The spectrum of paediatric uveitis in New Zealand.

AIMS: To describe the aetiology, complications, treatment and outcomes of paediatric uveitis. METHODS: This was a retrospective chart review including all paediatric participants presenting with uveitis to a tertiary referral hospital in Auckland, New Zealand between January 1997 and March 2020. RESULTS: Two hundred and twenty-four eyes of 143 participants were included. One hundred and three (46.0%) eyes were found to have uveitis without the child reporting any symptoms. Non-infectious uveitis occurred in 97 (67.8%) participants and infectious aetiology occurred in 46 (32.2%) participants. One hundred and twenty-six (56.3%) eyes developed complications by final follow-up, including ocular hypertension (60 eyes, 26.8%), cataract (55 eyes, 24.6%) and glaucoma (21 eyes, 9.4%). Conventional disease modifying anti-rheumatic drugs (DMARDs) were required in 58 (59.8%) participants, and biologic disease modifying anti-rheumatic drugs in 31 (32.0%) participants with non-infectious uveitis. Participants who were younger at presentation were more likely to require a DMARD (OR 0.896 p=0.032). Vision loss of 6/15 or worse occurred in 38 (17.0%) eyes. CONCLUSIONS: Infections are an important cause of uveitis in this age group. Asymptomatic presentation and complications commonly occur. A large proportion of children with non-infectious uveitis will require steroid sparing immunosuppression.

Informed consent for strabismus surgery: the importance of patient information sheets.

PURPOSE: To analyze the additive effect of supplementing verbal consent with written patient information sheets in optimizing patients' and families' understanding of strabismus surgery. METHODS: A prospective randomized study was conducted with 28 patients for strabismus surgery randomized into two groups: group 1 with standardized oral informed consent, and group 2 with standardized oral consent and a written information sheet. A confidential questionnaire with 13 questions was completed by patients and families before surgery. RESULTS: A total of 7 adults and 21 children were included in the study. The mean score (number of correct answers) for group 1 was 4.14 ± 1.99; for group 2, 5.79 ± 2.12 (P = 0.044), indicating that patients and families in group 2 understood their strabismus surgery better than those in group 1. Areas needing more emphasis during the consent process were identified, including risk of under- or overcorrection or repeat surgery and use of eyedrops postoperatively. CONCLUSIONS: In this study, patient information sheets seemed to help patients and families better understand information about their surgery. Patient recall of information provided is poorly reliable and must be considered in decision making for medicolegal cases.

A worldwide survey of retinopathy of prematurity screening.

BACKGROUND: To ascertain which countries in the world have retinopathy of prematurity (ROP) screening programmes and guidelines and how these were developed. METHODS: An email database was created and requests were sent to ophthalmologists in 141 nations to complete an online survey on ROP screening in their country. RESULTS: Representatives from 92/141 (65%) countries responded. 78/92 (85%) have existing ROP screening programmes, and 68/78 (88%) have defined screening criteria. Some countries have limited screening and those areas which have no screening or for which there is inadequate knowledge are mainly Southeast Asia, Africa and some former Soviet states. DISCUSSION: With the increasing survival of premature babies in lower-middle-income and low-income countries, it is important to ensure that adequate ROP screening and treatment is in place. This information will help organisations focus their resources on those areas most in need.

Practice preferences for glaucoma drainage device implantation and cyclodestruction in Australia and New Zealand.

PURPOSE: To evaluate the practice patterns in the use of glaucoma drainage devices (GDD) and cyclodestruction among consultant ophthalmologists in Australia and New Zealand. MATERIALS AND METHODS: A 22-part questionnaire regarding GDD implantation and cyclodestruction practices was sent to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in 2008 by post or e-mail. RESULTS: Sixty-six percent of 872 questionnaires were returned, of these, 14% were from glaucoma subspecialists. Ten percent of all respondents performed GDD implantations. Molteno drains were the most popular device (69%). The most commonly recognized indications for GDD implantation were a history of 2 failed trabeculectomies (85%), neovascular glaucoma (71%), iridocorneal endothelial syndrome (55%), and uveitic glaucoma (52%). Only a minority of surgeons used intraoperative mitomycin C (38%) or 5-fluorouracil (26%) when implanting GDD. Cyclodestruction had been performed by 20% of all respondents. External diode cyclophotocoagulation was the most preferred treatment mode (73%). Sixty-seven percent treated 180 degrees of the ciliary body during initial treatment. Fifty-five percent treated only the earlier untreated area during retreatment. Only 11% of surgeons who performed cyclodestruction agreed that the indications for cyclodestruction are expanding. CONCLUSIONS: A wide range of practice patterns for GDD implantation and cyclodestruction exist among Australian and New Zealand ophthalmologists. This likely reflects a paucity of good evidence to guide practice. The Australasian indications for GDD implantation were moderately different from the reported practice in America. Well-designed clinical trials are needed to better define the indications and best practice for these 2 important glaucoma treatment modalities.

Comparison of 90-s versus 5-min intraoperative 5-fluorouracil in trabeculectomy.

To compare the relative efficacy of trabeculectomy surgery with 90-s and 5-min intraoperative exposure time to 5-fluorouracil. This was a retrospective, non-randomized comparative study. 41 eyes of 33 consecutive patients in the study group were compared to 40 eyes of 30 consecutive patients in the historical control group. Both groups were exposed to 5-fluorouracil (50 mg/ml) during trabeculectomy surgery. The exposure time was 90 s for the study group and 5 min for the control group. Three criteria were used to define surgical success: IOP (intraocular pressure) less than 21 mmHg; IOP less than 21 mmHg with more than 30% reduction in pressure; and IOP less than 15 mmHg with more than 30% reduction. The number of antiglaucoma medications, visual acuity, complications, and interventions were recorded at regular intervals. Mean preoperative IOP was 21.6 +/- 4.8 in the 90-s group and 21.2 +/- 4.9 in the 5-min group. Mean follow-up was 28.2 +/- 5.1 months in the 90-s group and 48.0 +/- 4.9 months in the 5-min group. During the first 30 postoperative months, there were no statistically significant differences in IOP and requirement for antiglaucoma medications between the two groups. The 90-s group had shorter survival rates using the 1st success criteria, but no significant difference was detected when the more stringent 2nd and 3rd criteria were applied. Choroidal effusions were significantly less common in the 90-s group (P = 0.0076). The results of this small study suggest that a 90-s application of 5-fluorouracil may be as effective as a 5-min one in trabeculectomy.

Relationship between second-generation frequency doubling technology and standard automated perimetry in patients with glaucoma.

PURPOSE: The aim of the study was to establish the correlation between visual filed loss as shown by second-generation Frequency Doubling Technology (Humphrey Matrix) and Standard Automated Perimetry (Humphrey Field Analyser) in patients with glaucoma. Also, compared were the test duration and reliability. METHODS: Forty right eyes from glaucoma patients from a private ophthalmology practice were included in this prospective study. All participants had tests within an 8-month period. Pattern deviation plots and mean deviation were compared to establish the correlation between the two perimetry tests. Overall correlation and correlation between hemifields, quadrants and individual test locations were assessed. RESULTS: Humphrey Field Analyser tests were slightly more reliable (37/40 vs. 34/40 for Matrix)) but overall of longer duration. There was good correlation (0.69) between mean deviations. Superior hemifields and superonasal quadrants had the highest correlation (0.88 [95% CI 0.79, 0.94]). Correlation between individual points was independent of distance from the macula. CONCLUSION: Generally, the Matrix and Humphrey Field Analyser perimetry correlate well; however, each machine utilizes a different method of analysing data and thus the direct comparison should be made with caution.

An adjustable medial orbital wall suture for third nerve palsy.

A 16-year-old girl presented with a large-angle exotropia due to congenital third nerve palsy. She had undergone recession/resection surgery as a child. A nasal transposition of the superior oblique and the lateral rectus produced some improvement but the result was still cosmetically unacceptable. Subsequent surgery to permanently secure the globe to the medial orbital wall using an intraoperatively adjustable nonabsorbable traction suture produced a satisfactory outcome.