age of the 18 preterm babies was 30 wk(range 27-36),and mean birth weight was 1319 g(range 650-1980 g).Mean post-menstrual age(PMA)at the time of primary treatment was 35.5 wk(range 31-41 wk).All eyes showed regression of plus disease and FVP.5 eyes of 3 babies showed reactivation of disease and were treated with repeat IVA(n=2 eyes)or peripheral laser photocoagulation(n=3 eyes)respectively.16 out of 36(44%)reached retinal vascular maturation at final follow up at 5 years.CONCLUSION There was good resolution of severe posterior ROP with FVP with IVA,with retinal maturity of 44%at 5 year follow-up and a reactivation rate of 13.8%.When the IVA injection is given prior to 37 wk PMA,while disease is in phase 2,it is less likely to cause contracture of pre-existing FVP.

Retinopathy of prematurity: Past, present and future

Retinopathy of prematurity(ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940 s and 1950 s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

Is myopia a protective factor against central serous chorioretinopathy?

AIM： To evaluate if any association exists between central serous chorioretinopathy （CSCR） and the refractive status of the eye. METHODS： This retrospective, institutional, case control study included 499 patients, wherein 262 patients diagnosed as acute CSCR, were compared with an age and gender matched control group of 237 patients. All patients were evaluated with a detailed systemic and ocular history, objective and subjective refractions for both eyes and complete ocular examination by a retina specialist, at all visits. Optical coherence tomography confirmed the diagnosis of CSCR. ~ RESULTS： The mean age was found to be 40.7y in the study group （Group 1） compared to 38 10y in the control group （Group 2）. Most common refractive status in the study group, was emmetropia seen in 191 patients （72.9%）, followed by hypermetropia seen in 47 patients （17.9%） and astigmatism seen in 21 patients （8.0%）. Only 3 subjects （1.1%） had myopia, which was less than or equal to 1.0 D, compared to 70 subjects （29.5%） in the control group, suggesting a statistically significant lower incidence of CSCR among the myopic patients （P〈 0.0001）. With respect to the systemic factors, 26 （9.9%） patients were using systemic steroids in the study group （Group 1） compared to none in the control group （Group 2） suggesting a statistically significant association of CSCR with systemic steroid use （P〈0.05）. No other significant systemic risk factors were noted. CONCLUSION： Though CSCR is a multifactorial disease, myopia serves as a protective factor for CSCR. Thus, myopic eyes are less likely to develop CSCR. Since both retinal pigment epithelium （RPE） and choriocapillaris are postulated in the pathogenesis of CSCR, chorio-retinal thinning and atrophy seen in myopic eyes are less likely to cause CSCR.

Clinical profile and outcomes of pediatric endogenous endophthalmitis: A report of 11 cases from South India

AIM To study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODS A total of 13 eyes of 11 children presented to us with varied symptoms and presentations of endogenous endophthalmitis, over a five-year period from January 2010 to December 2015 were studied. Except for two eyes of a patient, vitreous aspirates were cultured from all 11 eyes to isolate the causative organism. These eleven eyes also received intravitreal injections. All patients were treated with systemic antibiotics. RESULTS Two cases had bilateral endophthalmitis. Ages ranged from 4 d to 11 years. Five cases were undiagnosed and treated, before being referred to our center. Ten of the 13 eyes underwent a core vitrectomy. The vitrectomy was done at an average on the second day after presenting(range 0-20 d). Five of the 11 vitreous aspirates showed isolates. The incriminating organisms were bacteria in three and fungus in two. An underlying predisposing factor was found in seven patients. At a mean follow-up 21.5 mo, outcome was good in 7 eyes of 6 cases(54%), five eyes of four cases(38%) ended up with phthisis bulbi while one child died of systemic complications. CONCLUSION Endogenous endophthalmitis is a challenge for ophtha-lmologists. Early diagnosis and intervention is the key for a better outcome.

In vitro and comparative study on the extracellular enzyme activity of molds isolated from keratomycosis and soil

AIMTo isolate and identify the molds involved in mycotic keratitis; to isolate corresponding species from soil samples; to compare the extracellular enzyme activity indices of the molds isolated from keratitis cases and the corresponding soil isolates.

The Indian retinopathy of prematurity society:a baby step towards tackling the retinopathy of prematurity epidemic in India

Background:India leads all nations in the number of preterms born annually.With over 3.5 million infants,a reducing infant mortality rate and an expanding base of rural neonatal intensive care units,the number of infants requiring retinopathy of prematurity(ROP)screening has dramatically increased.The number of ROP specialists in the country is currently inadequate.Leading ROP specialists of the country initiated the Indian ROP(IROP)society to address these challenges.Methods:In 2016,the IROP society was conceived and registered as a professional body with a mission to prevent needless blindness from ROP by promoting standards of excellence.A national online membership drive was carried out.The data collected in this survey was analyzed to collate information on past training,practice patterns,ease of screening and treatment,use of wide-field imaging and willingness to be certified.Results:Of the 113 members at the time of submission,67.3%were male.88.5%were formally trained for ROP and 85.8%were vitreo-retinal specialists.Of the practicing members,96%were“comfortable”with screening and 86%with ROP treatment and this correlated with training(P=0.001 and P=0.002 respectively).Only 25.7%performed vitreous surgery for ROP.Wide field imaging was used by 33%of members in their practice and 52%of those who did not,wanted to use it in the future.Members who used imaging performed more number of laser treatments than those who did not(P=0.008).Laser was the preferred modality of treatment for 98%of members.A majority of the members(92.5%)were willing to be audited.Conclusions:The IROP society is a novel platform for ROP specialists to collaborate.The society has setup short,mid and long-term goals to make ROP care more accessible and affordable with appropriate use of technology.

Outcomes of transconjuctival sutureless 27-gauge vitrectomy for stage 4 retinopathy of prematurity

AIM To report our initial experience with lens-sparing vitrectomy for stage 4 retinopathy of prematurity using the 27-gauge(G) system.METHODS This retrospective case series involved nine eyes of five babies with active stage 4 ROP, who underwent 27-G lens-sparing vitrectomy. Surgery was done using 27-G valved cannulas and sclerotomies were made 1.5 mm from the limbus. Bilateral sequential vitrectomy was done in eight eyes. RESULTS At one-year follow-up, anatomical outcome was favourable in all nine(100%) eyes. High-speed cutting and smaller sclerotomies were helpful in reducing the intra and post-operative complications. CONCLUSION27-G vitrectomy is well suited for stage 4 ROP surgeries.

Outcomes of additional posterior to ridge diode laser versus conventional laser anterior to ridge in severe stage 3 retinopathy of prematurity-a randomized control trial

Background:Laser photocoagulation restricted to ablation of the avascular retina has been the conventional but not a completely effective treatment strategy in the management of threshold retinopathy of prematurity(ROP).The purpose of this study was to compare the structural outcomes of additional posterior to ridge diode laser compared to conventional diode laser to avascular retina alone in threshold stage III ROP.Methods:This was a prospective,randomized study involving infants diagnosed with threshold stage III ROP in one or both the eyes.The infants were randomized into control and study groups.Infants under the control group underwent conventional laser to avascular retina alone while infants under the study group received additional two rows of laser posterior to the ridge in the vascular retina.The infants were followed up at 2 weeks,1 month and up to 6 months after the laser procedure.Results:During the study period of 1 year,42 eyes of 24 infants were recruited into this study with 21 eyes in each group.The mean birth weight was 1,310.48±400.92 g in the test group and 1,341.9±396.2 g in the control group.The mean post conceptional age at the time of intervention was 36.43±2.79 weeks in test group and 36.29±2.55 weeks in the control group.At 1-month post laser,19 eyes in the study group showed regression of neovascularization laser compared to 18 eyes in the control group.However at the end of 3 and 6 months post laser,both groups had showed similar rates regression of neovascularization(19 of 21 eyes in both groups).Five eyes in the study group and six in the control group required additional laser treatment.Two eyes in the study group and one eye in the control group developed post laser vitreous hemorrhage.Conclusions:Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser.