The Accuracy of Digital Imaging in Diagnosis of Retinopathy of Prematurity in Iran: A Pilot Study.

PURPOSE: To evaluate sensitivity and specificity of digital retinal image reading in the diagnosis of referral-warranted retinopathy of prematurity (ROP). METHODS: Infants referred to the ROP clinic underwent fundus examination through indirect ophthalmoscopy. Fundus photographs were acquired using RetCam (shuttle 2; Clarity medical systems, Pleasanton, CA, USA). Four retinal specialists who were blind to patients' information reviewed the RetCam fundus photographs. By comparing the results of photographs' readings with that of indirect ophthalmoscopy as the gold standard, the sensitivity and specificity of telescreening was determined. RESULTS: A total of 147 treatment-naïve patients met the inclusion criteria and were enrolled in the study. Mean gestational age (GA) was 28.6 ± 2.0 weeks. Digital retinal imaging had sensitivity of 85% and specificity of 35% in detecting referral-warranted ROP in our study. Positive predictive value of digital photography was 80%, and negative predictive value was 43%. CONCLUSION: Digital photography for diagnosis of ROP may show good potential as a screening modality in developing countries. It can facilitate early diagnosis, prevent unnecessary referrals, and be implemented for investigational purpose. However, the overall study result did not provide evidence to propose digital photography as a substitute for indirect ophthalmoscopy in the diagnosis of ROP.

Sharp-object-induced open-globe injuries in Iranian children admitted to a major tertiary center: a prospective review of 125 cases.

UNLABELLED: Ocular trauma in children can result in catastrophic visual and psychological outcomes both for the child and his/her family. According to the WHO, childhood blindness is one of the major causes of avoidable blindness and so target of the Vision 2020 program. To achieve this program's goals, it is necessary to explore the epidemiological patterns of ocular trauma in different countries which in its turn could be a valuable means to guide us in developing preventive measures. Our study is a hospital-based prospective study which was conducted to reveal detailed information about children who were admitted to a large tertiary care hospital with the diagnosis of lacerating globe injury due to a sharp object. PATIENTS AND METHODS: During a 6-month period (December 2006 to June 2007), 125 eyes of 125 children (age ≤16 years) with the diagnosis of open-globe injury were enrolled. Clinical data were documented. Demographic data and details of the event were explored and documented based on the study questionnaire (adopting the Birmingham Eye Trauma Terminology and the United States Eye Injury Registry model as basis) by interviewing the parents and the child. RESULTS: The mean age was 8.5 years (SD = 4.36 years, range: 1-16). The boys:girls ratio was 2.5:1; this ratio was age dependent, showing a significant increase with age. The home was the most frequent place (61.7%) for the trauma to occur in. Most traumas (50%) occurred in the afternoon (12 midday to 6 p.m.). Almost half of the traumas were unintentional self-injuries and occurred when the child was alone. A knife and fireworks were the two most frequent causes of injury. CONCLUSION: As the home is the most common place of ocular trauma in this age group and as lack of proper supervision and accessibility of sharp objects such as knives are the background of the event in most cases, it is strongly recommended to educate parents about providing a safe environment at home for their children. Work-related eye injuries in this age group should also be reduced by regulations for prohibiting children's work or at least providing the necessary education and safety goggles.

Clinical presentation and outcome of chorioretinitis sclopetaria: a case series study.

PURPOSE: To report the clinical presentation, treatment approach and natural course of a series of chorioretinitis sclopetaria patients. METHODS: Thirteen consecutive patients with clinical diagnosis of chorioretinitis sclopetaria were included in a case series study during 2000-2006. All patients underwent clinical examination, including the best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, funduscopy and fundus photography. Three-port standard vitrectomy was performed in two patients due to dense vitreous haemorrhage and suspected retinal detachment in both cases. All patients were followed up at week 4, months 2 and 6 and then every 6 months. RESULTS: The mean age of the patients was 16+/-6 (range: 5-27) years and 11 patients (84.6%) were male. The mean follow-up period was 37+/-18 (range: 17-82) months. Baseline best-corrected visual acuity ranged from no light perception (NLP) to 20/1600, and final visual acuity range was from NLP to 20/1200. Only one patient developed acute retinal detachment, and the retina remained attached in others through follow-up. CONCLUSION: In spite of severe retinal and choroidal injuries in chorioretinitis sclopetaria, retinal detachment does not usually occur, probably due to spontaneous retinopexy and scar formation. Whilst dealing with chorioretinitis sclopetaria, it is important to make an accurate diagnosis to prevent unwarranted surgical intervention.

Long-term surgical outcome of posterior choroidal melanoma treated by endoresection.

PURPOSE: To report the visual acuity, enucleation rates, and initial mortality after transvitreal endoresection of posterior uveal melanoma. METHODS: Twenty consecutive patients with medium-sized posterior choroidal melanomas were treated. Vitrectomy was performed, followed by posterior hyaloid dissection, retinotomy, melanoma removal with a vitrectomy probe, retinal reattachment with perfluorocarbon liquid, and silicone oil or gas exchange. RESULTS: Twenty patients (13 men [65%] and 7 women [35%]) were included in the study. The mean patient age +/- SD was 47.1 +/- 16 years (range, 22-70 years). Tumor thickness and tumor diameter ranged from 5.5 mm to 11 mm and 8.0 mm to 15.7 mm, respectively. Preoperative visual acuity ranged from hand motion to 20/40, and postoperative visual acuity ranged from no light perception to 20/30. Two eyes (10%) were enucleated during tumor resection due to severe bleeding. Enucleation was performed on 3 eyes (15%) during follow-up due to tumor recurrence at the edge of surgical coloboma in 1 patient, new focus of tumor in another sector distant from surgical coloboma in 1 patient, and painful blind eye in 1 patient. Fifteen eyes (75%) were saved. One patient (5%) died of metastasis to the liver. The mean follow-up period +/- SD was 89.55 +/- 38.4 months (range, 24-132 months. CONCLUSION: These data suggest that transvitreal endoresection of posterior uveal melanoma is an acceptable management option to conserve the globe and functional vision in selected patients. Distant metastasis is an infrequent event in this modality of treatment.