Correlation and agreement between the Mohindra and cycloplegic retinoscopy techniques in children.

PURPOSE: As an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients not good candidates for cycloplegic retinoscopy (RC). The aim of the present research was to compare both techniques and to determine the correlation and agreement of their measurements. MATERIAL AND METHODS: A total of 47 boys and girls of ages ranging from 3 to 11 years old were included in the study. Cycloplegic (cyclopentolate 1%) and Mohindra retinoscopy were conducted in both eyes, and refraction was also assessed with an autorefractometre (AR). The results from the three techniques were compared and a correction factor between RM and RC was calculated. RESULTS: Statistically significant differences were found between RM and RC (median of -0.42 D; p < 0.001) and between RM and AR (median of -0.42 D; p = 0.008), but not between RC and AR (median of 0.00 D; p = 0.758). A strong correlation was found between RM and RC (rho = 0.846; p < 0.001), although the Bland-Altman test revealed a larger difference between these techniques in patients with larger hyperopic refractive errors, with a correction factor of RC = 1.15 RM + 0.42. CONCLUSIONS: The Mohindra technique may be considered a valid alternative to cycloplegic retinoscopy in patients of young age, with a good correlation between both techniques, albeit less agreement in patients with high hyperopic refractions.

Correlación y concordancia entre la técnica de retinoscopia de Mohindra y la retinoscopia con ciclopléjico en la infancia / Correlation and agreement between the Mohindra and cycloplegic retinoscopy techniques in children

Objetivo: La retinoscopia, como técnica objetiva de evaluación del estado refractivo, es especialmente útil en la edad infantil. La técnica de Mohindra (RM) es una alternativa para aquellos pacientes en los que no es viable la retinoscopia mediante ciclopléjico (RC). En el presente estudio se pretende comparar ambas técnicas para determinar su correlación y concordancia.Materiales y métodos: Se seleccionaron a 47 niños y niñas con edades comprendidas entre los 3 y 11 años. Se determinó para ambos ojos la refracción con RM y RC (ciclopentolato 1%), así como con autorefractómetro (AR). Se compararon los resultados de las tres técnicas y se calculó el factor de corrección correspondiente para equiparar RM con RC.Resultados: Se encontraron diferencias significativas entre RM y RC (mediana de -0,42 D; p<0,001) y entre RM y AR (mediana de -0,42 D; p=0,008), pero no entre RC y AR (mediana de 0,00 D; p=0,758). La correlación entre RM y RC fue excelente (rho=0,846; p<0,001) pero el test de Bland-Altman evidenció una mayor discrepancia entre técnicas a medida que aumentaba la refracción hipermetrópica, con un factor de corrección de RC=1,15 RM + 0,42. Conclusiones: La técnica de Mohindra se puede considerar como una alternativa válida a la retinoscopía mediante ciclopléjico en pacientes en edad escolar y preescolar, con una buena correlación entre ambas técnicas, pero con menor concordancia en hipermetropías elevadas.

Purpose: As an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients not good candidates for cycloplegic retinoscopy (RC). The aim of the present research was to compare both techniques and to determine the correlation and agreement of their measurements.Material and Methods: A total of 47 boys and girls of ages ranging from 3 to 11 years old were included in the study. Cycloplegic (cyclopentolate 1%) and Mohindra retinoscopy were conducted in both eyes, and refraction was also assessed with an autorefractometre (AR). The results from the three techniques were compared and a correction factor between RM and RC was calculated.Results: Statistically significant differences were found between RM and RC (median of -0.42 D; p<0.001) and between RM and AR (median of -0.42 D; p=0.008), but not between RC and AR (median of 0.00 D; p=0.758). A strong correlation was found between RM and RC (rho=0.846; p<0.001), although the Bland-Altman test revealed a larger difference between these techniques in patients with larger hyperopic refractive errors, with a correction factor of RC=1.15 RM + 0.42.Conclusions: The Mohindra technique may be considered a valid alternative to cycloplegic retinoscopy in patients of young age, with a good correlation between both techniques, albeit less agreement in patients with high hyperopic refractions.

Sarcoma de Kaposi conjuntival gigante por el virus de inmunodeficiencia humana: remisión total tras terapia antirretroviral y quimioterapia sistémica / Human immunodeficiency virus-associated giant conjunctival Kaposi's sarcoma: complete remission with antiretroviral therapy and systemic chemotherapy

CASO CLÍNICO: Paciente varón de 35 años con lesión conjuntival tumoral hemorrágica unilateral y otra contralateral poco elevada, de curso subagudo y asociadas a máculas cutáneas violáceas en extremidades y angiomas digestivos como primera manifestación de inmunodepresión por el virus de inmunodeficiencia humana (VIH). La biopsia cutánea, de mucosa estomacal y conjuntival confirmó el diagnóstico de sarcoma de Kaposi con resolución total de las lesiones con terapia antirretroviral y quimioterapia sistémica. CONCLUSIÓN: El sarcoma de Kaposi conjuntival asociado a infección por el VIH, incluso de grandes dimensiones, puede tener una buena respuesta al tratamiento antirretroviral y quimioterápico sistémicos sin necesidad adicional de terapia ocular local

CASE REPORT: A 35-year-old male patient with a large unilateral haemorrhagic conjunctival tumour lesion and another contralateral haemorrhagic conjunctival flat lesion associated with violaceous cutaneous macules on the extremities and angiomatous lesions in the upper gastrointestinal tract as initial clinical manifestation of HIV-related immunodeficiency. Cutaneous, gastric mucosal and conjunctival biopsy was consistent with Kaposi's sarcoma with complete remission after highly active antiretroviral therapy and systemic chemotherapy. CONCLUSION: HIV-related conjunctival Kaposi's sarcoma, even a large one, can have a good response to antiretroviral therapy and systemic chemotherapy without any additional topical eye treatment

Human immunodeficiency virus-associated giant conjunctival Kaposi's sarcoma: complete remission with antiretroviral therapy and systemic chemotherapy. / Sarcoma de Kaposi conjuntival gigante por el virus de inmunodeficiencia humana: remisión total tras terapia antirretroviral y quimioterapia sistémica.

CASE REPORT: A 35-year-old male patient with a large unilateral haemorrhagic conjunctival tumour lesion and another contralateral haemorrhagic conjunctival flat lesion associated with violaceous cutaneous macules on the extremities and angiomatous lesions in the upper gastrointestinal tract as initial clinical manifestation of HIV-related immunodeficiency. Cutaneous, gastric mucosal and conjunctival biopsy was consistent with Kaposi's sarcoma with complete remission after highly active antiretroviral therapy and systemic chemotherapy. CONCLUSION: HIV-related conjunctival Kaposi's sarcoma, even a large one, can have a good response to antiretroviral therapy and systemic chemotherapy without any additional topical eye treatment.