Effect of different mydriatic regimens used for pupil dilation on the vital signs of premature infants for retinopathy of prematurity screening in a Philippine tertiary hospital: A randomized double-blind clinical trial

@#<p style="text-align: justify;"><strong>Objectives.</strong> To determine the safety and efficacy of three different mydriatic regimens in premature infants referred for retinopathy of prematurity (ROP) screening using (1) multiple alternate instillations of 0.5% cyclopentolate hydrochloride and 2.5% phenylephrine (MAI), (2) single instillation of 0.5%/0.5% tropicamide + phenylephrine (SI) and (3) single instillation of 0.5%/0.5% tropicamide + phenylephrine with a cotton wick placed in the inferior fornix (SIW) in a Philippine tertiary hospital.</p><p style="text-align: justify;"><strong>Methods.</strong> A randomized, double-blind, clinical trial included preterm infants for ROP screening at a Philippine tertiary hospital. After instillations via MAI, SI, and SIW, systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate, and oxygen saturation were monitored. Pupillary dilation was also measured.</p><p style="text-align: justify;"><strong>Results.</strong> Sixty preterm infants, 20 to each intervention, were included. The MAI group did not have significant changes relative to its baseline vital signs. The use of SI produced lower DBP (p<0.0106) and MAP (p<0.0027) compared to MAI. The use of SI produced lower DBP (p<0.01) and MAP (p<0.003) compared to MAI. The SIW group exhibited significant increases in SBP (p<0.002) and in MAP (p<0.04) compared to MAI. This increase in SBP exceeded the clinical normal values for <37 weeks old infants. Pupillary dilation did not have significant differences among groups (p=0.24).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Due to significant increase in SBP, it is recommended to discontinue SIW in preterm infants for ROP screening since it may promote the mydriatic's systemic absorption. Except for the clinically increased heart rate in infants aged ?37 weeks at examination, SI was found to be at par with the recommendation of the UK ROP Guidelines of May 2008.</p>

Implementation and pilot data on diabetic retinopathy in a teleophthalmology program at a multispecialty primary care clinic

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.<br /><strong>METHODS:</strong> This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.<br /><strong>RESULTS:</strong> Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).<br /><strong>CONCLUSION:</strong> In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.</p>

Baseline macular pigment optical density among Filipinos with age-related macular degeneration

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the macular pigment optical density (MPOD) among Filipinos with and without age¬related macular degeneration (AMD).</p> <p style="text-align: justify;"><strong>METHODS:</strong> Consecutive patients with AMD and without posterior segment disease were recruited into the study Baseline MPOD measurements using an autofluorescence spectrometer were obtained. MPOD in the 0.5 degree retinal eccentricity and the average of 3 measurements (MPOD Max) was the primary outcome measure.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> 120 patients, aged 50 to 80 years, were included into 3 groups: group 1 (n=40) without retinal disease, group 2 (n=40) with non-neovascular AMD, and group 3 (n=40) with neovascular AMD. The mean baseline MPOD were: 0.382 ± 0.10 DU for group 1, 0.333 ± 0.07 DU for group 2, and 0.283 ± 0.07 DU for group 3. Significant differences were present comparing the MPOD values of the 3 groups.</p> <p style="text-align: justify;"><strong>CONCLUSION: </strong>Eyes without retinal disease had higher MPOD than those with early non-neovascular or neovascular AMD.</p>

Criteria for the timing of the initial retinal examination to screen for retinopathy of prematurity

Objective@#To determine the applicability of a modified criteria for initiating retinal examinations to screen for retinopathy of prematurity (ROP).@*Methods@#All ROP charts of babies who had initial retinal examination to screen for ROP from January 1, 2005 to December 31, 2008 at the neonatal-intensivecare nursery and eye center of a tertiary hospital were reviewed. Date of birth, sex, age of gestation (AOG), birth weight (BW), postnatal age (PNA), postconceptional age (PCA), and ROP classification were recorded. Descriptive statistics and Student’s t-test were used to analyze the data.@*Results@#A total of 690 eyes of 345 babies, 174 males and 171 females, were included in the study. At the initial retinal exam, the mean AOG was 31.39 ± 2.46 weeks; BW, 1,268.77± 317.12 grams; PNA, 4.56 ± 2.95 weeks; and PCA, 35.94 ± 3.26 weeks. Immature retinas in both eyes were seen in 175 (50.72%) babies, while 113 (32.75%) had ROP of any stage in both eyes and 51 (14.78%) had immature retina in one eye and ROP of any stage in the other eye. Among the 113 babies with ROP, 33 (29.2%) were assessed to have pre-threshold ROP.@*Conclusion@#This study supported the applicability of the modified criteria which are in agreement with the Joint Statements of the American Academy of Pediatrics, American Academy of Ophthalmology and American Association of Pediatric Ophthalmology and Strabismus, and the United Kingdom Royal College of Pediatrics and Child Health for initiating retinal exams to screen for ROP.

Intravitreal bevacizumab for neovascular age-related macular degeneration

Objectives@#Anti-vascular endothelial growth factor (anti-VEGF) drugs delivered intravitreally have been proven effective and safe for the treatment of patients diagnosed with neovascular age-related macular degeneration (ARMD). This study evaluated the short-term biologic efficacy and safety of multiple intravitreal injections of bevacizumab in patients with neovascular ARMD.@*Methods@#A prospective, interventional, placebo-controlled, randomized clinical trial was done involving patients with active subfoveal neovascular ARMD. Excluded were patients with significant media opacity, concomitant retinal/ocular diseases, previous intravitreal injections, recent laser treatment or intraocular surgery, and contraindications to the drug. Demographic data were taken and a complete ocular examination, fluorescein angiogram (FA), and optical coherence tomogram (OCT) were performed. Patients received either 3 monthly intravitreal injections of 1.25mg bevacizumab or sham injections. Best-corrected visual acuity (BCVA) and central macular thickness were recorded at baseline, 2, 4, 8, and 12 weeks follow-up. Ocular/Periocular or systemic drug-related side effects or toxicities and iatrogenic complications were noted.@*Results@#Thirty eyes (15 per group) were included in the final analysis. Both treatment and control groups were comparable in baseline characteristics. There was a significant increase in the mean visual acuity (p < 0.001) in eyes treated with bevacizumab across all time periods. The average gain at the end of the study was 11.6 letters. This paralleled a similar significant decrease in central macular thickness for the treatment group (p < 0.02). No major ocular adverse events were noted.@*Conclusion@#This study supported the growing body of evidence that intravitreal injections of bevacizumab 1.25 mg result in short-term anatomical as well as functional improvement with minimal adverse events in patients with neovascular ARMD.