Increase in treatment of retinopathy of prematurity in the Netherlands from 2010 to 2017.

PURPOSE: Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. METHODS: Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1-1-2010 to 31-3-2013 and P2: 1-4-2013 to 31-12-2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. RESULTS: Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1-fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born <25 weeks increased by factor 1.23 and higher oxygen saturation levels were aimed at in most centres. At treatment decision, 59.6% (P1) versus 83.5% (P2) (p = 0.263) infants were classified as Type 1 ROP (ETROP classification). Infants were treated with laser photocoagulation (98 versus 96%) and intravitreal bevacizumab (2 versus 4%). Retreatment was necessary in 10 versus 21 (p = 0.160). Retinal detachment developed in 6 versus 13 infants (p = 0.791) of which 2 versus 6 bilateral (p = 0.599). CONCLUSION: In period 2, the number of infants treated according to the ETROP criteria (Type 1) increased, the number of ROP treatments, retinal detachments and retreatments doubled and the absolute number of retinal detachments increased. Neonatal data did not provide a decisive explanation, although changes in neonatal policy were reported.

Classification for treatment urgency for the microphthalmia/anophthalmia spectrum using clinical and biometrical characteristics.

PURPOSE: Current clinical classifications do not distinguish between the severity of the MICrophthalmia/Anophthalmia (MICA) spectrum with regard to treatment urgency. We aim to provide parameters for distinguishing mild, moderate and severe MICA using clinical and biometrical characteristics. METHODS: We performed a single-centre, cross-sectional analysis of prospective cohort of 58 MICA children from September 2013 to February 2018 seen at the Amsterdam University Medical Center, The Netherlands. All patients with a visible underdeveloped globe were included. We performed full ophthalmic evaluation including horizontal palpebral fissure length, axial length by ultrasound and/or MRI measurements, paediatric and genetic evaluation. Cases were subdivided based on clinical characteristics. Biometrical data were used to calculate the relative axial length (rAL) and the relative horizontal palpebral fissure length (rHPF) compared with the healthy contralateral eye for unilateral cases. RESULTS: In previously untreated patients, a strong correlation exists between rAL and rHPF, distinguishing between severe, moderate and mild subjects using rAL of 0-45%, 45-75% and 75%-100%, respectively. Clinical subgroups were randomly dispersed throughout the scatterplot. CONCLUSION: Current classifications lack clinical implications for MICA patients. We suggest measuring eyelid length and axial length to classify the severity and determine treatment strategy. The 'severe' group has obvious asymmetry and abnormal socket configuration for which therapy should quickly be initiated; the 'moderately' affected group has normal socket anatomy with a microphthalmic eye with disturbing asymmetry for which treatment should be initiated within months of development; the 'mild' group has a slightly smaller axial length or less obvious eyelid asymmetry for which reconstructive correction is possible, but expansive conformer treatment is unnecessary.

[Corneal perforation due to 'lost' contact lenses]. / Corneaperforatie door 'zoekgeraakte' contactlenzen.

An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.

[A 4-year-old girl with double vision following trauma]. / Een 4-jarig meisje met dubbelzien na een trauma.

BACKGROUND Due to its long intracranial course, the abducens nerve is vulnerable in case of acceleration injury of the head. In rare cases, this may lead to posttraumatic paralysis of this cranial nerve. CASE DESCRIPTION A 4-year-old girl visited the emergency department after sustaining a head trauma. Neurological examination revealed no focal abnormalities at first. Three days later, she experienced diplopia, the consequence of isolated abducens nerve paralysis. CT and MRI brain imaging revealed no abnormalities. We treated her with an eye patch for a short time. At examination after 1 year, she was no longer experiencing any symptoms and the paralysis had almost completely disappeared. CONCLUSION Isolated paralysis of the abducens nerve may occur until up to 6 days after a trauma, without any visible intracranial abnormalities revealed by imaging. Even though only few children with this condition have been described, prognosis seems to be favourable and symptoms disappear in the majority of patients. Frequent follow-up by the ophthalmologist and the orthoptist is recommended, possibly with symptomatic treatment of the diplopia.