Unusual presentation of a vascularized iris lesion in an infant.

We report an unusual presentation of a 10-month-old girl with left eye (LE) redness and watering. Evaluation showed an iris vascular lesion and lens opacity in her LE. Child underwent USG B-scan and ultrasound biomicroscopy, by which an extensive mass lesion arising from iris and ciliary body with absent calcification was revealed. Following extensive evaluation, child underwent cataract extraction and trans-scleral total excision of the mass lesion. Histopathology proved it as juvenile xanthogranuloma (JXG) with vascular proliferation. JXG is a rare benign self-limiting dermatologic disorder affecting mainly infants and small children. Ocular lesions are the most common extracutaneous manifestation. Cataract in JXG is less frequently reported. This case is reported due to its rarity and as it presented solely as an intraocular lesion with combined diffuse infiltration into ciliary body and cataract which is unusual. Early recognition and systematic approach helped in sight saving and organ salvaging.

Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.

Purpose: To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic. Methods: This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed. Results: One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity. Conclusion: The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.

Pigmented ciliary body medulloepithelioma in a newborn infant.

Ciliary body medulloepithelioma is a nonpigmented tumor which presents during the first decade of life. It is rarely seen in newborn infants. We report a pigmented medulloepithelioma in a newborn infant, which showed a rapid growth. Ciliary body medulloepithelioma should be considered in the differential diagnosis in a newborn infant presenting with leukocoria.

Retinopathy of Prematurity: Clinical Features, Classification, Natural History, Management and Outcome.

CONTEXT: Retinopathy of prematurity is an avoidable cause of childhood blindness. Proper understanding of the classification and treatment methods is a must in tackling this disease. EVIDENCE ACQUISITION: Literature search with PubMed was conducted covering the period 1940-2015 with regards to retinopathy of prematurity, retrolental fibroplasia, its natural history, classification and treatment. RESULTS: The clinical features, screening and staging of retinopathy of prematurity according to International classification of retinopathy of prematurity (ICROP) has been included with illustrations. The standard current treatment indications, modalities and outcomes from landmark randomized controlled trials on retinopathy of prematurity have been mentioned. CONCLUSION: This review would help pediatricians to update their current knowledge on classification and treatment of retinopathy of prematurity. Screening for retinopathy of prematurity, in India, should be performed in all preterm neonates who are born <34 weeks gestation and/or <1750 grams birthweight; as well as in babies 34-36 weeks gestation or 1750-2000 grams birthweight if they have risk factors for ROP. Screening should start by one month after birth.

Retinopathy of prematurity: Past, present and future.

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

Outcomes of Intra- and Extraocular Retinoblastomas from a Single Institute in South India.

AIM: To report treatment outcomes of intra- and extraocular retinoblastomas seen at Aravind Eye Hospital, Coimbatore, South India. METHODS: Retrospective case series from January 2006 to December 2011 involving 106 babies. Clinical records were reviewed and data collected on presenting signs, gender, age, family history, ocular findings and treatment outcomes. All eyes were classified using the International Retinoblastoma Classification. RESULTS: The mean follow up was 35.4 months (range 1-75 months, SD 20.2, median 33 months). The mean age of presentation was 20.8 months (range 5 days to 120 months). There were 68 unilateral and 38 bilateral cases. Globe salvage rates were 100% for group A (11 eyes), B (16 eyes) and C (2 eyes). For group D, eye salvage rate was 29.5% (10/34 eyes). Survival rate of orbital retinoblastoma in our study was 55.5% (5/9 cases) at a mean follow up of 33.6 months. The overall patient survival rate was 89.6% with 11 deaths (10.4%). The commonest cause of death (7/11) was distant metastasis due to refusal to take initial treatment. CONCLUSION: Greater improvement in patient survival can be achieved not only by early treatment of intraocular disease but also to convince patients to accept treatments including enucleation in this part of the world.

Intravitreal bevacizumab for incontinentia pigmenti.

Two eyes of two siblings affected with incontinentia pigmenti having severe proliferative retinopathy are reported. Both cases showed complete resolution of new vessels after a single injection of intravitreal bevacizumab. At 7 months of follow-up, the first case revealed vascularization to the mid-periphery including a vascularized fovea (which was avascular before injection) but recurrence of some peripheral neovascularization, which was treated by conventional laser. The second case had no recurrence. No ocular or systemic adverse effects were observed. Intravitreal bevacizumab as an adjunct therapy in incontinentia pigmenti with macular ischemia could be beneficial.

Aggressive posterior retinopathy of prematurity in large preterm babies in South India.

OBJECTIVE: To describe aggressive posterior retinopathy of prematurity (APROP) in a subset of premature babies, having gestational age (GA) of ≥28 weeks and birth weight (BW) of ≥1000 g. DESIGN: Retrospective observational case series. SETTING AND PATIENTS: Case records of 99 babies, who were diagnosed to have APROP between July 2002 and October 2010 were reviewed. Fundus fluorescein angiography (FFA) was carried out in 19 babies. RESULTS: The mean GA was 31.7 weeks (range 28-35 weeks) and mean BW was 1572 g (range 1000-2310 g). All these babies received supplemental unblended oxygen 3 days or longer after birth. Of the 52 babies who had an eye exam in the neonatal intensive care unit prior to discharge, 35 babies had loss of vascularised retina from zone II to zone I and four babies from zone III to zone I, when examined as an outpatient. FFA revealed large geographic areas of vaso-obliteration (more than 30 disc areas) posterior to the shunt vessels within vascularised retina. CONCLUSIONS: Features of severe capillary bed loss in the vascularised retina were seen in our cases. Oxygen could be a precipitating factor in causing this retinopathy of prematurity in large babies.

Appearance and Spontaneous Resolution of Macular Pucker After Triple Freeze-Thaw Cryotherapy for Retinoblastoma.

This report describes a case of macular pucker after triple freeze-thaw cryotherapy for retinoblastoma. Seven months after cryotherapy, the macular pucker resolved spontaneously.

Multivariate analysis of childhood microbial keratitis in South India

<p><b>INTRODUCTION</b>Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children <or=15 years were included in the study. Full ophthalmic examination was performed for all cases.</p><p><b>RESULTS</b>Of the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.</p><p><b>CONCLUSION</b>The most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.</p>