Oral Sirolimus for Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome.

This case report describes an 8-year-old girl who received oral sirolimus as an adjuvant therapy for pulse dye laser of her port-wine stain and as an off-label treatment of exudative retinal detachment secondary to diffuse choroidal hemangioma.

Comparison of three modalities of teleophthalmology delivery in regional Western Australia during the COVID-19 lock-down.

CLINICAL RELEVANCE: In conjunction with local optometry services, telehealth may be used in to provide specialist care for patients living in rural areas underserved by ophthalmology. BACKGROUND: To combat travel restrictions for specialist outreach to regional areas during the 2020 COVID-19 lockdown, Lions Outback Vision introduced three different modalities of teleophthalmology consultations; home-based telephone, hospital-based video, and optometry-based video. This study evaluated the utility of these in providing specialist care to rural patients during the pandemic. METHODS: Data from patients referred during the COVID-19 lock-down period (23 March 2020 to 5 June 2020) were analysed. If sufficient clinical information and imaging were available then ophthalmologists conducted home-based telephone consultations. If further ocular imaging or examination was required, then optometry-based video or hospital-based video were used. Data were analysed using ANOVA and two-sided t tests for continuous data and Chi Square statistics for categorical data (p < 0.05). RESULTS: Majority of the 431 consultations were conducted via home telephone (38%) or optometry-based video (37%). Indigenous patients (p = 0.014) and patients in very remote communities (p < 0.01) were more likely to receive a home-based telephone consultation. Because sufficient clinical information had already been obtained for home-based consultations, these patients were more likely to be booked for surgery than optometry (p < 0.01).Cataracts were the predominant diagnosis in optometry consults compared to hospital (p < 0.01). CONCLUSION: Primary optometry and home telephone represent a new modality for providing specialist care for patients living in very remote regions and for Indigenous patients. When appropriate clinical testing has been completed, telephone-based ophthalmology may continue to be useful for certain conditions such as waitlisting patients for cataract surgery and should continue to be funded beyond the duration of the pandemic for rural patients.

A systematic review of diabetic retinopathy screening intervals.

The current evidence on whether annual diabetic retinopathy (DR) screening intervals can be extended was reviewed. A systematic review protocol was followed (PROSPERO ID: CRD42022359590). Original longitudinal articles that specifically assessed DR screening intervals were in English and collected data after 2000 were included. Two reviewers independently conducted the search and reviewed the articles for quality and relevant information. The heterogeneity of the data meant that a meta-analysis was not appropriate. Twelve publications were included. Studies were of good quality and many used data from DR screening programs. Studies fit into three categories; those that assessed specific DR screening intervals, those that determined optimal DR screening intervals and those that developed/assessed DR screening risk equations. For those with type 2 diabetes, extending screening intervals to 3- to 4-yearly in those with no baseline DR appeared safe. DR risk equations considered clinical factors and allocated those at lower risk of DR progression screening intervals of up to five years. Those with baseline DR or type 1 diabetes appeared to have a higher risk of progression to STDR and needed more frequent screening. DR screening intervals can be extended to 3-5 yearly in certain circumstances. These include patients with type 2 diabetes and no current DR, and those who have optimal management of other risk factors such as glucose and blood pressure.

Adult onset xanthogranuloma of the eyelid.

Purpose: To report a rare case of an eyelid lesion in an adult, with histological features of juvenile xanthogranuloma (JXG). Observations: Juvenile xanthogranuloma primarily affects the skin of infants and young children. It infrequently can involve the structures of the eye and orbit and rarely occurs in individuals beyond the second decade of life. We present a case of adult onset xanthogranuloma (AXG) involving the eyelid of a 29-year-old female. This lesion required management with multiple treatment modalities. Conclusions: This is a rare example of an eyelid xanthogranuloma in an adult. As such, JXG-like lesions should be included as a differential diagnosis for lesions of the eye and orbit in adults. Surgical management may be required if there is no response to intralesional steroids.