Isolated Depo-Medrol Administration under Tenon's Capsule for Post-COVID-19 Uveitis in a Child: A Case Report and Literature Review.

Coronavirus disease 2019 (COVID-19) can manifest with ocular symptoms. These symptoms can be divided into isolated events attributed to COVID-19, and those occurring in multisystem inflammatory syndrome in children (MIS-C), a newly diagnosed disease entity associated with COVID-19 infection. Currently, the literature lacks specific guidelines and treatment regimens for COVID-19 ocular symptoms, especially in children. The authors present the case of a 14-and-a-half-year-old boy with bilateral uveitis of the anterior and posterior segments along with vasculitis and optic neuritis associated with SARS-CoV-2 infection. The authors also perform an up-to-date review of all available publications on the treatment of post-COVID-19 uveitis in children described in the literature between 2020 and 2023. In the case described by the authors, the treatment involved a Depo-Medrol 40 mg/mL injection uder the Tenon capsule, with two subconjunctival injections of epinephrine, topical steroid therapy and non-steroidal anti-inflammatory drugs: dexamethasone 0.1%; diclofenac eye drops. In addition, acetylsalicylic acid (150 mg) and pentoxifylline (100 mg, orally) were administered throughout the course of the disease as well as up to 12 months after its termination, until a complete improvement in visual acuity and the withdrawal of ocular lesions were achieved. It can be assumed that this type of treatment is far more beneficial for pediatric patients, with an effect comparable to systemic steroid administration with a preserved improvement in retinal-vascular circulation, without exposing the child to systemic post-steroid complications.

Association of Positive Bacterial Cultures Obtained from the Throat, Anus, Ear, Bronchi and Blood in Very-Low-Birth-Weight Premature Infants with Severe Retinopathy of Prematurity-Own Observations.

BACKGROUND: The causative factors responsible for the development of Retinopathy of Prematurity (ROP) are still unexplored. Therefore, one of the most important factors can be perinatal inflammation. METHODS: This retrospective study included 114 premature infants (228 eyes) meeting a birth criteria of ≤ 32 weeks gestational age (GA) and a birth weight (BW) ≤ 1710. Examined Group (EG) n = 51 of BW 852.7 ± 255.7; GA 26.3 ± 2.0 with severe ROP treated by diode laser or anti-VEGF intravitreal injection. Control Group (CG) n = 63 of BW 1313.9 ± 284.5; GA 28.8 ± 1.6 without ROP. Microbiological bacterial and fungal cultures of the ear, anus, bronchial throat and blood were taken. Medical data and laboratory tests in correlation to 3 ROP and A-ROP were analysed. RESULTS: Positive bacterial tests dominated in EG, 47% vs. CG, 23%. Significant correlations between positive cultures obtained from natural cavities: anus (p < 0.001), throat (p = 0.002), as well as from blood (p = 0.001) and severe ROP which requires diode laser and anti-VEGF treatment were noted. Significant inflammation markers which correlate with the development of severe ROP are Klebsiella pneumoniae (KP) (p = 0.002) and Coagulase-negative Staphylococci (CoNS) (p < 0.001). CoNS, p < 0.001; KP, p = 0.002; the remaining Maltophilia stenotrophomonas (MS); Staphylococcus aureus (SA), p = 0.005; and Enterobacter cloacae (EC), p = 0.02 were the most frequent bacteria in severe ROP. High levels of white blood cells (WBC), C-reactive protein (CRP), lymphocytes (LYM) and low thrombocytes (PLT) correlated sequentially with (Odds Ratio, OR) CoNS (2.3); MS (5.9); KP (3.1); and all positive cultures (APC) (9.5). An important correlation between the BPD-EC (4.3); intrauterine inflammation-KP (3.4); PDA-EC (3.9); and asphyxia-CoNS (3.0) was identified. CONCLUSIONS: It cannot be ruled out that positive microbiological results of blood, anal and pharyngeal cultures may become prognostic markers for the early development of ROP, which would enable early initiation of ophthalmological treatment in premature infants from the VLBW group.

Most Up-to-Date Analysis of Epidemiological Data on the Screening Guidelines and Incidence of Retinopathy of Prematurity in Europe-A Literature Review.

INTRODUCTION: Global predictions indicate that the incidence of retinopathy of prematurity (ROP) is increasing, but the lack of current epidemiological data on the occurrence of ROP in Europe prompted the authors to update these data. METHODS: European studies related to the presence of ROP were analyzed, and the reason for the differences in the percentage of ROP and different screening criteria were checked. RESULTS: The study presents results from individual and multiple centers. Current ROP incidence data varies from a low of 9.3% in Switzerland to the highest values of 64.1% in Portugal and 39.5% in Norway. The national screening criteria are used in the Netherlands, Germany, Norway, Poland, Portugal, Switzerland, and Sweden. Uniform criteria-Royal College of Paediatrics and Child Health guidelines are used in England and Greece. American Academy of Pediatrics screening guidelines are used in France and Italy. CONCLUSIONS: The epidemiology of ROP in European countries varies significantly. The increase in the diagnosis and treatment rate of ROP in recent years correlates with the narrowing of diagnostic criteria in newly issued guidelines (which include the WINROP and G-ROP algorithms), a higher number of less developed preterm infants, and a lower percentage of live births.

Disturbances of Ocular Circulation in Color Doppler Imaging, Retinal Changes and Electrophysiological Tests with Neuro-Ophthalmological Clinical Symptoms in the Course of CADASIL Syndrome-A Case Report.

The authors present a new paper examining the disturbances in ocular circulation and electrophysiological changes in the presence of neuro-ophthalmic manifestations in a patient with cerebral autosomal dominant arteriopathy with subcortical infracts and leucoencephalopathy (CADASIL). Symptoms reported by the patient included: transient vision loss (TVL), migraines, diplopia, bilateral peripheral visual field loss and convergence insufficiency. CADASIL was confirmed by the presence of NOTCH3 gene mutation (p.Cys212Gly), the presence of granular osmiophilic material (GOM) in cutaneous vessels in an immunohistochemistry test (IHC) and bilateral focal vasogenic lesions in the white matter of the cerebral hemisphere, with micro-focal infarct in the left external capsule on a magnetic resonance imaging test (MRI). Color Doppler imaging (CDI) confirmed decreased blood flow and increased vascular resistance in the retinal and posterior ciliary arteries, with reduced P50 wave amplitude on a pattern electroretinogram (PERG). An eye fundus examination and fluorescein angiography (FA) revealed the constriction of retinal vessels and a peripheral retinal pigment epithelium (RPE) atrophy with focal drusen. The authors suggest that the cause of TVL may be changes in the hemodynamics of the retinochoroid vessels associated with the narrowing of small vessels and the presence of druses in the retina-which is supported by a decrease in the amplitude of the P50 wave in PERG, changes in OCT correlating simultaneously with changes in MRI imaging and other neurological symptoms.

The Use of Optical Coherence Tomography and Electrophysiological Tests in the Early Diagnosis of Inflammatory Changes in the CNS in children with ASD-A Review of Contemporary Literature.

This article is a review of the contemporary literature on the possibility of using modern ophthalmological diagnostics, such as optical coherence tomography and electrophysiological tests, in the assessment of changes in eyesight correlating with inflammatory changes in the central nervous system (CNS) as one of the risk factors for neurodevelopmental disorders in children with ASD. A significant role is attributed to the activation of nerve and glial cells, as well as inflammatory changes in the brain, both of which can be of great importance in regard to an autism development predisposition. This fact indicates the possibility of using certain ophthalmic markers to depict an early correlation between the CNS and its outermost layer, i.e., the retina. A comprehensive ophthalmological assessment, and above all, characteristic changes in the functional function of photoreceptors and disorders of the structures of the retina or optic nerve fibers found in the latest OCT or ERG tests may in the future become diagnostic tools, further confirming the early characteristics of autism in children and adolescents. The above information, therefore, emphasizes the importance of cooperation between specialists in improving the diagnosis and treatment of children with autism.

Observations for Sjögren's Pigment Epithelial Reticular Dystrophy in a 16-Year-Old Boy-An Extremely Rare Retinal Case Report.

The purpose of this publication is to present an extremely rare case of Sjögren's pigment epithelial reticular dystrophy. So far, 10 such publications have been found in world literature. A 16-year-old boy was diagnosed due to a slight loss of visual acuity, confirmed in static perimetry/24-2/. Abnormal dense clusters of retinal pigment epithelium (RPE) cells forming a reticular network pattern (resembling a fishing net) with marked knots were detected by fundoscopy in the macular area and the mid-periphery of the retina. No abnormalities were found in the anterior segment, intraocular pressure, kinetic perimetry, Ishihara or Farnsworth D-15 tests or OCT. Fluorescein angiography confirmed blocked fluorescence from the choroidal vessels caused by the pigment in RPE. An autofluorescence test showed hypofluorescent foci corresponding to symmetrical and bilateral retinal hyperpigmentation with an RPE reticular pattern. Multifocal ERG (mfERG) revealed slight cone photoreceptor and bipolar bioelectrical dysfunction. Electrooculography (EOG) showed significant asymmetry (Arden Ratio 1.8), suggesting bioelectrical dysfunction of RPE/photoreceptors. Flash ERG (ERG) revealed only slight increase in implicit time of the a and b waves of the rod and cone responses and exclude cone-rod dystrophies. This article highlights the importance of the results of ophthalmoscopy, fluorescein angiography, autofluorescence, mfERG, fERG, EOG and genetic tests for Sjögren's reticular dystrophy with a pathogenic variant in the region of the C2 gene-c.841_849+19del (dbSNP rs9332736).