Bilateral Choroidal Detachment in the Absence of Previous Intraocular Surgery.

The aim of this report was to present a case of bilateral choroidal detachment following treatment with topical therapy dorzolamide/timolol without history of previous surgery. An 86-year-old woman, with intraocular pressures of 40.00/36.00 mm Hg, was treated with preservative-free double therapy with dorzolamide/timolol. One week later, she presented with bilateral vision loss and irritative symptoms in the face, scalp, and ears, with well controlled pressures. The anterior exam showed LOCS III N4C3 cataracts, and the fundus and ultrasound exams revealed a bilateral infero-temporal choroidal detachment in the absence of neoplasia or other systemic cause. One week in absence of hypotensive treatment and receiving topical prednisolone, she showed reattachment of the choroidal detachment. Six months after cataract surgery, the patient remains stable, without choroidal effusion regression. Hipotensive treatment following chronic angle closure can lead to choroidal effusion similar to cases of acute angle closure treated with oral carbonic-anhydrase inhibitors. The combined strategy of removing hipotensive treatment and topical corticosteroids could be useful for the initial management of choroidal effusion. Also, performing cataract surgery after choroidal reattachment can help with stabilization.

Nuevas evidencias sobre el efecto protector de la ganancia de peso en la retinopatía del prematuro / New evidence on the protector effect of weight gain in retinopathy of prematurity

Introducción: La retinopatía del prematuro (ROP) se caracteriza por el desarrollo vascular insuficiente en la retina que, en los casos severos precisa tratamiento precoz para evitar secuelas visuales. Es actualmente la segunda causa mundial de ceguera infantil prevenible.Pacientes y métodos: Estudio observacional, retrospectivo, de casos-controles sobre 233 recién nacidos prematuros explorados entre 1999-2019.Resultados: La ganancia de peso posnatal en las primeras 4 semanas, el peso al nacer, la edad gestacional, la ventilación mecánica, las transfusiones recibidas y la presencia de sepsis, ductus arteriovenoso persistente, enterocolitis necrosante, hemorragia intraventricular o leucomalacia periventricular, mostraron diferencias significativas entre el grupo de ROP no susceptible de tratamiento frente al grupo candidato a tratamiento. La ganancia ponderal media fue 12,75±5,99g/día en el grupo no susceptible de tratamiento y 9,50±5,45g/día en el susceptible de tratamiento. El riesgo de ROP candidata a tratamiento se redujo progresivamente con el aumento de ganancia ponderal. La reducción del riesgo fue de 2,76 - 8,35% en ganancias de 10g/día, y alcanza el 7,17 - 12,76% en ganancias de 20g/día.Conclusiones: El riesgo de presentar ROP severa candidata a tratamiento disminuye con el aumento de la ganancia de peso posnatal en las primeras 4 semanas. Esta relación se mantiene en ganancias de peso >14g/día. Sin embargo, se deben tener en cuenta la edad gestacional y peso al nacer del recién nacido, la duración de la ventilación mecánica y su comorbilidad para la evaluación global del riesgo de ROP que precisa tratamiento. (AU)

Introduction: Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world.Patients and methods: This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019.Results: Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75±5.99g/day, whereas it was 9.50±5.45g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76 - 8.35% in preterm infants gaining 10g/day, and 7.17 - 12.76% in infants gaining 20g/day.Conclusions: The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥ 14g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment. (AU)

New evidence on the protector effect of weight gain in retinopathy of prematurity.

INTRODUCTION: Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world. PATIENTS AND METHODS: This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019. RESULTS: Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75 ±â€¯5.99 g/day, whereas it was 9.50 ±â€¯5.45 g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76%-8.35% in preterm infants gaining 10 g/day, and 7.17%-12.76% in infants gaining 20 g/day. CONCLUSIONS: The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥14 g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment.

Risk Calculator for Retinopathy of Prematurity Requiring Treatment.

Importance: Vascular delay that occurs early in the development of retinopathy of prematurity (ROP) is a risk factor that can be compensated by ensuring a good rate of retinal vascularization to avoid ROP that requires treatment. Background: The objective of the present study was to determine the association between ROP that requires treatment and risk factors such as the extent of the temporal avascular area of the retina and the number of days of mechanical ventilation (MV). Design: Observational retrospective case-control study. Participants: Two hundred and twenty-eight premature newborns included in the screening protocol for retinopathy of prematurity. Methods: Subjects underwent retinal examination in the 4 and 6th postnatal weeks. Main Outcome Measures: The temporal avascular area was measured in disc diameters (DD), while the MV time was measured in days of treatment. Results: Patients with a longer MV time had a higher risk of treatment (R 2: 24.7, p < 0.0001; increase in risk of 8.1% for each additional day), as did those who showed greater avascular area (R 2: 24.7, p < 0.0001; increase in risk of 111% for each additional DD). An online calculator system and a table are presented for calculating the risk of ROP requiring treatment as a function of these two risk factors. Conclusions and Relevance: The temporal avascular area of the retina and MV time must be taken into account in the first examination of the newborn to predict the need for ROP treatment.

Multicenter validation study of the WINROP algorithm as a method for detecting retinopathy of prematurity.

Purpose: To assess the validity of the online WINROP algorithm in two Spanish populations of premature infants.Materials and methods: The study population consisted of 502 premature infants born in the San Cecilio University Hospital of Granada and the Regional University Hospital of Málaga in the years 2000-2015. The WINROP algorithm was used to determine an alarm threshold for retinopathy of prematurity (ROP). The results were compared with those obtained from serial examinations of premature infants.Results: The global WINROP algorithm showed a sensitivity of 62%, specificity of 74%, positive predictive value (PPV) of 59%, and negative predictive value (NPV) of 77%. This algorithm showed a greater sensitivity (76%) to identify severe ROP.Conclusions: The WINROP screening algorithm in this study showed moderate sensitivity, so many ROP cases amenable to treatment were not detected. Other criteria should be added to the algorithm to increase the sensitivity.

Retinal vascular speed <0.5 disc diameter per week as an early sign of retinopathy of prematurity requiring treatment.

PURPOSE: To analyse the speed of temporal retinal vascularisation in preterm infants included in the screening programme for retinopathy of prematurity. MATERIAL AND METHODS: A total of 185 premature infants were studied retrospectively between 2000 and 2017 in San Cecilio University Hospital of Granada, Spain. The method of binocular indirect ophthalmoscopy with indentation was used for the examination. The horizontal disc diameter was used as a unit of length. Speed of temporal retinal vascularisation (disc diameter/week) was calculated as the ratio between the extent of temporal retinal vascularisation (disc diameter) and the time in weeks. RESULTS: The weekly temporal retinal vascularisation (0-1.25 disc diameter/week, confidence interval) was significantly higher in no retinopathy of prematurity (0.73 ± 0.22 disc diameter/week) than in stage 1 retinopathy of prematurity (0.58 ± 0.22 disc diameter/week). It was also higher in stage 1 than in stages 2 (0.46 ± 0.14 disc diameter/week) and 3 of retinopathy of prematurity (0.36 ± 0.18 disc diameter/week). The rate of temporal retinal vascularisation (disc diameter/week) decreases when retinopathy of prematurity stage increases. The area under the receiver operating characteristic curve was 0.85 (95% confidence interval: 0.79-0.91) for retinopathy of prematurity requiring treatment versus not requiring treatment. The best discriminative cut-off point was a speed of retinal vascularisation <0.5 disc diameter/week, with a sensitivity and a specificity of 84.8% and 77%, respectively. CONCLUSION: The rate of temporal retinal vascularisation is a quantifiable observation that can help to alert a clinician that treatment of retinopathy of prematurity may be required. However, before becoming a new standard of care for treatment, it requires careful documentation, with agreement between several ophthalmologists.