Observation of hyaloid artery remnants in premature infants

AIM: To observe the hyaloid artery remnants in the eyes of premature infants. METHODS: This retrospective study recruited premature infants who consecutively attended the Tongji Hospital for retinopathy of prematurity screening from May 2018 to November 2018. The binocular indirect ophthalmoscope was used for examination. RESULTS: In total, 60 cases were pulled for data analysis. The cases were categorized as having the following condition: hyaloid artery remnants positive or hyaloid artery remnants negative. It was showed that the remnants positive group had significant lower gestational age and birth weight than those of the negative group (P<0.05). There was no significant difference in gender, labor presentation and retinopathy of prematurity between the two groups (P>0.05). The hyaloid artery remnants completely regressed in all the follow-up cases. The range of disappearing time of hyaloid artery remnants was 37-44wk of corrected gestational age. CONCLUSION: The hyaloid artery remnants in preterm infants are most likely to be physiological residues. Younger or lower weight premature infants will have higher positive detection rates of hyaloid artery remnants. It seems like co-existence with retinopathy of prematurity (ROP) has no significant association with the detection of hyaloid artery remnants. When the corrected gestational age extends over 43wk, if the hyaloid artery remnants don’t regress, there is a possibility of pathological changes, and appropriate interventions should be selected according to the severity of the lesions.

Comparative evaluation of a new frugal binocular indirect ophthalmoscope

Objectives We compare the optical quality and design characteristic a new low cost solar powered binocular indirect ophthalmoscope (BIO), Holo, to Keeler BIO. Methods Twenty-four participants each examined 10 simulation eyes using both the Holo and the Keeler BIO with a 30-diopter condensing lens. Number of Lea symbols printed on the retina of simulation eyes seen and time taken to identify them was recorded. Stereoacuity of 12 participants was tested while using the BIOs. Using 7-point Likert scale, participants gave feedback on design characteristic of both BIOs. Results There was no statistical difference in number of Lea symbols correctly identified (15.63/20 for Holo vs. 15/20 for Keeler BIO, p = 0.366, paired t test) or time taken to correctly identify each symbol (Holo 0.39 s faster; 95% confidence interval −2.24 to 3.03 s, p = 0.763) using each device. 12 out of 12 participants achieved stereoacuity of 60 arcsec using the Holo while with the Keeler BIO 11 achieved 60 arcsec and one 90 arcsec. There was no statistically significant difference in the scores for clarity of view, quality of illumination, field of view, binocularity, eye strain and robustness between the two devices. The Holo, scored higher for ease of use (6.5 vs. 6, p = 0.00488, Wilcoxon signed-rank test), comfort of wear (6 vs. 5, p = 0.000337) and portability (7 vs. 6, p = 0.000148). Conclusion The Holo has the potential to be a clinically useful yet affordable diagnostic tool suitable for the first time of equipping eye care workers in low resource settings with a BIO at volume.

Inexpensive Binocular Indirect Ophthalmoscopy

We aim to discuss an inexpensive method of conducting binocular indirect ophthalmoscopy without the binocular indirect ophthalmoscope headset. This technique only requires the examiner to hold a light source between their eyes and hold a condensing lens at an arm’s length. This may be particularly valuable in resource-poor settings.

Prevalence of risk factors associated with ocular problems in males and females in type 1 & 2 diabetes

Background: The aim of current study was exploring the ocular abnormalities in individuals with Type 1 & 2 diabetes. Methods: Patients referred for diabetic ocular abnormalities (retinopathy, cataract, glaucoma and refractive error) on fundoscopy from LRBT eye hospital Korangi, Karachi were randomly included in the study. Retinopathy, cataract and refractive error were evaluated by slit lamp biomicroscope or indirect ophthalmoscope, & categorized into lacking, non-proliferative, proliferative retinopathy, maculopathy, capsular or sub capsular cataract, myopia and hypermetropia. While glaucoma was assessed by tonometry. Prevalence of eye complication has been seen in subjects. Outcome of substantial risk factors on the diverse phases of retinopathy, multivariate regression analysis was performed. Results: 200 diabetic subjects (106 males and 94 females) when the compared; diabetic subjects and subjects with hypertension; 28.0 % retinopathy, 9.75 % cataract, 7.31 % with glaucoma, and about 2.43% refractive error were found out among the diabetic males. 47.61 % retinopathy, 11.9% Cataract, 40.47% refractive error were found in females. In males with diabetes and hypertension were found 60.46 % retinopathy, 27.9 5% cataract, 11.62 % refractive error & in females 46.15% retinopathy, 19.23 % cataract, and 34.61 % with refractive error. Conclusions: This current study emphasizes screening of diabetic subjects regularly so as to distinguish ocular abnormalities and increasing public awareness.

Study of Occurrence of Cataract and their Surgical Management in Dogs

Background: Present study investigated the occurrence of cataract in dogs presented to the Teaching Veterinary Clinical Complex (TVCC) and Department of Veterinary Surgery and Radiology under Odisha University of Agriculture and Technology, Bhubaneswar during a period of four months. During the study period, a total number of 3847 canine cases were registered at TVCC, out of which 23 cases registered under the RKVY project for different types of ophthalmic affections. There were only eight canine cataract cases with overall prevalence of 0.2% among total canines presented to TVCC and 34.78% of total canines presented with some sorts of ophthalmic affections. Methods: Menace reflex, pupillary light reflex, maze test, obstacle test, catoptrics test, Schirmer’s tear test (STT), Schiotz tonometry, Slit lamp bio microscopy and fundus examination -using indirect ophthalmoscope (IO) and fundus camera, were carried out in all the cases studied. Result: Occurrence of cataract was higher in Spitz (50%). Males had more incidences (62.5%) of cataract. The ages of the dogs were less than 10 years. B mode ultra-sonographic (USG) examination revealed increased echogenecity of lens in all cataract affected dogs while corneal opacification was found in two cases. Cataract was extracted by phaco-emulsification in three dogs and by small incision cataract surgery (SICS) technique in one dog.

A Longitudinal Study of Retinopathy of Prematurity at Great Eastern Medical School and Hospital, Srikakulam

BACKGROUND Retinopathy of prematurity (ROP) is a vasculopathy affecting the premature retina. In India ROP is increasing due to the increased premature deliveries, well improved neonatal care and better neonatal survival rate. ROP screening by an experienced ophthalmologist plays an important role in screening, identifying and management of at-risk premature infants. Nowadays, the gold standard treatment is laser photocoagulation of avascular retina and anti-vascular endothelial growth factor (VEGF) depending on the severity of disease. METHODS This observational study included 152 babies who were referred to the Department of Ophthalmology at Great Eastern Medical School (GEMS), Srikakulam for ROP screening. The screening of eyes was done with a binocular indirect ophthalmoscope with 20 D lens. Eyes were examined by application of topical anaesthetic drops after applying topical tropicamide drops till full dilatation was noted. ROP was staged and treatment was given accordingly. RESULTS Totally 152 infants were screened for ROP in the Department of Ophthalmology. Babies with gestational age between 26 weeks and 36 weeks were included in the present study. Babies with birth weight between 900 gm and 2000 gm were also included in the study. Of the 152 babies which were included in the study, 54 babies presented with different stages of ROP. The incidence of ROP in the present study was found out to be 35.5 %. When incidence of ROP was noted with respect to birthweight, in extremely low birth weight (ELBW) babies, incidence was found out to be 71.4 %; in very low birth weight (VLBW) babies incidence rate was found to be 48.4 %. When incidence of ROP was noted with respect to gestational age ROP incidence was found to be 65.2 % in babies with gestational age of < 32 weeks. There was no association with gender in the incidence of ROP. When ROP incidence was noted in babies who received O2 therapy 59.2 % babies who received O2 therapy developed ROP. CONCLUSIONS In our study, at our institute the incidence of ROP was 35.5 %. With appropriate screening for the babies at risk we can prevent the development of ROP and further complications. According to study results our recommendations are that initial screening should to be done as early as 4 weeks of postnatal age or 34 - 35 weeks post conceptional age and to be followed till term gestation. In the present study we found that usage of anti VEGF came out with promising outcome results. The procedure of anti VEGF was relatively safe and easy with a smaller number of complications when compared to laser photocoagulation. KEYWORDS Retinopathy of Prematurity, Laser Photocoagulation, Indirect Ophthalmoscope, Tropicamide, Anti VEGF

Survey of the use of laser protective eyewear among international retina specialists: a European vitreoretinal society study

ObjectiveTo report the trends for the use of eye protection methods during retinal laser in clinic and operating room.Methods and analysisRetrospective analysis of a 14-item survey questionnaire submitted to the European Vitreoretinal Society members.ResultsResponses from 630 members were analysed. Most of the respondents practised in Europe (52.7%), followed by North America (21.0%). The majority of respondents had laser filters in the microscope for the operating surgeon (92.1%), or used protective goggles (6.8%). Only 38.9% of respondents indicated that auxiliary staff in the operative room used protective goggles during laser treatment. Three-dimensional retina viewing system was used by only 22.5% of respondents, of those, 34.5% reported use of laser protection goggles by the operating surgeon. Rates of laser protection by auxiliary staff were 62.9% for indirect laser and 60.8% for slit lamp laser. We found a higher rate for use of laser protection by auxiliary staff in North America-based practices for endolaser (p<0.00001), laser indirect ophthalmoscope (p<0.00001) and slit lamp laser (p=0.00033) compared with the rest of the world.ConclusionThe use of laser protection methods is routinely adopted by the physicians in the operating room and clinic, but less so by their assisting or auxiliary staff.

Prevalence of Ocular Abnormalities in Term Infants

Objective: To exhibit the results of routine ophthalmologic screening in infants between 0-1 years of age referred to the ophthalmology clinic from the departments of pediatrics and family medicine. Method: Referred to the ophthalmology clinic between August 2014 and November 2019, 11196 eyes of 5598 term infants were retrospectively investigated in the study, and all participants were ophthalmologically examined at 1st, 6th, and 12th months of age. Infants’ pupils were dilated with 0.5% tropicamide and 2.5% phenylephrine. On examination, eye and face symmetries were evaluated with inspection, fixation, and ocular tracking. Pupil responses and motility were evaluated with the light source. While the red reflex test was evaluated using a direct ophthalmoscope, fundus was assessed through an indirect ophthalmoscope. Results: Congenital cataract (6), congenital glaucoma (3), strabismus (81), epiphora (426), non-specific retinal hemorrhages (42) and retinal pigmentation changes (10), coloboma (4) (one eyelid, four iris, one optical disc and three chorioretinal), optic disc abnormalities (3), congenital ptosis (13) (unilateral in 12 patients and bilateral in one patient), corneal dysgenesis (2) and microphthalmia (3) were determined in 11196 eyes of 5598 infants (2709 females, 2889 males). Conclusion: Perinatal ophthalmologic screening program is likely to diagnose several diseases earlier, such as congenital cataracts, congenital glaucoma, strabismus, corneal opacities, causing vision losses in infants. Treatment options are available, and some diseases can be treated due to early intervention. Early treatment can also eliminate the problems precluding the development of complex visual ability continuing in perinatal period. Consequently, final visual acuity may be increased.

Evaluation of real-time video from the digital indirect ophthalmoscope for telemedicine consultations in retinopathy of prematurity

Introduction This study aimed to evaluate the validity of using real-time video indirect ophthalmoscopy for telemedicine consultations for paediatric retinal findings, using retinopathy of prematurity (ROP) as a model disease. Methods An ophthalmologist simultaneously performed and recorded routine ROP screenings on enrolled premature infants (aged ≤30 weeks and weighing <1500 g) using the Keeler digital indirect ophthalmoscope. Examinations were graded as no ROP, mild, type 1 or type 2. Masked to clinical findings, another ophthalmologist reviewed and graded streamed video feed transmitted at 4096 kbps. We compared the sensitivity and specificity of diagnosing ROP via streamed and stored-and-forwarded video clips to the gold-standard in-person examination. Results A total of 150 examinations of individual eyes from 34 babies were included. The median postmenstrual age (PMA) at delivery was 24 weeks (range 23–34 weeks), the median birth weight was 630 g (range 455–1530 g) and the median PMA at examination was 37 weeks (range 31–54 weeks). Of those infants with any ROP, the sensitivity and specificity of streamed examinations were 100% and 70.6%, respectively. For type 2 or worse ROP, the sensitivity and specificity were 92.5% and 86.1%, respectively. For type 1 ROP, the sensitivity and specificity were 100% and 99.3%, respectively. Sensitivities (unless already 100%) and specificities were slightly higher for store-and-forward evaluations. Discussion Streamed video feed from the digital indirect ophthalmoscope can be utilised to diagnose clinically significant ROP accurately, though store-and-forward video review yielded slightly better results.