The severity and associated comorbidities of retinopathy of prematurity among micro-premature infants with birth weights less than 750 grams.

OBJECTIVES: To evaluate the characteristics and comorbidities associated with ROP in micro-premature infants and their results. METHODS: This is a retrospective chart review involving multiple intensive care units in Central Texas from 2011 to 2016. Infants were included if birth weight (BW) was≤750 g with confirmed ROP by the International Classification of Retinopathy of Prematurity (ICROP). Neonates were examined and treated with laser ablation or intravitreal ranibizumab (IVR) with subsequent laser treatment, guided by fluorescein angiography, if met treatment criteria defined as type 1 ROP by the Early Treatment of Retinopathy of Prematurity standards. Time to regression was defined clinically. Results were analyzed using chi-squared test. RESULTS: 100 neonates were included in the study. Mean BW was 599 grams and mean gestational age was 24.2 weeks. Forty neonates were classified as type 1 ROP and therefore required intervention; of them 21 received laser alone and 19 required IVR with subsequent laser. Only 2 patients received more than one IVR injection. None of the patients progressed to stage 4 or 5 ROP. CONCLUSIONS: Despite such low birth weights, none of these neonates progressed to stage 4 or 5 ROP likely because of prompt examination and treatment with laser or with IVR and subsequent laser. IVR might serve as a bridge to laser in type 1 ROP allowing some retinal vessel development prior to definitive laser treatment.

Management of native warm-season grasses for beef cattle and biomass production in the Mid-South USA.

Native grasses, such as switchgrass (SG; L.), big bluestem (BB; Vitman), indiangrass (IG; Nash), and eastern gamagrass (EG; [L.] L.) may be capable of providing desirable summer forage for cattle as well as a source of biomass for renewable energy. To evaluate that potential, experiments were conducted at 2 locations in Tennessee comparing weaned beef () steers (268 ± 25 kg initial BW) during early-season grazing (Early; 30 d, typically corresponding to May, followed by postdormancy biomass harvest) and full-season grazing (Full, mean duration = 98 d). For Exp. 1, which compared SG, a blend of BB and IG (BBIG), and EG, ADG was greater ( < 0.05) for BBIG (1.02 kg/d) than SG (0.85 kg/d), and both were greater ( < 0.05) than EG (0.66 kg/d). Grazing days for SG and EG were similar (389 and 423 animal unit days [AUD]/ha, respectively) and exceeded ( < 0.05) that of BBIG (233 AUD/ha) during Full. In Exp. 2 (SG and BBIG only), rates of gain were comparable to that of Exp. 1, but AUD were 425 (SG) and 299 (BBIG) AUD/ha. Such rates of gain and grazing days indicate that these grasses can provide desirable summer forage for growing cattle. Early produced 211 to 324 kg BW gain/ha, depending on experiment and forage, followed by dormant-season harvests of 7.5 to 10.5 Mg/ha of biomass, indicating a potential for beef cattle forage and biomass production on the same land resource. Native grasses provided productive summer pasture and good rates of gain on growing cattle and could contribute to forage programs, especially where cool-season grasses currently predominate.

Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia.

AIM: We examined the association of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) and HbA1c with retinopathy and microalbuminuria using both deciles of glycaemia and change point models, to validate current diagnostic criteria for diabetes and to identify therapeutic thresholds for glycaemic control. METHODS: The Australian Diabetes Obesity and Lifestyle study (AusDiab), conducted in 1999-2000, included adults aged > or =25 years from 42 randomly selected areas of Australia. Retinopathy and albuminuria were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,182 participants with retinal photographs and 2,389 with urinary albumin/creatinine results. RESULTS: The prevalence of retinopathy in the first 8 deciles of FPG and HbA1c and the first 9 deciles of 2hPG were 7.2, 6.6, and 6.3%, respectively and showed no variation with increasing glucose or HbA1c. Above these levels, the prevalence rose markedly to 18.6% in the top 2 deciles of FPG, 21.3% in the top 2 deciles of HbA1c and 10.9% in the top decile of 2hPG. The thresholds for increasing prevalence of retinopathy were 7.1 mmol/l for FPG, 6.1% for HbA1c and 13.1 mmol/l for 2hPG. The prevalence of microalbuminuria rose gradually across deciles of each glycaemic measure. Thresholds were less clear than for retinopathy, but were seen at a FPG of 7.2 mmol/l and HbA1c of 6.1%, with no evidence of a threshold effect for 2hPG. CONCLUSIONS: The prevalence of retinopathy rose dramatically in the highest deciles of each glycaemic measure, while for microalbuminuria the increase of prevalence was more gradual. The FPG values corresponded well with the WHO diagnostic cut-point for diabetes, however the 2hPG value did not. HbA1c thresholds were similar for both retinopathy and microalbuminuria and compared well to values shown in other studies. These results support current targets for FPG and HbA1c in preventing microvascular complications.

Rates of diabetes mellitus-related complications in a contemporary adolescent cohort.

BACKGROUND: Ten years after the Diabetes Control and Complications Trial there is a paucity of data as to what are current rates of diabetes-related complications in adolescence. OBJECTIVE: To assess the incidence of diabetes-related complications in a contemporary cohort of adolescents with type 1 diabetes mellitus. DESIGN: Retrospective cross-sectional survey. PATIENTS: Adolescents aged >10 years with type 1 diabetes mellitus for >5 years from the Royal Children's Hospital, Melbourne Diabetes Clinic. RESULTS: 382 patients were studied (191 male). The mean HbA1c for males was 8.72% and for females was 8.80%. The rates of hypothyroidism and hypercholesterolaemia were 1.5% and 22% respectively. Twenty-five patients (8%) had intermittent microalbuminuria and six (2%) had persistent microalbuminuria. Only one patient had macroalbuminuria (0.3%). Only two patients (0.7%) with mild non-were diagnosed proliferative diabetic retinopathy. Coeliac disease was diagnosed in 6% of patients. CONCLUSIONS: In this representative and contemporary cohort of diabetic adolescents the incidence of microvascular diabetes-related complications is quite low.

Occurrence of malignant glaucoma after laser iridotomy.

A case is described of malignant glaucoma with extreme shallowing of the anterior chamber (AC) and an abnormally high intraocular pressure (IOP) following laser iridotomy for acute angle closure glaucoma. The episode followed the use of strong miotic (pilocarpine hydrochloride 4%) and was reversed by mydriatics including phenylephrine hydrochloride. Serial estimation of anterior chamber depth is important in the management of angle closure glaucoma.

Recruitment methods for community-based screening for diabetic retinopathy.

Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.

The VECAT study: methodology and statistical power for measurement of age-related macular features. Vitamin E, Cataract, and Age-related Maculopathy Study.

PURPOSES: (1) To develop the methodology for the grading of macular one-frame stereoslides and to assess the reliability of the system. (2) To determine the prevalence of soft drusen (> 63 microm) and pigment abnormalities synonymous with age-related maculopathy (ARM) at baseline, in a clinical trial of volunteers aged between 55 and 80 years of age. (3) To ascertain the power of the study to detect the 4-year incidence and progression of ARM in vitamin E versus placebo treated participants, given the baseline prevalence. METHODS: The 1204 participants enrolled in the Vitamin E, Cataract, and Age-related Maculopathy Study (VECAT) had colour stereoslides of their fundus taken using the Nidek 3-DX mydriatic fundus camera. The stereoslides were graded by two masked graders according to the "International Classification System for ARM and AMD". Assessment of inter- and intra-observer reliability was carried out on a regular basis on 15% of randomly selected slides. Anticipated rates of incidence and progression were based on results reported by the Beaver Dam Eye Study and the Chesapeake Bay Waterman Study. Power estimations were determined using the "nQuery Advisor" software program. Analyses were carried out on the worse affected eye. RESULTS: Inter-observer reliability was moderate to substantial (Kappa 0.5-0.88) whilst intra-observer agreement was high (0.6-1.0). The prevalence of any soft drusen was 32%. Significant associations were found between soft large indistinct drusen, hypopigmentation, hyperpigmentation and age (p = 0.0001, 0.024 and 0.0001, respectively). The study has at least 87% power to detect an odds ratio equal to two for the progression of soft distinct, soft indistinct, hyperpigmentation and hypopigmentation. CONCLUSIONS: The VECAT study methodology appears to be highly reliable and to have sufficient power to detect the differences in the four-year progression of soft distinct and indistinct drusen and pigment abnormalities between the treatment groups.

Subclavian steal syndrome. A report of two cases.

Two cases of subclavian steal syndrome are reported. Symptoms included light-headedness or syncope, reflecting vertebrobasilar insufficiency, and in one case, numbness and tingling in the left upper extremity, reflecting ischemia. Many persons with this syndrome are asymptomatic. Key findings include unilaterally decreased pulses and a significant difference in blood pressure between the upper extremities. Arch aortography, the "gold standard" of diagnosis, must be performed before surgical intervention.

Gout presenting as a popliteal cyst. A case of pseudothrombophlebitis.

A 64-year-old man with progressive swelling and erythema of his right calf preceded by dull aching in the right popliteal fossa was presumed to have deep vein thrombophlebitis. A venogram revealed normal circulation in the right lower leg, and an ultrasound examination of the right popliteal fossa revealed a 2 X 5-cm popliteal cyst. Fluid aspirated from the cyst confirmed the diagnosis of gout. Popliteal cysts associated with gout are rare, and those that rupture, leak, dissect, or enlarge can mimic thrombophlebitis (a phenomenon known as pseudothrombophlebitis). Thus, the primary care physician should consider the diagnosis of popliteal cyst in patients who appear to have deep vein thrombophlebitis.

Ranibizumab treatment for neovascular age-related macular degeneration: from randomized trials to clinical practice.

BACKGROUND: Although randomized clinical trials (ANCHOR and MARINA) have shown excellent results of ranibizumab treatment in patients with neovascular age-related macular degeneration (AMD), it is unclear whether such an outcome is achievable in daily practice. We evaluated the results of ranibizumab treatment for neovascular AMD in clinical practice in Australia. METHODS: A retrospective chart review of patients in four practices injected with ranibizumab in 2006 for AMD. Patients who had been diagnosed with subfoveal choroidal neovascular membrane in the preceding 6 months and had completed at least 6 months follow-up were enrolled. No standard treatment protocols were required. The main outcome measure was visual acuity (VA) at 6 and 12 months. RESULTS: A total of 158 patients fulfilled the entry criteria. The mean baseline VA (decimal) was 0.35+/-0.21 (Snellen equivalent 6/17). At 6 months, the mean VA improved to 0.46+/-0.27 (6/13) and remained stable until month 12 (0.48+/-0.30). The improvement in VA between baseline and months 6 and 12 was statistically significant (P<0.0001). Both the mean and the median number of injections were four in the first 6 months and nine at 12 months. VA results were comparable with those of the ANCHOR and MARINA trials, and were achieved with a lower number of injections (P<0.0001). CONCLUSION: VA results achieved in daily clinical practice using ranibizumab for neovascular AMD are similar to large prospective randomized trials.

Increased serum pigment epithelium-derived factor is associated with microvascular complications, vascular stiffness and inflammation in Type 1 diabetes.

AIMS: To determine in Type 1 diabetes patients if levels of pigment epithelium-derived factor (PEDF), an anti-angiogenic, anti-inflammatory and antioxidant factor, are increased in individuals with complications and positively related to vascular and renal dysfunction, body mass index, glycated haemoglobin, lipids, inflammation and oxidative stress. METHODS: Serum PEDF levels were measured by ELISA in a cross-sectional study of 123 Type 1 diabetic patients (71 without and 52 with microvascular complications) and 31 non-diabetic control subjects. PEDF associations with complication status, pulse-wave analysis and biochemical results were explored. RESULTS: PEDF levels [geometric mean (95% CI)] were increased in patients with complications 8.2 (7.0-9.6) microg/ml, vs. complication-free patients [5.3 (4.7-6.0) microg/ml, P < 0.001] and control subjects [5.3 (4.6-6.1) microg/ml, P < 0.001; anova between three groups, P < 0.001], but did not differ significantly between control subjects and complication-free patients (P > 0.05). In diabetes, PEDF levels correlated (all P < 0.001) with systolic blood pressure (r = 0.317), pulse pressure (r = 0.337), small artery elasticity (r = -0.269), glycated haemoglobin (r = 0.245), body mass index (r = 0.362), renal dysfunction [including serum creatinine (r = 0.491), cystatin C (r = 0.500)], triglycerides (r = 0.367), and inflammation [including log(e)C-reactive protein (CRP; r = 0.329), and soluble vascular cell adhesion molecule-1 (r = 0.363)]. Age, blood urea nitrogen, systolic blood pressure, pulse pressure and log(e)CRP correlated with PEDF levels in control subjects (all P < 0.04). PEDF levels were not significantly correlated with measures of oxidative stress: isoprostanes, oxidized low-density lipoprotein or paraoxonase-1 activity. On stepwise linear regression analysis (all subjects), independent determinants of PEDF levels were renal function, triglycerides, inflammation, small artery elasticity and age (r(2) = 0.427). CONCLUSIONS: In Type 1 diabetes, serum PEDF levels are associated with microvascular complications, poor vascular health, hyperglycaemia, adiposity and inflammation.

Comparative study of the polaroid and digital non-mydriatic cameras in the detection of referrable diabetic retinopathy in Australia.

AIM: To show that the non-mydriatic retinal camera (NMRC) using polaroid film is as effective as the NMRC using digital imaging in detecting referrable retinopathy. METHODS: A series of patients with diabetes attending the eye out-patients department at the Royal Victorian Eye and Ear Hospital had single-field non-mydriatic fundus photographs taken using first a digital and then a polaroid camera. Dilated 30 degrees seven-field stereo fundus photographs were then taken of each eye as the gold standard. The photographs were graded in a masked fashion. Retinopathy levels were defined using the simplified Wisconsin Grading system. We used the kappa statistics for inter-reader and intrareader agreement and the generalized linear model to derive the odds ratio. RESULTS: There were 196 participants giving 325 undilated retinal photographs. Of these participants 111 (57%) were males. The mean age of the patients was 68.8 years. There were 298 eyes with all three sets of photographs from 154 patients. The digital NMRC had a sensitivity of 86.2%[95% confidence interval (CI) 65.8, 95.3], whilst the polaroid NMRC had a sensitivity of 84.1% (95% CI 65.5, 93.7). The specificities of the two cameras were identical at 71.2% (95% CI 58.8, 81.1). There was no difference in the ability of the polaroid and digital camera to detect referrable retinopathy (odds ratio 1.06, 95% CI 0.80, 1.40, P = 0.68). CONCLUSION: This study suggests that non-mydriatic retinal photography using polaroid film is as effective as digital imaging in the detection of referrable retinopathy in countries such as the USA and Australia or others that use the same criterion for referral.

Combined hamartoma of the retina and RPE: an unusual cause of the dragged disc appearance.

Combined hamartoma of the retina and retinal pigment epithelium (RPE), is a rare, benign, congenital fundal lesion which contains a mixture of glial tissue, blood vessels and pigment epithelium. Such tumours are variably pigmented and may be wrongly diagnosed as malignant melanoma or retinoblastoma. We report two cases which were located in the periphery of the fundus and which produced a dragged disc appearance.

Perfluorocarbon liquid in traumatic vitreous hemorrhage and retinal detachment.

Patients with penetrating ocular trauma also may have severe vitreous hemorrhage and associated retinal detachment. Removing the hemorrhage and repairing the detachment can be a difficult surgical problem. Besides the limited surgical view due to the hemorrhage, an incomplete separation of the posterior hyaloid membrane can allow the detached retina to be drawn toward the port of the vitrectomy instrument, producing an inadvertent retinal tear. We have used perfluoroperhydrophenanthrene (Vitreon) to manage three cases of penetrating ocular trauma with concurrent retinal detachment and a partial vitreous detachment, either at the time of surgery or as noted ultrasonographically. The perfluorocarbon liquid helped to separate the partially detached posterior hyaloid membrane and flatten the detached retina. This maneuver simplified removal of the vitreous hemorrhage and management of the retinal detachment.

Early detection of diabetic retinopathy.

Diabetic retinopathy remains a leading cause of blindness in Australia. Most cases can be prevented by timely laser photocoagulation and this requires early detection of asymptomatic retinopathy. The Australian Diabetes Society recommends regular retinal examinations through dilated pupils, either at diagnosis of diabetes (onset over 30 years), or five years after diagnosis (onset under 30 years). Examination should be repeated at least every two years, or more frequently in the presence of visual symptoms, pregnancy or other risk factors. Diabetic patients and primary care physicians should be better informed about the effectiveness of timely treatment of diabetic retinopathy and the need for regular eye examinations, either by general practitioners or through referral to ophthalmologists.

The aetiology of ocular toxoplasmosis in Melbourne.

The biological mothers of 23 patients presenting with acute chorioretinal toxoplasmosis had sera screened for the presence of antibodies to Toxoplasma gondii. Twenty-two of the mothers (96%) had positive serology and one (4%) had negative serology. This is consistent with the hypothesis that most cases of ocular toxoplasmosis are congenital in origin, but indicates that some cases are due to acquired toxoplasmosis.

A comparison of the efficacy of betaxolol and timolol in ocular hypertension with or without adrenaline.

Betaxolol hydrochloride, a selective beta 1-adrenergic blocker, is claimed to be less likely to aggravate chronic obstructive airways disease than timolol maleate, a nonselective beta-blocker. It is not clear which drug is more effective in lowering intraocular pressure (IOP) and how each acts in combination with topical adrenaline. To assess this we conducted a randomised clinical trial on ocular hypertensive patients. Both betaxolol and timolol produced a significant fall in IOP though not in all patients. No significant difference was found between betaxolol and timolol. The addition of dipivefrin gave an additional fall in some eyes only. No significant difference was found between the addition of dipivefrin and adrenaline. Some fellow eyes had a fall in IOP when dipivefrin was added to timolol. It is important to assess the response carefully in each individual eye when using betaxolol or timolol or when adding additional medication.