Periocular port wine stain: the great ormond street hospital experience.

PURPOSE: To identify the sensitivity and specificity of risk factors for the development of glaucoma in patients with port wine stain (PWS). DESIGN: A retrospective case-control study involving a large cohort of patients with PWS. PARTICIPANTS: A total of 216 patients (total of 252 eyes) with unilateral or bilateral PWS seen in the eye department in Great Ormond Street Hospital, London, United Kingdom. METHODS: We studied the anatomic distribution of PWS and the incidence of choroidal hemangioma, episcleral hemangioma, iris heterochromia, and Sturge-Weber syndrome (SWS). We analyzed the sensitivity and specificity of these features as risk factors for glaucoma. MAIN OUTCOME MEASURES: Development of glaucoma. RESULTS: Mean age at presentation was 2.9 years (3 weeks to 18.8 years). Mean follow-up was 3.2 years (0-15 years). A total of 180 patients (83.3%) had unilateral lesion, and 36 patients (16.7%) had bilateral lesion. Thirty-one patients (14.3%) had isolated V1 lesion, 35 patients had V2 lesion only (16.2%), and 93 patients (43%) had both V1 and V2 involved. On the last visit, 46 eyes (18.3%) in 39 patients had glaucoma; their mean age was 3.25 years. Glaucoma was more common if PWS was bilateral (P=0.0001), both upper and lower lids were involved (P < 0.0001), and episcleral hemangioma (P < 0.0001), iris heterochromia (P=0.004), or choroidal hemangioma (P < 0.0001) was present. Twenty-four patients had SWS; this was significantly associated with upper lid PWS (P=0.001) and bilateral PWS (P=0.0003). Glaucoma was more common in patients with SWS compared with those without (66.7% vs. 18%, P=0.01). Combined upper and lower lid PWS, episcleral hemangioma, SWS, and iris heterochromia are sensitive prognosticators for the development of glaucoma. CONCLUSIONS: Iris heterochromia is associated with the development of early glaucoma in patients with PWS. Patients at high risk of glaucoma should be seen more often in clinic. Patients who do not have combined lid involvement or episcleral hemangioma have a lower risk and can therefore be seen less often in clinic. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Impact of retinopathy of prematurity screening examination on cardiorespiratory indices: a comparison of indirect ophthalmoscopy and retcam imaging.

PURPOSE: To compare the impact of retinopathy of prematurity (ROP) screening examination between a digital fundus camera and conventional binocular indirect ophthalmoscopy (BIO) using cardiorespiratory indices as a measure of distress. DESIGN: Prospective comparative (nonrandomized) interventional study. PARTICIPANTS: Eighty-six preterm infants with a birth weight of < or =1500 g or gestational age of < or =32 weeks and undergoing ROP screening were included. METHODS: Retinopathy of prematurity screening examination with BIO or the digital fundus camera was performed. Cardiovascular indices were recorded before, during, and 1 hour after examination. Race, birth weight, gender, twin status, duration of the examination, gestational age, and postconceptual age were recorded. MAIN OUTCOME MEASURES: Heart rate (HR), oxygen saturation, respiratory rate (RR), and mean blood pressure (BP). RESULTS: Thirty-four infants underwent indirect ophthalmoscopy, whereas 52 underwent digital fundus camera examination. The increase in HR and RR was significantly higher in the indirect ophthalmoscopy group than in the digital fundus camera group (P<0.05). There was a significant increase in HR and mean BP during examination in both groups (P<0.05). No clinically significant response persisted at 1 hour. Digital fundus camera examination took significantly longer (P<0.001). CONCLUSIONS: Screening for ROP with a digital fundus camera is associated with a significantly lower stress-related response than conventional indirect ophthalmoscopy.