Neonatal eye screening for 203 healthy term new-borns using a wide-field digital retinal imaging system

Background The current practice for new-born eye examination by an Ophthalmologist in Malaysian hospitals is limited to only preterm new-borns, syndromic or ill infants. Healthy term new-borns are usually discharged without a thorough eye examination. This study is aimed at determining the proportion and types of ocular abnormalities detected in purportedly healthy term new-borns. Method This cross-sectional study is comprised of 203 participants, all purportedly healthy term new-born infants from the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a 6 months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared and correlated with similar studies published in the literature previously. Results Total ocular abnormalities were detected in 34% of the infants. The most common finding was retinal haemorrhage in 29.6% of the infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of new-borns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1-min increment in the duration of 2nd stage of labour. Conclusion Universal eye screening for all new-borns using a wide-field digital imaging system is realistically possible, safe, and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage.

3,4-methylenedioxymethamphetamine (MDMA)-induced macular haemorrhage: A case report

A case of 28-year-old female patient with retinal haemorrhage after taking 3,4-methylenedioxymethamphetamine (ecstasy, MDMA) and having a sexual intercourse is described. Ecstasy is a drug that is often consumed by young people. It leaves various consequences on the human body. Retinal haemorrhage in the eye caused by ecstasy has been described before. Like in this case, the experience in spontaneous resolving of the MDMA-induced retinal haemorrhage is favourable.

Disability and visual outcomes following suspected abusive head trauma in children under 2 years

AimTo report disability and visual outcomes following suspected abusive head trauma (AHT) in children under 2 years.MethodsWe present a retrospective case series (1995–2017) of children with suspected AHT aged ≤24 months. King’s Outcome Score of Childhood Head Injury (KOSCHI) was used to assess disability outcomes at hospital discharge and at follow-up. The study used a retinal haemorrhage score (RHS) to record findings at presentation and a visual outcome score at follow-up.ResultsWe included 44 children (median age 16 weeks). At presentation, 98% had a subdural haemorrhage and 93% had a retinal haemorrhage. At discharge, 61% had moderate-to-severe disability, and 34% a good recovery. A higher RHS was observed in those with more disability (r=−0.54, p=0.0002). At follow-up, 14% had a worse KOSCHI score (p=0.055). 35% children had visual impairment, including 9% with no functional vision. Those with poorer visual function had a higher RHS (r=0.53, p=0.003). 28% attended mainstream school without support; 50% were in foster care or had been adopted, 32% lived with birth mother and 18% with extended family.ConclusionIt is known that injuries from suspected AHT result in high levels of morbidity; our cohort showed significant rates of disability and visual impairment. Those with higher disability at discharge and poorer visual function showed more significant retinal changes. The extent of disability was not always apparent at hospital discharge, impacting on provision of prognostic information and targeted follow-up.

MO002OPHTHALMOLOGICAL EFFECTS OF ROXADUSTAT IN THE TREATMENT OF ANAEMIA IN CHRONIC KIDNEY DISEASE PATIENTS ON DIALYSIS IN A PHASE 3, RANDOMISED, DOUBLE-BLIND, ACTIVE-COMPARATOR CONVERSION STUDY

Background and Aims Roxadustat is an orally administered hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) approved in China for the treatment of dialysis-dependent (DD) and non–dialysis-dependent chronic kidney disease (CKD) anaemia, and in Japan for the treatment of DD CKD anaemia. An acceptable safety profile as well as noninferiority of roxadustat to darbepoetin alfa (DA), measured by haemoglobin (Hb) change from baseline (BL), was shown in patients (pts) with DD CKD in a Japanese phase 3, randomised double-blind, double-dummy study (CL-0307). Some nonclinical data suggest that HIF stimulation may promote angiogenesis, thereby increasing the risk of certain retinal pathologies. As such, this report focuses on a prospective analysis of ophthalmological/retinal-related events observed during the 24-week study period of the aforementioned phase 3 study. Method Japanese pts with DD CKD were randomised 1:1 to receive roxadustat three times weekly or DA once weekly; doses were titrated to maintain Hb between 10–12 g/dL. Ophthalmological/retinal-related outcomes were evaluated in pts who received ≥1 dose of study drug (SAF) and included emergence of adverse events assessed by the investigator and ophthalmological findings based on assessments performed by centralised grading. Ophthalmic imaging (colour fundus photography, optical coherence tomography) and assessment of visual acuity were performed at BL, Week 12, and Week 24 or at study discontinuation according to Ophthalmic Image Acquisition Guidelines. Each investigator evaluated the ophthalmic images and assessed the clinical relevance of any changes. Central evaluation of ophthalmological examination results was then performed by two independent specialists who were blinded to study treatment. During central evaluation, the reviewers assessed ophthalmic images in accordance with the Safety Independent Ophthalmology Review Charter. If graders’ results disagreed, adjudication was performed by a blinded, independent grader who did not participate in the primary review of the patient data. Grading results and visual acuity were analysed descriptively. Results In the SAF, a total of 302 pts were randomised to receive either roxadustat (n=150) or DA (n=152). At BL, previous or concurrent retinal vascular disorders were present in 41.3% (62/150) and 37.5% (57/152) of pts in the roxadustat and DA groups, respectively; 32.7% (49/150) and 27.6% (42/152) of pts presented with a history of both diabetes mellitus and retinal vascular disorders, respectively. The mean (SD) duration of exposure to study drug was 146.7 (45.8) days in the roxadustat group and 154.7 (37.4) days in the DA group. The proportion of pts with new or worsening retinal haemorrhages during the treatment period was 32.4% (n=46/142) with roxadustat and 36.6% (n=53/145) with DA. In a subgroup analysis of pts with no retinal haemorrhage at BL, the proportion of pts with new retinal haemorrhages was 19.1% (n=18/94) with roxadustat and 25.0% (n=24/96) with DA during the treatment period; in pts with ≥1 retinal haemorrhage at BL, the proportion of pts with new or worsening retinal haemorrhages was 58.3% (n=28/48) with roxadustat and 59.2% (n=29/49) with DA during the treatment period. From BL, no clinically meaningful changes in visual acuity or retinal thickness were found in either treatment group. Similarly, from BL, no clinically meaningful changes were found in the proportion of pts exhibiting intra-/sub-retinal fluid, hard exudates, or cotton wool spots in either treatment group. Conclusion These findings suggest that, during the 24-week treatment period, DD CKD pts treated with roxadustat were not at an increased risk of ophthalmic abnormalities—including retinal haemorrhages or increased retinal thickness—compared with pts treated with DA.

Neonatal Eye Screening for 203 Healthy Term Newborns Using a Wide-Field Digital Retinal Imaging System

Purpose: This study aimed to determine the proportion and types of ocular abnormalities detected in healthy term newborns and also the risk factors associated with retinal haemorrhages.Method: This cross-sectional study comprised of 203 participants, all healthy term newborn infants in the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a six months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared with similar studies previously published in the literature.Results: Total ocular abnormalities were detected in 34% infants. The most common finding was retinal haemorrhage in 29.6% infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of newborns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1 minute increment in the duration of 2nd stage of labour. Conclusion: Universal eye screening for all newborns using a wide-field digital imaging system is possible, safe and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage. Although most resolve spontaneously, a longitudinal study is needed to study the long term effect of retinal haemorrhages in these infants.