Systematic Review of the Effect of Reflective Materials Around a Phototherapy Unit on Bilirubin Reduction Among Neonates With Physiologic Jaundice in Developing Countries.

OBJECTIVE: To identify the efficacy and safety of the use of various cost-effective reflective materials around phototherapy units to reduce the duration of phototherapy and hasten the reduction of bilirubin among neonates with physiologic jaundice. DATA SOURCES: A systematic review of randomized controlled trials identified from searches in the Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase, and the Cochrane Library with the use of keywords, MeSH terms, operators, and the review of reference lists of retrieved articles. STUDY SELECTION: From a total of 186 studies initially screened, five were eventually included in this analysis. DATA EXTRACTION: Two authors independently reviewed each study with a standard template. Review parameters included the quality of each study based on the Physiotherapy Evidence Database scale and the Consolidated Standards of Reporting Trials guidelines. DATA SYNTHESIS: All studies were generalizable and were rated as high quality on the Physiotherapy Evidence Database scale; one study scored 8 points, and the other four scored 6 points each. The reflective materials used in these studies included the following: white 100% cotton cloths (one study), white plastic covers (two studies), underpads (one study), and silver fabric cloth (one study). Pooled analysis of three studies indicated that reflective materials significantly reduced the duration of phototherapy with a large effect size of 0.82 (p = .04). Pooled analysis of another three studies indicated that the mean decrease of the total serum bilirubin 4 hours after the initiation of phototherapy was significantly greater when reflective materials were added (mean difference of 11.39 µmol/L, 95% confidence interval [2.26, 20.52 µmol/L], p = .01). CONCLUSION: The addition of reflective materials to phototherapy units may be therapeutic for neonates with physiologic jaundice.

Orbital inflammation secondary to a delayed hypersensitivity reaction to sub-Tenon's hyaluronidase.

We report a rare case of a delayed orbital inflammation with raised intraocular pressure as a result of hyluronidase allergy following sub-Tenon's anaesthesia. Here, we have shown evidence to prove the orbital inflammation to be an allergic response to hyluronidase with a skin patch test. This is the first case to our knowledge of a delayed hypersensitivity reaction to sub-Tenon's hyluronidase comprising of an initial exposure to hyluronidase in the fellow eye with no subsequent allergic response, but with a subsequent delayed reaction to hyluronidase during a second eye cataract surgery. This case demonstrates hyaluronidase allergy should be considered as a differential diagnosis among patients presenting with acute post-operative orbital inflammation, even if there is a history of previous exposure to hyaluronidase in the fellow eye with no subsequent allergic response.

Management of inflammatory choroidal neovascularization (CNV) secondary to punctate inner choroidopathy in a young female of childbearing age with intra-vitreal ranibizumab and half-fluence photodynamic therapy (PDT) - a holistic approach.

Choroidal neovascularization (CNV) may occur in up to 40% of patients with punctate inner choroidopathy (PIC). We report a case of a young woman of childbearing age treated successfully for an inflammatory choroidal neovascular membrane (CNV) secondary to PIC with a combination of intravitreal ranibizumab and photodynamic therapy (PDT).

Diplopia following sub-tenon's anaesthesia: an unusual complication.

Diplopia is a rare but well recognised complication following retrobulbar and peribulbar local anaesthesia but it has not been widely reported following sub-tenon's local anaesthesia (STLA). We report on a 76-year-old woman who developed vertical diplopia after left phacoemulsification. She had received a STLA. She had left hypotropia measuring 30 prism diopters for near and distance. She was managed with occlusion but there was no improvement in her findings over 6 months. Ocular motility opinion was then sought and a presumptive diagnosis of inferior rectus fibrosis was made. She subsequently underwent a left inferior rectus recession using adjustable sutures. Postoperatively she had a residual left hypotropia measuring 8 prism dioptres and single vision. Possible causes of inferior rectus fibrosis include muscle damage during traumatic sub-tenon's block or myotoxicity due to local anaesthetic agents. This case highlights the importance of close supervision of inexperienced staff administering regional anaesthetics.