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.

A Case of Morning Glory Disc Associated With Unilateral Retinopathy of Prematurity.

Morning glory disc anomaly is associated with serous retinal detachments, high refractive errors, amblyopia, and strabismus. There have been limited reports of an association between morning glory disc and peripheral retinal non-perfusion. The authors report a case of unilateral morning glory disc anomaly associated with markedly asymmetric retinopathy of prematurity. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e55-e57.].

New Synthesis Routes toward Improvement of Natural Filler/Synthetic Polymer Interfacial Crosslinking.

Among the critical issues dictating bio-composite performance is the interfacial bonding between the natural fibers and polymer matrix. In this regard, this article presents new synthesis routes comprising the treatment and functionalization of both date palm powder (DPP) filler and a polypropylene (PP) matrix to enhance filler-polymer adhesion in the newly developed bio-composites. Specifically, four bio-composite forms are considered: untreated DPP filled PP (DPP-UT/PP), treated DPP filled PP (DPP-T/PP), treated DPP filled functionalized PP using 2-isocyanatoethyl methacrylate (DPP-T/PP-g-IEM), and treated and functionalized DPP using 4-toluenesulfonyl chloride filled functionalized PP using 2-acrylamide ((DPP-T)-g-TsCl/PP-g-AcAm). The functional groups created on the surface of synthesized PP-g-IEM react with activated hydroxyl groups attached to the filler, resulting in chemical crosslinking between both components. Similarly, the reaction of TsCl with NH2 chemical groups residing on the mating surfaces of the filler and polymer generates an amide bond in the interface region. Fourier transform infrared spectroscopy (FTIR) is used to confirm the successful coupling between the filler and polypropylene matrix after applying the treatment and functionalization schemes. Owing to the introduced crosslinking, the DPP-T/PP-g-IEM bio-composite exhibits the best mechanical properties as compared to the neat polymer, unfunctionalized polymer-based bio-composite, and (DPP-T)-g-TsCl/PP-g-AcAm counterpart. The applied compatibilizers assist in reducing the water uptake of the manufactured bio-composites, increasing their durability.

Evaluation of Novel Compatibility Strategies for Improving the Performance of Recycled Low-Density Polyethylene Based Biocomposites.

The interfacial compatibility of the natural filler and synthetic polymer is the key performance characteristic of biocomposites. The fillers are chemically modified, or coupling agents and compatibilisers are used to ensure optimal filler-polymer compatibility. Hence, we have investigated the effect of compatibilisation strategies of olive pits (OP) flour content (10, 20, 30, and 40%wt.) filled with recycled low-density polyethylene (rLDPE) on the chemical, physical, mechanical, and thermal behaviour of the developed biocomposites. In this study, we aim to investigate the filler-polymer compatibility in biocomposites by employing novel strategies for the functionalisation of OP filler and/or rLDPE matrix. Specifically, four cases are considered: untreated OP filled rLDPE (Case 1), treated OP filled rLDPE (Case 2), treated OP filled functionalised rLDPE (Case 3), and treated and functionalised OP filled functionalised rLDPE (Case 4). In general, the evaluation of the performance of biocomposites facilitated the application of OP industrial waste as an eco-friendly reinforcing agent for rLDPE-based biocomposites. Furthermore, surface treatment and compatibilisation improved the properties of the developed biocomposites over untreated filler or uncoupled biocomposites. Besides that, the compatibilisers used aided in reducing water uptake and improving thermal behaviour, which contributed to the stability of the manufactured biocomposites.

Chemical Treatment of Bio-Derived Industrial Waste Filled Recycled Low-Density Polyethylene: A Comparative Evaluation.

The search for renewable alternatives for petroleum products that can be used in industrial applications is increasing. Each year, several tons of bio-derived industrial waste is produced and most of it is burned or placed in landfills. Olive pits (OP) have unique characteristics such as abundance, renewability, and biodegradability, which can be utilized to develop new types of biocomposites. One of the most promising uses of OP is that they can reinforce the mechanical properties of polymeric biocomposites. This study describes the preparation of recycled low-density polyethylene (rLDPE) that is filled with OP flour (10, 20, 30, and 40 wt.%) using a twin-screw extruder. The effects of the chemical treatment of the OP surface (sodium hydroxide (NaOH) and dimethyl sulfoxide (DMSO)) on the bio-filler/polymer compatibility along with the produced composite's chemical, physical, mechanical, and thermal properties have been explored. Overall, the reinforced composites that were obtained with alkali-treated OP have better biocomposite properties. This indicates an improved compatibility between the bio-filler and matrix. The results are promising in terms of using OP flour in developing green composites.

Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients.

PURPOSE: One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. METHODS: 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. RESULTS: The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P < 0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P < 0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. CONCLUSIONS: This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

Corrigendum: The Need for a Unified Protocol for Termination of Amblyopia Treatment.

[This corrects the article DOI: 10.22599/bioj.109.].

The Need for a Unified Protocol for Termination of Amblyopia Treatment.

INTRODUCTION: Many authors have investigated the methodology and outcomes of amblyopia treatment. However, the evidence on termination of treatment, specifically referring to the stability of visual outcome and timing of reviewing patients after treatment ends, has received less interest with no agreement on risk factors of visual regression. PURPOSE: To study the final part of amblyopia service with particular emphasis to stability of visual outcome; efficacy and timing of follow up after treatment ends. METHODS: A retrospective review of patients discharged following treatment for strabismic and anisometropic amblyopia. Exclusion criteria were ocular pathology, poor attendance or poor compliance. Collected data included: age at the start of treatment, type and duration of treatment, number of visits, visual acuity (at start and end). Additionally, we analysed the duration and number of visits after stopping treatment, final visual acuity at discharge and duration of treatment with minimal change in vision. RESULTS: Thirty-nine patients were identified with a mean age 4.2 ± 1.7SD years. Patients had an average of 116.6 ± 13.9SD visits over 30.5 ± 21.5SD months. Of these, 71.8% had occlusion only and 28.2% in combination with atropine. All but three patients had improved vision, with mean letters gained 13.2 ± 8.7SD LogMAR. The improvement in vision was statistically significant p < 0.005 and patients were further followed without treatment for 10 ± 13.5SD months over 5.2 ± 6.6SD visits. The mean final vision at discharge was not significantly different from vision at termination (p = 0.68) and we found no significant recurrence. CONCLUSION: Amblyopia treatment is effective; however, there is inconsistency in many aspects of ending treatment. Further improvement is needed to standardise care from termination of treatment up to discharge from service.

Screening for retinopathy of prematurity: a report from upper Egypt.

AIM: To detect the incidence of retinopathy of prematurity (ROP) in a tertiary referral neonatal intensive care unit in upper Egypt and to describe the obstacles faced during implementing the screening protocol for the first time. METHODS: Consecutive infants were enrolled at birth and screened for ROP. We used the UK ROP guideline (May 2008) for infant selection, follow up and treatment. Repeat examinations were performed until retinal vascularisation was complete. RESULTS: Fifty-two infants were enrolled: 24 males and 28 females. Mean gestational age was 31.3wk (±2.8 SD) and mean birth weight was 1234.6 g (±221.1 SD). Incidence of ROP was 36.5% (stages 1, 2, 3 and 4a were 9.6%, 9.6%, 15.4% and 1.9% respectively), no stages 4b or 5 were found in this series. Six infants (11.5%) died during screening without ROP, 25 infants (48.1%) were discharged from screening with retinal vascularisation reaching zone III, 5 infants (9.6%) were treated with indirect diode with or without additional cryotherapy and 16 infants (30.8%) were lost to follow up. In this series gestational age rather than birth weight was found significantly correlated and predictive (P<0.05) with ROP stages. CONCLUSION: ROP in a single site in Upper Egypt appears to have comparable incidence to other areas worldwide. The main screening obstacle was missing cases due to the absence of a national ROP screening protocol.

Parameters predicting outcomes of strabismus surgery in the management of Graves' ophthalmopathy.

BACKGROUND: Ocular dysmotility is a common feature of Graves' ophthalmopathy and frequently requires strabismus surgery. We reviewed the short-term results of strabismus surgery for Graves' ophthalmopathy to determine pre- and perioperative parameters predictive of postoperative outcome. METHODS: A retrospective review of Graves' ophthalmopathy patients who underwent strabismus surgery. Outcomes were correlated with preoperative and operative characteristics. The main outcome measure was field of binocular single vision score. Residual postoperative strabismus was considered a secondary outcome. Preoperative characteristics examined included age and laterality at onset, sex, disease activity, smoking status, and treatment for Graves' ophthalmopathy. Good outcome was defined as field of binocular single vision >50% and heterophoria in the primary position. Moderate outcome was defined as a field of binocular single vision 1% to 50% with heterotropia but with correctable diplopia in the primary position using prisms or head tilt. Poor outcome was defined as no measurable field of binocular single vision and intractable diplopia. RESULTS: Fifty patients were identified: 28 women, 22 men; mean age, 54 years (SD +/- 12.8). Thirty-seven (74%) had good and 13 (26%) had moderate or poor outcomes. Preoperative characteristics that were associated with good outcomes were symmetry of orbitopathy at Graves' ophthalmopathy onset (chi(2) = 7.5, p = 0.001) and earlier timing of surgery (t = -2.9, p = 0.003). CONCLUSION: Relative symmetry of orbitopathy at onset and a shorter time interval between onset of orbitopathy and surgery, while allowing for disease stability, are predictive of a good outcome following strabismus surgery for Graves' ophthalmopathy.