The Royal College of Paediatrics and Child Health Retinopathy of Prematurity Screening Guidelines (2022): a series of treated infants falling outside the updated criteria.

BACKGROUND/OBJECTIVES: Screening for retinopathy of prematurity (ROP) is a core healthcare intervention in premature babies to avoid preventable sight loss. A variety of screening criteria are in place globally for this purpose. The Royal College of Paediatrics and Child Health recently updated the United Kingdom ROP screening guidelines (March 2022). A key change was the reduction in the gestational age (GA) to warrant retinal screening (from 32 to 31 weeks). SUBJECTS/METHODS: In the course of informal national surveillance during guideline development (2017-2022) and soon after, babies under our care falling outside the updated screening criteria who underwent treatment for ROP were identified. A retrospective case review was carried out. RESULTS: Six babies were identified as having undergone screening and treatment, prior to implementation of the new guidance. Screening and treatment would have been forfeited as per the March 2022 guidelines. All six had numerous systemic risk factors for developing ROP. Specifically, all had documented poor postnatal weight gain. CONCLUSIONS: We present this case series to bring forth an urgent discussion amongst key stakeholders as to whether the new guidance, as it stands, is safe and fit for purpose.

Incorporation of a virtual assessment into a care pathway for initial glaucoma management: feasibility study.

PURPOSE: To investigate the feasibility of a glaucoma triage assessment based on the consideration of clinical data in a virtual clinic environment. METHODS: One hundred consecutive new patients were assessed by masked observers for a possible diagnosis of glaucoma or ocular hypertension by evaluation of clinical data compiled by a technician in the absence of the patient. The virtual clinic diagnoses were compared with those made by actual examination of the patient in the outpatient clinic. RESULTS: A total of 22% of subjects were excluded from interobserver comparison because of atypical scanning laser ophthalmoscopy. Of the 78% of subjects completing virtual and actual clinical assessments diagnostic agreement was good, weighted Kappa was of 0.72 (95% confidence interval 0.85 to 0.59), sensitivity 94.4% and specificity 86.7%. No case of glaucoma was misdiagnosed as normal by virtual assessment. CONCLUSION: Clinical findings and data relating to glaucoma may be evaluated in a virtual clinic with satisfactory diagnostic accuracy.

Usefulness of cell counter-based parameters and formulas in detection of beta-thalassemia trait in areas of high prevalence.

The present study aimed to retrospectively evaluate the usefulness of cell counter-based parameters and formulas in beta-thalassemia trait (BTT) detection. The study included 170 BTT cases (hemoglobin [Hb]A(2) >4.0% [0.04]) and 30 non-BTT cases (HbA(2), 2.3%-3.5% [0.02-0.04]). Depending on the hemoglobin level and iron deficiency, the BTT group was further classified into classic BTT (n = 112) and BTT with iron deficiency anemia (n = 58). The RBC count, MCH, MCV, RDW, and Shine and Lal, Mentzler, Srivastava, England and Fraser, Ricerca, and Green indexes were applied. For the first time in the population of India, these 10 cell counter parameters and manual formulas were compared with high-performance liquid chromatography-derived HbA2 levels for deriving a cost-effective alternative method; and receiver operating characteristic curves were applied. We found that the Shine and Lal, Srivastava, and Mentzler indexes, MCV, and MCH have better discriminative function than the RBC count and red cell distribution width and their related formulas.

A survey of the management of globe perforation during strabismus surgery in the United Kingdom.

INTRODUCTION: Globe perforation is a potentially devastating complication of strabismus surgery. The purpose of this study is to investigate the management of suspected globe perforation encountered during strabismus surgery in the United Kingdom. METHODS: A postal survey of all consultant ophthalmologists in the United Kingdom was undertaken. The questionnaire solicited data on the management and outcomes of globe perforation encountered during strabismus surgery. RESULTS: Five hundred and seventeen of 850 (60.8%) surgeons responded to the survey. Of these, 240 (46.4%) performed strabismus surgery, of whom 58.8% performed fewer than 50, 32.1% performed 50 to 100, and 8.3% performed more than 100 surgical procedures annually. Ninety-eight (40.8%) had suspected globe perforation during strabismus surgery, of whom 86 subsequently carried out dilated fundoscopy. There were 74 reported globe perforations. Fifty-four detailed treatment with cryopexy (50%), retinal laser (31.5%), both (9.3%), cautery (1.9%), and not reported (7.4%). In 27% of cases surgeons chose not to treat the perforation observed postoperatively. Thirty-five respondents prescribed additional antibiotics. Visual loss occurred in 6 cases, with 2 cases of endophthalmitis, 2 retinal detachments, 1 suprachoroidal hemorrhage, and 1 from a chorioretinal scar. DISCUSSION: Complications leading to visual loss were infrequent. Of the surgeons reporting globe perforations, approximately three quarters chose to treat the injury and one quarter chose to observe without treatment. Cryotherapy was the most popular intervention. Further prospective study is required to elucidate optimal management strategies.

Diagnosis of acute malaria by laser based cell counter with comparison of conventional and recent techniques in Indian scenario.

UNLABELLED: Malaria is one of the most important parasitic diseases in humans affecting 103 countries worldwide. AIMS: The present study aims to determine the diagnostic utility of cell counter data--hemoglobin, total leukocyte count, platelet count and depolarized laser light (DLL)-based purple-coded events (PCEs) in detection of acute malaria. This is a retrospective study of 523 patient data that came for complete blood count for the first time. RESULTS: One hundred thirty-five of the 523 patients showed microscopic evidence of malaria. Platelet count showed the highest sensitivity of 77.77% (105/135). PCEs (> or = 1) showed 43.7% (59/135) sensitivity. CONCLUSIONS: It is concluded that a low platelet count (< 150 x 109/L) is a good hematological parameter for presumptive diagnosis of malaria. If we change the cut-off for PCEs from > or = 1 to > or = 2, the sensitivity would be 56.29% (76/135) and the specificity would be 94.58% (367/388), respectively. The sensitivity of DLL was low, particularly with a low parasitic index (PI). The number of PCEs does not correlate with the PI. The cut-off number of PCEs in DLL-based malaria detection should be modified in highly endemic areas.

Anterior uveitis, poliosis, and skin hypopigmentation associated with topical chloramphenicol allergy following ptosis surgery.

The association of uveitis and vitiligo has long been established in specific disease entities: Vogt-Koyanagi-Harada syndrome and sympathetic ophthalmia. We report an unusual case of topical chloramphenicol allergy associated with an anterior uveitis with subsequent poliosis and periocular vitiligo, following anterior approach levator advancement surgery.

Comparative study of plateletpheresis using Baxter CS 3000 plus and Haemonetics MCS 3P.

Platelet concentrates made from cell separators are used more frequently due to less donor exposure and leucodepletion. This retrospective study was done to compare plateletpheresis done on two cell separators: Baxter CS 3000 plus and Haemonetics MCS 3p. Plateletpheresis procedures, done from January 1997 to April 2002, were included in the study. One hundred and seven procedures were done on Haemonetics MCS 3p using SDP protocol, 49 procedures were done on Haemonetics MCS 3p using PLP protocol, and 107 were done on Baxter CS 3000 plus. Pre-procedure donor's platelet count and haemoglobin were comparable in all the groups. Platelet yield was comparable in PLP (6.44 x 10(11) platelets) and SDP (5.27 x 10(11)) protocols, but significantly less in Baxter (4.05 x 10(11) platelets, P < 0.001 for PLP and P < 0.05 for SDP). Efficiency of platelet removal was statistically significantly different in all the groups (P < 0.0001), however it was more in PLP (PLP-55.02%, SDP-47.38%, Baxter 38.98%). A significant number of products (19.51%) of Baxter failed to comply platelet count of product < or = 2,435 x 10(9)/l compared to 5.13% in PLP and 1.23% in SDP group; 36.96% of units from PLP and 28% from SDP qualified for split products compared to 1.18% of Baxter. PLP protocol of Haemonetics MCS 3p gives better platelet yield compared to Baxter CS 3000 plus and SDP protocol of Haemonetics MCS 3p.