RESUMO
Retinopathy of prematurity (ROP) is a leading cause of blindness in pre-term infants and is caused by incomplete vascularization of the retina at birth. Early diagnosis and treatment of ROP is important to reduce the risk of vision loss. The risk factors, pathogenesis, screening, diagnosis, and treatment of this disease will be reviewed.
Assuntos
Retinopatia da Prematuridade , Humanos , Recém-Nascido , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/terapia , Fatores de RiscoAssuntos
Infecções por Ascaridida/diagnóstico , Cegueira/parasitologia , Larva Migrans/diagnóstico , Meningite/diagnóstico , Transtornos Psicomotores/parasitologia , Infecções por Ascaridida/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Pré-Escolar , Diagnóstico Diferencial , Feminino , Granuloma/tratamento farmacológico , Granuloma/parasitologia , Humanos , Larva Migrans/tratamento farmacológico , Imageamento por Ressonância Magnética , Meningite/tratamento farmacológico , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/parasitologiaRESUMO
PURPOSE: To evaluate the validity of remote telemedicine screening for retinopathy of prematurity (ROP) in a population of at-risk preterm infants in Iowa and South Dakota. METHODS: The medical records for all preterm infants screened for ROP at neonatal intensive care units (NICUs) in Sioux City, Iowa, and Sioux Falls, South Dakota, from September 1, 2017, to July 31, 2018, were retrospectively reviewed. The RetCam Shuttle (Natus Medical Inc., Pleasanton, CA) was used to capture retinal images, which were posted on a secure server for evaluation by a pediatric ophthalmologist. Infants with suspected ROP approaching the criteria for treatment with anti-vascular endothelial growth factor (VEGF) medications were transferred to the Children's Hospital and Medical Center NICU in Omaha, Nebraska, where a comprehensive examination was performed and treatment was administered when indicated. The remaining infants received an outpatient comprehensive examination by one of two pediatric ophthalmologists within 2 weeks of discharge. RESULTS: A total of 124 telemedicine examinations were performed on 35 infants during the study period. Remote telemedicine screening for referral-warranted ROP using the RetCam Shuttle had a sensitivity of 100%, specificity of 97%, positive predictive value of 66.7%, and negative predictive value of 100%. Of the three infants transferred for referral-warranted ROP, two required treatment with anti-VEGF medications. Good outcomes were noted in all cases, and no patients progressed beyond stage 3 ROP. CONCLUSIONS: Telemedicine screening reliably detected referral-warranted ROP in at-risk premature infants at two remote sites, with no poor outcomes during the 11-month period. These results demonstrate the validity and utility of remote telemedicine screening for ROP. [J Pediatr Ophthalmol Strabismus. 2019;56(3):157-161.].
Assuntos
Triagem Neonatal/métodos , Retinopatia da Prematuridade/diagnóstico , Telemedicina/instrumentação , Desenho de Equipamento , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Iowa/epidemiologia , Masculino , Oftalmoscopia/métodos , Reprodutibilidade dos Testes , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , South Dakota/epidemiologiaRESUMO
We report a case of bilateral papillitis and anterior uveitis in a pediatric patient with preceding viral prodrome. Because this is a rare disease in the pediatric population, work-up in this case was extensive given the wide differential of papilledema in the pediatric setting. The clinical significance of this case is to bring to light the timely recognition, follow-up, and treatment of this disease to minimize the burden to the patient and family.
