Screening for retinopathy of prematurity in developing countries.

Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.

Comparison of three surgical procedures of differing complexity in the correction of trachomatous upper lid entropion: a prospective study.

OBJECTIVE: To compare the efficacy of three common surgical procedures of increasing complexity in the correction of trachomatous entropion. MATERIALS AND METHODS: In a prospective study, lids with moderate or severe (without lid gap) trachomatous entropion were randomly allocated to undergo either terminal tarsal rotation (I, n = 30), tarsal rotation with tarso-conjunctival advancement (II, n = 30), or anterior lamellar repositioning with lid margin split and wedge resection of tarsus (III, n = 30). The procedures were compared for improvement of symptoms, duration of surgery, cosmesis, rate and type of complications, anatomical correction, failure and recurrence. One-way and repeated-measure ANOVA, Chi-square and Fisher's exact tests were used. RESULTS: The study included 90 eyes of 77 patients (age range: 30-85 years). Symptomatic improvement was comparable after each procedure (p > 0.05). Procedure I, the simplest in technique, took significantly less time (p < 0.001). The three procedures were comparable in achieving cosmesis (p = 1.0), anatomical correction (p = 0.35), and rate of complications (p = 0.43). Failure of surgery was seen in two lids (procedure II), and recurrence in one lid (procedure III). CONCLUSION: In developing countries, where manpower and other resources are limited and patient-load high, ophthalmic surgeons should choose a procedure that is simple, quick and effective. This study suggests that terminal tarsal rotation after transverse tarsotomy should be the procedure of choice in the correction of moderate or severe (without lid gap) trachomatous entropion.

Retinopathy of prematurity--risk factors.

OBJECTIVE: Improved survival of low birth weight, premature babies have increased the incidence of retinopathy of prematurity. This hospital-based, prospective, study was undertaken to determine its incidence and risk factors in our neonatal unit. METHODS: Neonates with gestational age < or = 35 weeks and/or birth weight < or = 1500 gm born over a one-year period were examined by indirect ophthalmoscopy between 2 to 4 weeks after birth, and followed up till retinal vascularisation was complete. Maternal and neonatal risk factors were noted and data analyzed by statistical package SPSS-10.0. RESULTS: Sixty babies were thus examined. The incidence of retinopathy was 21.7% in the cohort, 33.3% in babies < or = 32 weeks gestation and 36.4% in babies weighing < or = 1250 gm. Oxygen (p=0.01), sepsis (p=0.04) and apnoea (p=0.02) were independent risk factors. Retinopathy was significantly more severe in babies with hyaline membrane disease (p=0.02) and lower birth weight (p=0.02). Severe disease was never seen before 6.5 weeks of age. CONCLUSION: Indirect ophthalmoscopy should be performed at 4 weeks of post natal age in all preterm babies with birth weight < or = 1500 gm, and intensified in the presence of risk factors like oxygen administration, apnoea and septicemia.

Comparison of single-drop mitomycin C regime with other mitomycin C regimes in pterygium surgery.

PURPOSE: To evaluate the safety and efficacy of single-drop instillation of mitomycin C (MMC) in pterygium surgery and to compare the results with both postoperative and intraoperative application of MMC. METHODS: Eighty eyes of 72 patients with pterygium were randomised into 4 equal groups: group 1--control--bare scleral excision (BSE); group 2--BSE with single-drop instillation of mitomycin C (MMC) 0.02% at the end of the surgery; group 3--BSE with postoperative MMC 0.02% drops twice a day for 5 days; and group 4--BSE with intraoperative MMC 0.02%. RESULTS: The recurrence of pterygium was observed in 14 (70%), 4 (20%), 4 (20%) and 3 (15%) eyes of group 1, 2, 3, and 4 respectively. The recurrence rate after BSE with single drop MMC regime (group 2) was significantly lower than group 1 recurrence (P=0.001) and was statistically comparable to that of group 3 and 4. Scleral defects in the bare area occurred in 4 (20%), 16 (80%) and 16 (80%) eyes of group 2, 3, and 4 respectively. The incidence of scleral defects was significantly lower in group 2 compared to group 3 (P=0.0001) and group 4 (P=0.0001). Compared to group 1 and 2, a significant delay in wound epithelialisation occurred in group 3 (P=0.003) and 4 (P=0.004). An ischaemic area in the bare sclera developed in 8 (40%) and 6 (30%) eyes of group 3 and 4 respectively, while ischaemic area did not develop in group 1 and 2. CONCLUSION: Single-drop instillation of 0.02% mitomycin C following pterygium excision appears both safe and efficacious.