Role of additional posterior barrage laser in type 1 zone 2 retinopathy of prematurity: A randomized trial.

Purpose: The efficacy of additional barrage laser posterior to ridge in advanced stage 3 or stage 4 retinopathy of prematurity (ROP) is established, but its role in early stages is not defined. The objective was to study the efficacy of additional posterior barrage laser in type I zone 2 disease. Methods: In a randomized trial, patients with type I zone 2 ROP were recruited between February 2016 and May 2017. One eye of each baby was randomized into study and control groups, respectively. Laser photocoagulation anterior to ridge was given in the control group, and additional posterior barrage laser was performed in the study group. The outcome measures were time to complete ridge regression and final cycloplegic refraction at 3 months post-laser. Results: Forty patients (40 eyes per group) completed the required follow-up. The mean birth weight and gestational age were 1357 ± 338 g and 29.72 ± 2.57 weeks, respectively. The mean post-conceptional age during laser was 36.67 ± 3.23 weeks. The number of eyes achieving ridge regression in control and study groups was 8/40 (20%) and 27/40 (67%) at 2 weeks (P = 0.001) and 39/40 (97%) and 40/40 (100%) at 4 weeks (P = 0.4). The mean time to complete ridge regression was 3.74 ± 1.17 weeks and 2.62 ± 0.91 weeks in control and study groups, respectively (P < 0.001). The mean spherical equivalent at 12 weeks in control and study groups was -1.9 ± 2.3 Diopters and -2.4 ± 2.6 Diopters, respectively (P = 0.41). Conclusions: Additional posterior barrage laser leads to significantly faster regression of type 1 zone 2 ROP without increasing induced myopia and thereby might be a useful adjunct to conventional treatment in selected cases. Trial registration number: CTRI/2018/05/013779.

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children.

Purpose: The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown. Methods: Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown. Results: Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4-214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8-80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension. Conclusion: The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.

Ultra-widefield fundus fluorescein angiography in pediatric retinal vascular diseases.

Purpose: To describe the utility of RetCam ultra-wide-field fundus fluorescein angiography in pediatric retinal vascular diseases. Methods: A retrospective chart review was carried out in 43 eyes of 22 pediatric patients who were diagnosed or suspected to have a retinal vascular disease. Fluorescein angiography was carried out using the 130 degree lens of RetCam 3. Fluorescein angiography guided treatment (laser/cryotherapy) was carried out wherever required. Results: Diseases studied included - coats disease, familial exudative vitreoretinopathy, retinopathy of prematurity, congenital retinal folds, double optic nerve head, persistent fetal vasculature and incontinentia pigmenti. RetCam assisted fluorescein angiography was helpful in establishing a diagnosis in 4 patients (18%), in decision making regarding treatment in 18 patients (82%), in deciding need for retreatment in 5 patients (23%), helped in staging of disease in 5 patients (23%) and in detecting clinically subtle findings in 6 patients (27%). Conclusion: RetCam assisted FFA is extremely useful to document peripheral retinal vascular pathologies in pediatric patients and helps to take crucial therapeutic and retreatment decisions.