Deeksha Katoch

Aggressive posterior retinopathy of prematurity in infants ≥1500 g birth weight

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty-nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co-morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty-five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co-morbidities could be a contributing factor.

Demographic profile of infants with stage 5 retinopathy of prematurity in North India: implications for screening.

Purpose: To study demographic profile of infants presenting as stage 5 retinopathy of prematurity (ROP) at a tertiary referral center of North India Methods: A retrospective review of consecutive infants with stage 5 ROP from 1999–2008. Various parameters retrieved included the inborn (born at level III nursery of our institute) /outborn (born outside study center) status, birth weight, gestational age, age at presentation, screening details,treatment details and reasons for consultation Results: Sixty -six infants are included. All infants were outborn (born outside study center). Mean birth weight was 1250.23 ± 486.45 g and gestational age at birth was 28.5 ± 2.2 weeks. Ten (15.1%) infants were above 1500g birth weight. Median age at presentation was 7 month (range, 2–84 months). Fifty-seven (86.4 %) infants were never screened for ROP and 2(3%) were lost to follow-up after single screening. Seven (10.6%) infants had screening and treatment. Forty-nine (74.2%) infants were self-referred (i.e brought by parents on their own) and 17(25.8%) were referred by ophthalmologists. Pediatricians referred none of the infants. Conclusion: Our study shows that lack of screening is responsible for stage 5 ROP in outborn infants. More needs to be done to spread awareness about the disease. Broader screening guidelines are needed to ensure screening for infants>1500 g birth weight.

Outcome of 23-gauge pars plana vitrectomy for pediatric vitreoretinal conditions.

PURPOSE To evaluate the feasibility and short-term outcome of 23-gauge vitrectomy in children for various vitreoretinal conditions. METHODS A retrospective chart review was conducted of consecutive children younger than 14 years who underwent 23-gauge transconjunctival sutureless vitrectomy for various vitreoretinal conditions from January 2008 to December 2011 at a tertiary care center. RESULTS Thirty-seven eyes of 31 children were included. There were 20 boys and 11 girls, aged between 1.25 months and 14 years (median: 10 years, mean: 7.23 years). The surgical indications were subluxated crystalline lens, retinopathy of prematurity stage 4, post-traumatic cataract with ruptured capsule, vitreous hemorrhage, dislocated crystalline lens, endophthalmitis, retinal detachment with vitreous hemorrhage, dislocated intraocular lens, epiretinal membrane, and increased intraocular pressure after intravitreal steroid implantation. Postoperative complications included loose blood, retinal detachment, early postoperative hypotony, and preretinal bleeding. CONCLUSIONS The 23-gauge transconjunctival sutureless vitrectomy approach in children appears safe and effective.

Structural sequelae and refractive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes.

Aim: The aim was to study the structural sequelae and refractive outcome after laser treatment for Type 1 prethreshold retinopathy of prematurity (ROP) in Asian Indian eyes. Materials and Methods: A retrospective chart review of infants with Type 1 prethreshold ROP (defined according to the Early Treatment for Retinopathy of Prematurity study) undergoing laser treatment at a tertiary center between January 2004 and December 2008 was done. The 1-year outcome of infants was analyzed. Results: Sixty-nine eyes of 36 infants were included. The mean birth weight was 1121.69 ± 254.81 g and the gestational age was 28.99 ± 2.03 weeks. Sixty-five eyes (94.2%) had zone 2 and 4 (5.8%) had zone 1 disease. Forty-four (63.77%) eyes had stage 2 ROP with plus disease and 25 (36.23%) eyes had prethreshold (fewer than five contiguous or eight cumulative clock hours) stage 3 ROP with plus disease. None of the eyes developed retinal structural sequelae. On cycloplegic retinoscopy, 59.4% eyes had nonsignificant hyperopia [spherical equivalent (SE) ≤ 4 D], 14.5% eyes had no refractive error (SE 0 D), 24.7% eyes had low myopia (SE < 5 D), and 1.4% eyes had high myopia (SE > 5.0 D). Eyes developing myopia were associated with a greater number of clock hours of ROP, greater number of laser spots used, and a longer time to disease regression. Two infants (5.6%) had esotropia and one (2.8%) had exotropia. Conclusion: Asian Indian infants treated for Type 1 prethreshold ROP did not develop retinal structural sequelae. Myopia was seen in nearly one-fourth of the eyes.The risk factors for myopia were a greater number of clock hours of ROP, greater number of laser spots, and a longer time to regression of ROP.

Safety and Outcome of Microincision Vitreous Surgery in Uveitis

ABSTRACT Purpose: To report the outcome of microincision vitreous surgery (MIVS) in uveitis. Methods: In total, 103 patients (106 eyes) underwent diagnostic MIVS between March 2012 and April 2015. Postoperative evaluation included vitreous haze grading from clinical/electronic records, best-corrected visual acuity (BCVA), and complications. Results: Mean age was 36.8 ± 13.9 years (range: 8–80 years). Mean follow-up after MIVS was 12.2 ± 7.2 months (median 12 months). Mean vitreous haze grading was 2.39 ± 0.98 (preoperatively), 0.36 ± 0.73 postoperatively (1 week), and 0.02 ± 0.2 at 1 month (p < 0.001). Mean BCVA was 1.5 ± 1.0 logMAR preoperatively and 0.72 ± 0.68 logMAR at 1 month (p = 0.000). Postoperative complications included cataract (14.6%), rise in intraocular pressure (13.2%), vitreous hemorrhage (4.7%), hypotony (3.2%), retinal detachment (2.8%), epiretinal membrane (2.8%), and worsening of inflammation (0.9%). Conclusions: MIVS is safe and may have a therapeutic role in uveitis.

A hybrid form of retinopathy of prematurity

Aims To study a hybrid pattern of retinopathy of prematurity (ROP) demonstrating both ridge tissue (simulating staged ROP) and flat neovascularisation (simulating aggressive posterior retinopathy of prematurity (APROP)) in the same eye. Methods Retrospective chart review from January 2006 to June 2010. We reviewed the retinal drawings and Retcam images for a hybrid pattern of ROP, that is, presence of ridge tissue (characteristic of staged ROP) along with flat neovascular syncytium (characteristic of APROP) in the same eye. Results 28 eyes of 18 infants had hybrid characteristics. All eyes had severe plus disease, flat new vessels at the junction of the vascular and avascular retina and ridge tissue at variable locations. Three patterns were noted: I Ridge at the junction of vascular and avascular retina (14 (50%) eyes); II Ridge in the vascularised posterior retina (10 (35.71%) eyes); III Ill-defined ridge close to the optic disc, with mat-like fibrous proliferation into the vitreous (4 (14.29%) eyes). After confluent laser photocoagulation, we observed favourable outcome in 92.3% eyes with pattern I, 100% eyes with pattern II and 25% eyes with pattern III disease. Conclusion Some eyes with ROP may have abnormal neovascularisation resembling both APROP and classical staged ROP. It is difficult to characterise these eyes according to the international classification of ROP. However, the presence of plus disease should serve as guide to treatment.

An Update on Retinopathy of Prematurity (ROP)

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the retina of premature infants. The clinical spectrum of ROP varies from spontaneous regression to bilateral retinal detachment and total blindness. Between these two extremes lies the form of ROP, which is amenable to treatment with laser photocoagulation, anti-vascular endothelial growth factor drugs or surgery. Increasing rates of preterm births coupled with better survival rates but lack of uniform quality of neonatal care and delays in diagnosis have led to increasing ROP blindness. Atypical forms of Aggressive Posterior ROP are seen in heavier birth weight babies in developing countries. Prevention of ROP by following stringent protocols for supplemental oxygen, prevention of sepsis, timely screening and laser treatment by a concerted and collaborative effort of neonatologists and ophthalmologists are required to fight the blindness from ROP.

Primary intraocular central nervous system lymphoma masquerading as diffuse retinal vasculitis

A 49-year-old woman had blurred vision and floaters of 4 days duration in the right eye. Ocular examination revealed granulomatous panuveitis, vitritis and diffuse retinal vasculitis. Following a strongly positive tuberculin skin test, she received antitubercular therapy with oral steroids and immunosuppressants. A year later, despite therapy, vitritis and vasculitis persisted. Additionally, yellowish white lesions appeared beneath the retinal pigment epithelium. Fluorescein angiography revealed a leopard skin appearance. Following a negative vitreous biopsy, she was subjected to a chorioretinal biopsy which revealed non-Hodgkins lymphoma. MRI was normal. The ocular lesions resolved following intravitreal methotrexate injections. MRI of the brain was repeated every 3 months to rule out central nervous system (CNS) involvement. About 2.5 years after initial presentation, she complained of ataxia, hypersomnia and speech difficulty. MRI of the brain now showed lesions in the thalamocapsular region and the corpus callosum splenium suggestive of CNS lymphoma. She underwent a whole brain radiation with symptomatic improvement followed by chemotherapy.

Diagnostic Challenges in Inflammatory Choroidal Neovascular Membranes

ABSTRACT Purpose: To describe the clinical presentations of inflammatory choroidal neovascular membranes (CNVMs) and factors leading to their delayed diagnosis. Methods: Retrospective analysis of chart records and digital images of 60 patients (73 eyes) with inflammatory CNVM (January 1998 to December 2013) to obtain demographic and clinical details, particularly the time of the first documentation of inflammatory CNVM by the uveitis specialist, time of its actual appearance on digital images, and the earliest clinical indicators of a CNVM. Results: In total, 14 (19.2%) eyes had a delayed diagnosis of inflammatory CNVMs, of which five developed significant visual loss. The earliest clinical indicators of CNVM that were overlooked initially due to their subtle appearance, included a tiny subretinal hemorrhage (five eyes), peripapillary halo/fluid/scar (eight eyes), and a subfoveal scar (one eye). The causes of uveitis in these eyes included Vogt–Koyanagi–Harada disease (five eyes, 35.7%), tubercular uveitis (five eyes, 35.7%), idiopathic (three eyes, 21.4%), and sympathetic ophthalmia (one eye, 7.1%). Presence of significant background fundus scarring, sunset glow fundus, visually significant cataract, poorly dilating pupil, media haze due to vitritis, cystoid macular edema, and multiple chorioretinal scars in these eyes probably predisposed to delayed detection of an underlying CNVM. Conclusions: A high index of suspicion and comparison of serial fundus photographs to identify the earliest clues of inflammatory CNVMs are important to prevent diagnostic delays and poorer outcomes.

Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India

Purpose: To study epidemiology, demographic profile, clinical characteristics, and outcome in pediatric patients with retinoblastoma. Methods: This was a retrospective review of retinoblastoma patients of a tertiary institute from January 1st 1998 to December 31st 2014. Results: The study included 467 patients (618 eyes) with a mean age of 34.7 ± 24.6 months (median = 30; 15 days to 144 months). Retinoblastoma was bilateral in 151 (32.3%) and there were 61.7% males. Intraocular disease was seen in 301 patients (451 eyes [72.9%]) and extraocular in 166 patients (167 eyes; 27.0%). Out of the 347 (74.3%) who received treatment, primary treatment was chemoreduction in 228 (65.7%) and enucleation in 117 (33.7%), while 25.6% of patients refused treatment and 151 (43.5%) defaulted therapy. Local recurrence was seen in 20 (4.3%), metastasis in 2 (0.4%), and deaths in 13 (2.8%) (average follow-up 28.5 ± 44.4 months). Histopathological high risk features were significantly less in the eyes that received chemoreduction (5.0%) versus primary enucleation (20.8%) (p < 0.0004), but there was no difference in the rate of metastasis, recurrence, and death between the two. Conclusions: The majority of retinoblastoma patients in our study had advanced disease, and nearly a third had extraocular extension. There were a significant number of therapy refusals and dropouts. Chemoreduction led to a significant decrease in the histopathological risk factors without affecting the outcomes.