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.

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.

Regaining birth weight and predicting ROP-a prospective, pilot study

Background:Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity(ROP).Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations.The duration taken to regain the lost weight is culturally important among Indian mothers.We report the correlation between this duration and the risk of developing ROP.Methods:Sixty-eight Asian Indian infants born<2,000 grams at birth or<34 weeks of gestation were enrolled.The number of days taken for these infants to regain baseline birth weight(BW)was recorded.This measure was correlated with the eventual ROP outcome categorized as“no ROP”,ROP that regressed spontaneously(type 2 ROP),and ROP that required treatment(type 1).Results:The mean BW of the cohort was 1,270±340 grams and mean gestational age(GA)was 31±2 weeks.Thirty-three infants(48.5%)developed no ROP,20 infants(29.4%)developed type 2 ROP and 15 infants(22.1%)developed type 1 ROP.The mean number of days to regain the lost weight was 11.9+4.6,17.9+7.9 and 26.6+12.9 days for the No ROP,type 2 and type 1 groups respectively(P<0.0001,one-way ANOVA with Boneferroni correction).Those babies who regained their BW within 10 days were at least risk of developing any stage ROP,moderate risk if they took between 11-20 days and highest risk if they took more than 21 days for developing type 2 or type 1 ROP.Conclusions:The date when a child regains its lost BW is culturally important and easily recalled by mothers.We report the use of this simple estimate as a predictor of ROP.This method could be useful in stratifying risk and predicting the development of“treatment requiring ROP”even before 21 days of life,which is the first mandated screening visit in India.