Minimally fibrotic stage 5 ROP: a clinical prognostic factor in eyes undergoing vitrectomy for stage 5 retinopathy of prematurity.

TITLE: Minimally fibrotic Stage 5: A clinical prognostic factor in eyes undergoing vitrectomy for stage 5 retinopathy of prematurity (ROP). PURPOSE: To define minimally fibrotic stage 5 ROP and to demonstrate better surgical outcomes in this subgroup. METHODS: A cohort of eligible eyes with stage 5 ROP undergoing vitrectomy were further divided into those with minimally fibrotic stage 5 and others. Minimally fibrotic stage 5 ROP was defined as those stage 5 eyes having a translucent retrolental membrane with visibility of the underlying retinal vessels and absence of anteriorly rotated ciliary processes. We reported on anatomic and visual outcomes in eyes with defined characteristics of this subgroup identified before surgery and then observing them post vitrectomy over a period of time as compared to others. RESULTS: Minimally fibrotic stage 5 eyes had better visual (p = .0068) and anatomical outcomes (p = .0001). CONCLUSION: Minimally fibrotic stage 5 ROP shows ridge to ridge traction that has resulted in a traction retinal detachment with a retrolental membrane, but fibrotic change has just begun. This stage 5 ROP with limited fibrosis represents a subset of this stage 5 ROP with a positive anatomic and visual prognosis.

Vision development over an extended follow-up period in babies after successful vitrectomy for stage 4b retinopathy of prematurity.

PURPOSE/BACKGROUND: To demonstrate improvement in the vision of babies after successful vitrectomy for stage 4b retinopathy of prematurity (ROP) over an extended period of time. METHODS: This was an observational prospective case series. Eight babies who had undergone successful vitrectomy in either their only seeing eye (or both eyes) with stage 4b ROP were followed up post-operatively for a period of 80 weeks or more. Vision with Teller acuity chart, refraction, binocular indirect ophthalmoscopy, and documentation with RetCam was done at each visit. Vision of the (only/better) seeing operated eye with corrective glasses was graded for the purpose of statistical evaluation. Paired t test was performed to compare the vision prior to 30 weeks and at or after 80 weeks. RESULTS: Statistically significant improvement in vision was noted at or after 80 weeks as compared to the vision recorded before 30 weeks (p = 0.0062). CONCLUSIONS: Unlike in adult intraocular surgeries where stable visual acuity is reached well before 30 weeks, continuing improvement at 80 weeks and beyond is noted. Gradual restoration of the retinal architecture and plasticity of the infant's developing brain are thought to be responsible.

Evaluation of 19 cases of inadvertent globe perforation due to periocular injections.

BACKGROUND: Inadvertent globe perforation due to periocular injection is a serious iatrogenic complication. AIM: To study risk factors, management and visual outcome of inadvertent globe perforation during periocular injection, in cases referred to a tertiary eye care center. DESIGN AND SETTING: Retrospective study at a tertiary referral center with a single investigator. MATERIALS AND METHODS: Nineteen consecutive cases with a clinical diagnosis of globe perforation were studied (1998-2004). Clinical setting, risk factors, clinical presentation, management and visual outcome were analyzed. RESULTS: Retrobulbar injections 6 (32%), peribulbar injections 10 (53%) and subconjunctival injections 3 (16%) were responsible for inadvertent globe perforation. Anesthetists accounted for 6 (32%) injections and 13 (69%) were referred from high volume community settings. Anesthetists identified the mishap on the table in 17% (1 out of 6) of cases and the ophthalmologists in 69% (9 out of 13) myopia was present in 10 (53%). Breaks were located inferotemporally in nine eyes. Four underwent laser and cryopexy, 14 (74%) underwent vitreous surgery. Visual acuity greater than 20/200 was achieved in 12 patients. CONCLUSION: Myopia was found to be a significant risk factor. Inferotemporal breaks were common. Anesthetists were more likely to miss this complication when it occurred. In this series, intervention salvaged vision in a significant number of eyes.

Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy.

PURPOSE: We sought to document the difference in the vitreoretinal configuration of Stage 4 retinopathy of prematurity (ROP) in photocoagulated and treatment naive eyes undergoing vitrectomy and to correlate it with surgical complexity. METHODS: Consecutive eyes posted for vitrectomy with Stage 4 ROP were documented preoperatively using a RetCam for the presence of peripheral traction (PT), presence of central traction just outside the arcades, and presence of traction extending to the lens. A note was made of the following intraoperative events: lensectomy, intraoperative bleeding, and iatrogenic breaks. Wilcoxon rank-sum test was used for analysis. RESULTS: From a total of 46 eyes, 16 and 30 eyes were from the treated and treatment naive group, respectively. More eyes in the treated group had central (P < 0.0001) and lenticular traction (P = 0.022). More eyes in the untreated group had PT (P < 0.0001). A significant number of eyes without photocoagulation needed lensectomy (P = 0.042), and no difference in intraoperative bleeding (P = 0.94) was demonstrable. Iatrogenic retinotomy occurred in three eyes, all naive. Notably, age at surgery was more in the untreated group (P = 0.00008). CONCLUSION: Vasoproliferative activity in all retinopathies occurs at the junction of the ischemic and nonischemic retina. In the natural course of ROP, this takes place peripherally, at the ridge. In photocoagulated eyes, this junction is displaced posteriorly due to peripheral ablation. Treated eyes manifested with posterior proliferative changes and were more amenable to lens-sparing vitrectomy. Naive eyes were older when they underwent surgery to relieve PT with greater chances of lensectomy and iatrogenic breaks.

Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014.

AIM: The aim of this study is to ascertain the prevalence of diabetic retinopathy (DR) in diabetic patients across the nation and attempt to establish history-based risk factors. MATERIALS AND METHODS: A cross-sectional study of diabetic patients was conducted as an initiative of the All India Ophthalmological Society from 14th November to 21st November 2014. Known diabetics were evaluated voluntarily by members of the society at 194 centers using a structured protocol provided by the society for examination. The results were evaluated to ascertain the prevalence of DR in the population studied and to establish relation with gender, age, and history-based risk factors such as duration of diabetes, insulin use, and other end-organ disease using the Chi-square test. RESULTS: A total of 6218 known diabetics were screened. Totally, 5130 data entry forms were considered suitable for further evaluation. About 61.2% were males, 88.6% were between 40 and 80 years of age, almost two-thirds of the patients were from the west and south zones, and over half had diabetes more than 5 years. The data set was predominantly urban 84.7% and 46.1% had no family history. DR prevalence in the entire data set was 21.7%. Prevalence was more in males (P = 0.007), diabetics more than 5 years (P = 0.001), those above 40 years (P = 0.01), insulin users (P = 0.001), and history of vascular accidents (P = 0.0014). Significantly 22.18% of patients detected with DR had a vision of 6/18 or better in the worse eye. CONCLUSION: The study reiterated the findings of earlier regional studies on a pan Indian scale and put data in perspective.

The posterior iris-claw lens outcome study: 6-month follow-up.

PURPOSE: The purpose of this study was to evaluate functional and anatomical outcomes of posterior iris-claw intraocular lens (IOL) implant for correction of aphakia in eyes with inadequate capsular support. MATERIALS AND METHODS: Prospective case series of 108 aphakic eyes with inadequate capsular support which underwent posterior iris-claw IOL with a 6-month follow-up period was conducted. The cases belonged to two clinical settings: elective secondary implantation and those with intraoperative posterior dislocation of cataractous lens or IOL. Main outcome measures were visual acuity, anterior chamber reaction, stability of IOL, endothelial cell count, intraocular pressure (IOP), and cystoid macular edema (CME). RESULTS: The mean best-corrected visual acuity was LogMAR 0.25. None had chronic anterior chamber inflammation. The mean difference in central endothelial counts before surgery and 1 month after surgery was 104.21 cell/mm2 (4.92%). There was no statistically significant difference in central endothelial cell count at 1 and 6 months (P = 0.91) and also in the central macular thickness at preoperative and after 6 months suggestive of CME (P = 0.078). Three eyes had raised IOP which were managed with neodymium-doped yttrium aluminum garnet laser peripheral iridotomy. There were no IOL dislocations or other adverse events in our series. CONCLUSION: Posterior chamber iris-claw lenses are a good option in eyes with inadequate posterior capsular support. Chronic inflammation, poor lens stability, or significant central endothelial cell loss was not observed during the 6-month follow-up period.

Successful Surgical Management of Retinopathy of Prematurity Showing Rapid Progression despite Extensive Retinal Photocoagulation.

The management of retinopathy of prematurity (ROP) can be challenging in preterm babies with a gestational age <30 weeks, those with very low birth weight and multiple risk factors (eg., oxygen therapy for respiratory distress, sepsis, neonatal jaundice). A premature infant presented with "hybrid" zone 1 disease in the right eye and aggressive posterior ROP in the left eye. Both eyes were adequately treated with laser photocoagulation; however, the eyes deteriorated and progressed to stage 4 ROP. Both eyes eventually underwent intravitreal bevacizumab followed by lens sparing vitrectomy with good anatomical and visual outcome. Anticipation of progression despite laser photocoagulation in certain clinical scenarios, frequent follow-up and timely surgical intervention is paramount.

Vitreoretinal surgery for advanced retinopathy of prematurity: presentation and outcomes from a developing country.

OBJECTIVE: To study the outcome of pars plana vitrectomy performed on patients with stage 4b and stage 5 retinopathy of prematurity and to examine differences in clinical presentation from developed countries. DESIGN: Observational prospective case series. PARTICIPANTS: Babies with stage 4b or 5 retinopathy of prematurity who underwent vitrectomy. METHODS: The study was undertaken at a tertiary care ophthalmology centre in a developing country. Demographic variables, postnatal risk factors, and anatomic and visual status were noted preoperatively. Patients with stage 4b ROP underwent a 3-port lens-sparing vitrectomy. Those with stage 5 ROP additionally underwent lensectomy and retrolental membrane dissection. Patients were assessed on their last follow-up for anatomic, visual, and functional results. Statistical evaluation was performed using the nonparametric Wilcoxon rank sum test. RESULTS: The results were evaluated by number of eyes treated, except for functional score. In 21 patients, 31 eyes underwent operation, of which 20 were stage 4b and 11 were stage 5. Anatomic success was achieved in 18 eyes (90%) with stage 4b. Mean vision in this anatomically successful group was 3.765, and the functional score was 5.36. In stage 5 eyes, anatomic success was achieved in 5 eyes (45.45%). Mean vision in this anatomically successful group was 1.833, and the functional score was 3. The visual results of stage 4b cases, compared with stage 5, were significantly better (p=0.0387). CONCLUSIONS: Larger, older babies and previously unablated eyes presented with retinopathy of prematurity for surgery compared with developed countries. Anatomic, visual, and (notably) functional recovery was found in a good percentage of eyes.

Spontaneous resorption of sub-retinal cortical lens material.

We report a rare case of retained sub-retinal cortical material, which underwent spontaneous resorption. Patient presented with a left eye traumatic retinal detachment with a large retinal tear and posteriorly dislocated cataractous lens. Vitrectomy, lensectomy, silicone oil injection, and endolaser were performed. A good visual result was achieved. The report draws attention to this condition and highlights possible technique for minimizing risk of this complication in similar cases.