Ophthalmic Pathology in the Offspring of Pregnant Women with Gestational Diabetes Mellitus.

BACKGROUND: Gestational diabetes (GD) occurs in 5.8% to 25.1% of pregnant women. This disorder has been linked with intrauterine growth delays, congenital anomalies, and neurobehavioral disorders following birth. As to ophthalmological effects, changes in macular thickness and hypoplasia of the upper quadrant of the papilla have been described. OBJECTIVE: To investigate whether GD has an effect on ophthalmological development in the children born of mothers with this condition. METHODS: Observational study carried out in children seen in the ophthalmological outpatient clinic of a pediatric hospital in Barcelona (Spain) between January 2011 and December 2015. Participants were ultimately divided into two groups, a study group whose mothers had GD managed either by insulin or diet (GD group) and a control group of children with non-diabetic mothers. Pregestational diabetes cases, were excluded. Complete information was collected on the children's refraction status, ophthalmological disease, and congenital malformations. RESULTS: Data were compiled on 350 children (229 children born of mothers with GD-186 managed with diet vs 43, with insulin- and 121 controls). The prevalence of amblyopia and strabismus was similar between the groups, but children of mothers with GD had a three-fold greater probability of having refractive errors than children born to mothers without GD. Hyperopia (14.8% vs. 7.4%) and myopia (3.5% vs 0%) were found to be significantly more prevalent in children born of mothers with GD than in the controls (p = 0.027 in both groups).The prevalence of astigmatism was similar in both groups (1.7% vs 0.8%). CONCLUSIONS FOR PRACTICE: Refractive errors are more common in children born of mothers with GD. These conditions are easily managed, but if they are not detected, they can lead to amblyopia or accommodative strabismus, interfere with acquisition of fine motor skills, and lead to learning problems. Regular ocular examinations would be recommended in these patients.

Hemorràgia retinal neonatal d’evolució prolongada / Hemorragia retiniana neonatal de evolución prolongada / Neonatal retinal hemorrhage of prolonged evolution

Introducció: es presenta el cas d'un nounat amb hemorràgies retinals d'origen perinatal i evolució atípica, i es discuteix el valor de la presència d'hemorràgies retinals en els infants menors de 12 mesos amb lesions que facin sospitar un possible maltractament. Cas clínic: nadó fill d'una mare sense control de l'embaràs en la qual es detecta serologia positiva a lues durant el part. L'estudi del nadó no presenta signes d'infecció luètica, però, en fer el cribratge d'una possible corioretinitis luètica, s'observen hemorràgies retinals. El seguiment de l'evolució de les hemorràgies mostra signes de reabsorció als 2 mesos que persisteixen més enllà dels 3 mesos. Comentaris: la freqüència global d'hemorràgies retinals en nadons sense altres símptomes varia, segons el tipus de part, entre un 10% en els casos de cesària electiva i fins a un 50% en els parts instrumentats amb vacuum. La majoria es reabsorbiran en 2-4 setmanes i la literatura només recull un cas que va desaparèixer als 58 dies. El cas presentat demostra que no és impossible que durin més enllà d'aquest límit. D'altra banda, la presència d'hemorràgies retinals en els infants amb lesions cerebrals és un dels signes que han de fer pensar en una causa no accidental, és a dir, per maltractament. S'ha de considerar, per tant, la poca especificitat de la presència d'hemorràgies retinals en els primers 2-3 mesos de vida

Introducción. Se presenta el caso de un recién nacido con hemorragias retinianas de origen perinatal y evolución atípica. Se discute el valor que tiene la presencia de hemorragias retinianas en los niños menores de 12 meses con lesiones que hacen sospechar un posible maltrato. Cas clínico. Recién nacido de una madre sin control del embarazo en la que durante el parto se descubre una serología positiva a lúes. El estudio del recién nacido no presenta signos de infección luética, pero, al efectuar el despistaje de una posible coriorretinitis luética, se observan hemorragias retinianas. El seguimiento de la evolución de las hemorragias muestra signos de reabsorción a los 2 meses que persisten mas allá de los 3 meses de edad. Comentarios. La frecuencia global de hemorragias retinianas en los recién nacidos sin otros síntomas varía según el tipo de parto entre un 10% en los casos de cesárea electiva y hasta un 50% en los partos instrumentados con ventosa. La mayoría se reabsorben en 2-4 semanas y la literatura solo recoge un caso que desapareció a los 58 días. El caso presentado demuestra que no es imposible que duren más allá de este límite Por otra parte, la presencia de hemorragias retinianas en los niños con lesiones cerebrales es uno de los signos que deben hacer pensar en una causa no accidental, es decir por maltrato. Debe considerarse, por tanto, la poca especificidad de la presencia de hemorragias retinianas en los primeros 2-3 meses de vida (AU)

Introduction. We present the case of a newborn with retinal hemorrhages of perinatal origin with an atypical evolution, and we discuss the significance of retinal hemorrhages in infants younger than 12 months of age, which could represent signs of child abuse. Case report. Newborn from a mother with no pregnancy control, who was found to have positive syphilis serology during delivery. On examination, the newborn did not have signs of congenital syphilis; however, during the screening for evidence of corioretinal disease, retinal hemorrhages were noted. On follow-up, the hemorrhages showed some signs of reabsorption at two months, but persisted beyond three months. Comments. The overall frequency of retinal hemorrhages in the newborn without other symptoms varies according to the type of delivery; it has been reported to be 10% in cases of elective caesarean section, and up to 50% in the instrumental delivery with vacuum. Most hemorrhages reabsorb within two to four weeks, but have also been reported to persist up to 58 days in one case. The case presented shows that in some cases resolution of neonatal retinal hemorrhages can be significantly delayed. Moreover, the presence of retinal hemorrhages in children with brain injuries could suggest a non-accidental cause, usually head trauma resulting from abuse. Given the low specificity of the presence of retinal hemorrhages during the first two to three months of life, a wide differential diagnosis must be considered (AU)

Graft-free Ahmed tube insertion: a modified method at 5 mm from limbus.

OBJECTIVE: To determine the medium-term outcome of Ahmed implants inserted through a needle tract at 5 mm from limbus that eliminates the need for a donor scleral graft. METHODS: A retrospective case series of 19 patients undergoing Ahmed implant surgery for refractory glaucoma with a mean follow-up of 12 months. Primary outcome measures included control of intraocular pressure after surgery. Secondary outcome measure included the frequency of intraoperative and postoperative complications. RESULTS: Intraocular pressure was maintained between 6 and 21 mmHg throughout the study. There was no postoperative hypotony. There were no complications related to this modified technique. CONCLUSION: Needle tract at 5 mm from limbus maintains implant's ability to control intraocular pressure and eliminates the need for a donor scleral graft or heterologous material.