Retinopathy of Prematurity among Preterm Newborn Admitted to the Neonatal Care Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: World Health Organization has identified retinopathy of prematurity as an important cause of preventable childhood blindness. The presentation of retinopathy of prematurity is varied and differs in the developed and developing worlds. The study aimed to find out the prevalence of retinopathy of prematurity among preterm newborn admitted to the Neonatal Care Unit in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among preterm newborn admitted to the Neonatal Care Unit after receiving ethical approval from the Institutional Review Committee (Reference number: IEC/MGMEI/I/2021/66). The study was conducted from 15 December 2021 to 17 February 2022. Basic demographic data, risk factors, clinical characteristics, and prevalence of retinopathy of prematurity were noted. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 204 participants, retinopathy of prematurity was found in 118 (57.84%) (51.06-64.62, 95% Confidence Interval) in at least one eye. Early treatment retinopathy of prematurity type 2 in 82 (69.49%) was the commonest one severity-wise. Supplemental oxygen was given to 118 (100%) cases, and low birth weight was present in 109 (92.37%) cases. Conclusions: The prevalence of retinopathy of prematurity was found to be higher in other similar studies done in similar settings. The screening and treatment for the retinopathy of prematurity require a dedicated trained team of ophthalmologists, vitreo-retina specialists, paediatricians, and neonatologists with well-developed facilities for retinopathy of prematurity clinics. Keywords: blood transfusion; low birth weight; oxygen; preterm births; retinopathy of prematurity.

Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity.

Purpose: The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR). Methods: In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser. Results: 63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: -1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002). Conclusion: Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.

Tuberculous scleral abscess with choroidal detachment.

We present a case of ocular tuberculosis (TB) presenting as scleral abscess with choroidal detachment. A 60-year-old woman presented with intense pain, redness, watering and decreased vision in the right eye (RE) for 1 week duration. Slit lamp examination of RE revealed diffuse scleritis with two pus-pointing areas in the supero-temporal quadrant suggesting scleral abscess. Fundus examination of the RE showed choroidal detachment in the temporal and inferior quadrant. Left eye examination was unremarkable. Ziehl-Neelsen staining of scleral biopsy showed acid-fast bacilli. PCR of the scleral tissue was also positive for Mycobacterium tuberculosis genome. The final diagnosis of tuberculous scleral abscess with choroidal detachment was made and patient showed good response to antitubercular treatment. In countries endemic for TB, it should be considered as a differential diagnosis for scleral abscess, since prompt diagnosis and treatment will ensure good visual outcome as depicted in our case.

Unusual choroidal mass.

We present a unique case of disseminated tuberculosis presenting initially in the eye solely as a choroidal mass without any inflammation, mimicking choroidal metastasis. A 19-year-old girl presented with a large choroidal mass lesion in the right eye. Systemic examination revealed axillary lymphadenopathy. A fundus fluorescein angiography, positron emission tomography scan, abdominal ultrasonography and raised biochemical markers such as serum CA-125 pointed towards the diagnosis of choroidal metastases with primary in the ovaries. Fine needle aspiration cytology of the adnexal mass and ascitic fluid revealed granulomatous inflammation with a negative acid-fast bacilli stain. A multiplex PCR of ascitic fluid for the sequence MPB64 and IS6110 was positive for tuberculosis. The final diagnosis of disseminated tuberculosis was made and the patient subsequently showed a good response to antitubercular therapy.