Effect of mode of delivery on incidence of retinopathy of prematurity: a systematic review and meta-analysis.

BACKGROUND: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Prompt diagnosis and treatment are crucial in ROP management. Thus, the identification of prominent risk factors could facilitate immediate action. Among various risk factors, the effects of mode of delivery on ROP remain unclear. Therefore, this study aims to assess the association between different modes of delivery on ROP incidence. METHODS AND ANALYSIS: Comprehensive literature search was conducted on PubMed, ProQuest, EBSCOHost and Cochrane databases, to evaluate the association of mode of delivery-vaginal delivery or caesarean section (c-section)-and the incidence of ROP from inception to December 2023. Random-effects meta-analysis was performed to estimate the pooled OR along with their 95% CIs. RESULTS: This review included 5 cohort studies involving 2048 babies. A higher incidence of ROP was observed in infants born through vaginal delivery compared with caesarean section. Meta-analysis showed that C-section decreased the unadjusted odds of having ROP infants by 46% with low heterogeneity (OR 0.54 (95% CI 0.40 to 0.73); I2=40.73%). However, pooled adjusted effects were statistically insignificant with moderate heterogeneity (adjusted OR 0.59 (95% CI 0.28 to 1.23); I2=70.51%), possibly stemming from multiple variations in the controlled variables of each study. CONCLUSION: Despite varying statistical significance, our findings underscore the crucial need to comprehend the influence of delivery mode on neonatal ophthalmic outcomes. Due to a limited number of existing studies, further research is needed to confirm the association. PROSPERO REGISTRATION NUMBER: CRD42023486278.

Emergency surgical management for ocular trauma with confirmed COVID-19 symptoms: A case report.

INTRODUCTION AND IMPORTANCE: Conducting urgent eye trauma surgery amidst the COVID-19 pandemic poses distinct difficulties, as strict infection control measures are crucial to safeguard both patients and medical staff. Nonetheless, eye trauma remains a significant contributor to avoidable vision loss in developing countries. CASE PRESENTATION: A 57-year-old man presented with redness, bleeding, and injury in the left eye after a motorcycle accident 9 h prior to hospital admission, along with a torn wound on his left cheek. The visual acuity in the left eye showed no light perception. Limited eye movement in all directions, eyelid hematoma, conjunctival injection, hyphema, and tissue protrusion from the limbus at 6 to 8 o'clock positions were observed. The patient had a history of cataract surgery (+) in both eyes and was diagnosed with an open globe injury with zone II penetrating trauma, accompanied by full hyphema, vitreous and choroid prolapse in the left eye, and a confirmed case of COVID-19. Evisceration of the left eye was performed following the basic guidelines for ocular trauma surgery during the COVID-19 pandemic. Postoperative follow-up was conducted as usual by the operator in isolation for confirmed COVID-19 patients with no significant complaints. CLINICAL DISCUSSION: Urgent surgical intervention is necessary to prevent visual impairment, following guidelines recommending surgery within 4-72 h. Ocular tissue may facilitate COVID-19 transmission via the nasolacrimal system, posing risks to healthcare workers, particularly during surgery. Preoperative measures, including obtaining COVID-19 status and providing appropriate personal protective equipment (PPE), are crucial. Minimizing aerosol-generating procedures and employing virucidal disinfection further mitigates the transmission risks. This case underscores the need to balance immediate intervention for eye injuries with safety protocols for COVID-19, emphasizing standardized PPE and surgical procedures to safeguard healthcare professionals. CONCLUSION: Incorporating insights gained during the COVID-19 pandemic will fortify healthcare systems against future pandemics. In particular, it enables effective surgical emergency response while mitigating infectious disease risks.