Development of a joint set of database parameters for the EU-ROP and Fight Childhood Blindness! ROP Registries.

BACKGROUND/AIMS: The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes. METHODS: A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice. RESULTS: For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice. CONCLUSIONS: We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.

Local delivery of corticosteroids in clinical ophthalmology: A review.

Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.

Visual Acuity Improves in Children and Adolescents With Idiopathic Infantile Nystagmus.

PURPOSE: Idiopathic infantile nystagmus is associated with reduced visual acuity. Recent work has linked extraocular muscle surgery to improvements in visual acuity through childhood but no work has reported long-term secular trends in visual acuity in infantile nystagmus. Our aim is to describe visual acuity changes for children and adolescents with idiopathic infantile nystagmus to allow comparison for future interventional studies. DESIGN: Retrospective chart review. METHODS: Review of patients attending our center up to the age of 18 with a diagnosis of idiopathic infantile nystagmus and visual acuity measured using Snellen visual acuity. Patients provided informed consent. RESULTS: We observed improvements in best corrected visual acuity in 43 children and adolescents with idiopathic infantile nystagmus. Binocular best corrected visual acuity improved at a rate of -0.16 logarithm of the minimum angle of resolution (logMAR)/log year of age (P < 0.001), an improvement of 0.05 logMAR (half a Snellen line) as the age doubles. Intraclass correlation was 0.95 and interindividual correlation between visual acuity and age was significant (r = -0.24, P < 0.001). CONCLUSIONS: We describe a natural history of gradual improvement in binocular visual acuity in infantile nystagmus and provide a baseline against which future interventional work can be compared.

Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children.

PURPOSE: To describe the acute and chronic ocular manifestations of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap syndrome (Overlap syndrome) in children. DESIGN: Retrospective case series. METHODS: Medical records of children admitted to the Hospital for Sick Children between 2001 and 2011 with SJS, TEN, and Overlap syndrome were reviewed. Demographic information, all abnormal ophthalmic findings (and median time to first diagnosis), visual acuities, and ophthalmic treatments prescribed were collected for each eye for every patient. RESULTS: Thirty-six children were identified for inclusion in the study. Twenty-nine (81%) had acute ocular involvement, including all patients with TEN (n = 7). Conjunctivitis was the most common (78%) clinical sign. This, together with conjunctival membranes and subconjunctival hemorrhage, were the earliest signs, presenting by a median of 1 day. The percentage of patients and median time to occurrence of complications were as follows: for lid margin ulceration and corneal epithelial defects, 25%, 3 days; conjunctival ulceration, 39%, 3.5 days; symblepharon, 28%, 4 weeks; corneal opacification, 11%, 4 months; limbal stem cell failure, 8%, 7 months; and corneal vascularisation, 8%, 10 months after admission. Over 90% of children maintain a visual acuity of 20/40 or better in each eye at a mean follow-up of 1.4 years. CONCLUSIONS: Ocular involvement in SJS, TEN, and Overlap syndrome is common and the ocular manifestations may develop many months after the initial presentation, mandating the need for long-term follow-up of these children. Despite the high frequency of sight-threatening disease, most children maintain good vision in the long term.

Refractive outcome of prethreshold retinopathy of prematurity treated by diode laser: follow-up at 5 years.

BACKGROUND: The purpose of this study was to evaluate the refraction of eyes treated with diode laser photocoagulation for prethreshold retinopathy of prematurity (ROP) at a mean of 5 years after treatment. MATERIALS AND METHODS: Fifty infants with prethreshold ROP treated with diode laser at Hanoi Childrens' Hospital during the period 2008 to 2009 were reviewed. Refractive error was identified by cycloplegic refraction with Cyclogyl 1%. Myopia was divided into two categories based on magnitude: high myopia (more than -5.00 D) and low myopia (between 0 and -5.00 D). Hypermetropia was subdivided into low hypermetropia (between 0 and +5.00 D) and high hypermetropia (greater than +5.00 D). Astigmatism was classified as high if >2.00 D. Eyes with media opacification that interferes with retinoscopy were excluded. The refractive outcome was correlated with birth weight and gestational age. The anatomical and visual outcomes were recorded. RESULTS: One hundred eyes from 50 infants were included in the study. The mean birth weight was 1,426.4 g and the mean gestational age was 29.88 weeks. After 5 years of follow-up, the average spherical equivalent for 100 eyes was -2.87 D. On cycloplegic retinoscopy, high myopia (more than -5.00 D) was seen in 32% of eyes. Twenty (20%) eyes had nonsignificant hypermetropia, and high hypermetropia (more +5.00 D) was seen in only one eye (1%). The prevalence of astigmatism and high astigmatism (more than -2.00 D) was 79% and 49%, respectively. Three infants (6%) had esotropia and two infants (4%) had exotropia. None of the infants had nystagmus. CONCLUSION: The majority of patients who underwent diode laser therapy for prethreshold ROP had favourable anatomical and visual outcomes. High refractive error is common and may be the cause of visual impairment.

Corneal perforation associated with pellucid marginal degeneration and treatment with crescentic lamellar keratoplasty: two case reports.

PURPOSE: To describe 2 cases of corneal perforation associated with pellucid marginal degeneration (PMD) and subsequent successful management with crescentic lamellar keratoplasty. METHODS: Two cases are discussed along with the relevant literature. RESULTS: Both patients presented with spontaneous corneal perforations and associated features consistent with PMD. In both cases, there was fellow eye evidence of PMD, and 1 of the patients was already known to our unit with this diagnosis. Initial conservative measures were unsuccessful, and both patients underwent crescentic lamellar keratoplasty as the definitive surgical management with a good visual outcome. CONCLUSIONS: Crescentic lamellar keratoplasty is an effective technique for the management of this rare complication of PMD.

Diffuse lamellar keratitis associated with gonococcal keratoconjunctivitis 3 years after laser in situ keratomileusis.

A 29-year-old man presented with a 5-day history of a red eye with a purulent discharge. Three years previously, he had undergone laser in situ keratomileusis elsewhere. A diagnosis of gonococcal keratoconjuntivitis was made clinically and confirmed with culture. The patient subsequently developed diffuse lamellar keratitis (DLK). The keratoconjunctivitis and DLK resolved with antibiotic therapy and topical steroids. The cause and effect relationship of these 2 uncommon events is of interest.