Outcomes for non-treatment-requiring infants evaluated for retinopathy of prematurity.

PURPOSE: To evaluate the rates of visually significant disorders in patients without treatment-requiring retinopathy of prematurity (ROP) at initial follow-up after completion of ROP examinations. METHODS: The medical records of all babies evaluated for retinopathy of prematurity between June 2015 and September 2020 were reviewed. Patients with documented gestational age, birth weight, and single versus multiple birth status who did not require ROP treatment and who followed-up with our institution's pediatric ophthalmologist were included. RESULTS: A total of 304 patients were included. Of these, 15 (4.9%) had strabismus (12 [4.0%] with esotropia, 3 [0.9%] with exotropia), 30 (9.9%) had myopia, 174 (57.2%) had hyperopia, 54 (18%) had astigmatism, 4 (1.3%) had amblyopia, 5 (1.6%) were labeled amblyopia suspects, 1 (0.3%) had congenital glaucoma, and 1 (0.3%) had congenital cataract. Nineteen (6.3%) had a condition requiring intervention at the first evaluation following completion of ROP examinations, and in 5 (2%), this was a condition that would typically not have been identified without evaluation by a pediatric ophthalmologist. CONCLUSIONS: In our population of infants evaluated for retinopathy of prematurity who did not require ROP treatment, the incidence of other ocular disorders requiring intervention at the first non-ROP evaluation was about 6%. This study highlights the need for further research that may aid in the creation of an evidence-based follow-up strategy for premature infants who never undergo ROP treatment.

Evidence-Based Screening to Optimize the Yield of Positive Ophthalmologic Examinations in Children Evaluated for Suspected Child Abuse.

PURPOSE: To determine nonocular findings associated with significant retinal hemorrhage on dilated fundus examination in cases of suspected child abuse. METHODS: This was a retrospective chart review from May 2014 to August 2021 at a level-1 trauma center. Two hundred seventy-four patients met the following inclusion criteria: (1) children 36 months and younger; (2) concern for child abuse; and (3) had an ophthalmology consultation. Through univariate and multivariate logistic regression, the study produced a screening algorithm for ophthalmic work-up in child abuse. RESULTS: One or more abnormal neuroimaging findings had a statistically significant association with retinal hemorrhages and produced the strongest association with a univariate odds ratio of 170 (confidence interval: 10.245 to > 999.999). The multivariate model (P < .0001 with a c-statistic of 0.980) proposes using the following variables for predicting retinal hemorrhage on examination: abnormal neuroimaging, Glasgow Coma Scale score less than 15, altered mental status on examination, seizure activity, vomiting, bruising, scalp hematoma/swelling, and skull fractures. CONCLUSIONS: This study elucidates clinical and imaging factors that correlate to retinal findings, validating previously studied variables and introducing new variables to be considered. The authors propose an evidence-based screening algorithm to increase the yield of positive dilated examinations and decrease the burden of potentially unnecessary child abuse ophthalmologic examinations. [J Pediatr Ophthalmol Strabismus. 2022;59(5):310-319.].

Idiopathic Intracranial Hypertension and Multiple Sclerosis Overlap.

Idiopathic intracranial hypertension (IIH) and multiple sclerosis (MS) occur with a higher incidence in women of childbearing age and may be associated with other clinical entities. Both disease processes alter cerebrospinal fluid (CSF) dynamics and may present similarly with headache and visual changes. We report a case of a 33-year-old morbidly obese woman who developed progressive worsening blurry vision and unilateral temporal headache. She was found to have papilledema which prompted workup for intracranial hypertension. Her imaging and CSF findings were suggestive of a demyelinating process such as MS in addition to IIH.