Eedy Mezer

Late postnatal systemic steroids predispose to retinopathy of prematurity in very-low-birth-weight infants: a comparative study

Background and objective: Retinopathy of prematurity (ROP) develops mostly in very‐low‐birth‐weight (VLBW) premature infants. Besides prematurity and hyperoxia, other variables have been brought up as risk factors for ROP. We aimed to search risk factors for ROP by comparing two groups of preemies, one with and the other without ROP.

Oral propranolol versus placebo for retinopathy of prematurity: a pilot, randomised, double-blind prospective study

Retinopathy of prematurity (ROP) can progress to neovascularisation (NV) and retinal detachment. Laser photocoagulation1 or intravitreal bevacizumab (Avastin)2 are the current interventions for severe ROP. Vascular endothelial growth factor (VEGF) plays a key role in ROP pathogenesis, being downregulated and upregulated in vaso-obliterative and vaso-proliferative phases of ROP, respectively. ROP and infantile haemangiomas share the same VEGF-mediated pathogenesis. Propranolol downregulates VEGF expression, and thus, mitigates progression of infantile haemangiomas3 and NV in oxygen-induced retinopathy in animals.4 We examined the safety and feasibility of propranolol for ROP.nnTwenty premature infants with ROP, born between 1 May 2010 and 31 July 2012 at 24–28 weeks’ gestation and birth weight <1500 g, were randomised either to oral propranolol (propranolol+sucrose 5%; n=10) or placebo (sucrose 5%; n=10) (figure 1). Inclusion criterion: evidence for ROP with any of the following: (a) stage 1 (zone I); (b) stage 2 or …

Do children and adolescents with attention deficit hyperactivity disorder have ocular abnormalities

Purpose. To investigate visual function and ocular features in children with attention deficit hyperactivity disorder (ADHD). Methods. Fifty-one children underwent a detailed ophthalmologic evaluation. Thirty-two were diagnosed with ADHD, and 19 children with attention deficit disorder (ADD). The mean age was 9.9±3.1 years. Results. The average best-corrected visual acuity of the better-seeing eye was 1 (range 0.9-1.25) and 0.96 (range 0.5-1.25) for the fellow eye. Eighteen percent (10) had amblyopia in one or both eyes (3 had strabismic and 7 had ametropic amblyopia). Heterotropia was found in 5 (10%), and absent stereoacuity was found in 3 (6%). Subnormal convergence amplitude was noted in 2 patients (4%). The mean spherical equivalent (SE) of the eyes in this study was 0.17±1.73 (range −5.5 to +7). Twenty-two subjects (43%) had a myopia of −0.50 D or higher. Hyperopia higher than 3.5 D was seen in 10 cases (20%), and astigmatism larger or equal to 1.0 D was observed in 10 patients (20%). With-the-rule astigmatism was by far most common type in the 29 eyes with an astigmatic refractive error (59%). Significant ametropia was detected in 42 (83%) of the patients. In contrast to other studies, we did not find a higher rate of convergence insufficiency or heterotropia. Conclusions. Children diagnosed with either ADHD or ADD can present with significant ametropia but infrequent heterotropia.

Bacteriological profile of ophthalmic infections in an Israeli hospital

Aim To find the optimal antibiotic treatment for ophthalmic infections in an Israeli hospital. Methods In a retrospective study from our laboratory, which serves as both a primary and secondary referral center, we analyzed the bacteriological profile and the antibiotic sensitivity of ophthalmic infections using the computerized laboratory reports of 331 consecutive ophthlamic bacteriological cultures from patients with various ophthalmic infections. Results Microbiological growth was obtained in 113 samples (34.1%). The most commonly isolated organism was coagulase-negative staphylococcus (19.5%), followed by coagulase-positive staphylococcus (16.8%), Enterobacteriaceae (14.2%), Pseudomonas aeruginosa (13.3%), and streptococcal species (8.9%). Pseudomonas species were the most common isolates from the lacrimal pathways (20.0%). Streptococci were the most common isolates cultured from the conjunctiva (27.3%). Coagulase-positive staphylococcus was the most common isolate from corneal ulcers (33.3%), and coagulase-negative staphylococcus from the vitreous (30.8%). The overall antibiotic sensitivity of common ophthalmic pathogens was similar to that reported from other parts of the world. Conclusions Although essentially similar to previous series, this report from the Middle East differs as follows. Firstly, Pseudomonas species were the most common isolates from the lacrimal pathways. Secondly, the overall rate of streptococcal isolates was lower than in previous reports. Thirdly, streptococcal species were rarely isolated from corneal samples. Although other studies from the region have described the causative organisms of ocular infections in specific ocular sites, this is the first study from the Middle East to summarize the full bacteriological profile of ocular infections in one medical center.

Cycloplegic autorefraction in young adults: is it mandatory?

PurposeThe precise correction of refractive error is especially important in young adults. It is unclear whether cycloplegic refraction is necessary in this age group. The purpose of this study was to compare the non-cycloplegic and cycloplegic spherical equivalent (SE) refractive error measured in young adults.MethodsThis was a prospective study of 1400 eyes (nu2009=u2009700) of enlisted soldiers aged 18 to 21xa0years who were consecutively evaluated in an outpatient army ophthalmology clinic. One drop of cyclopentolate 1xa0% was installed twice 10xa0min apart, and cycloplegic refraction was performed in both eyes 40xa0min later using an auto-refractor. The difference between non-cycloplegic and cycloplegic refractive measurements was analyzed.ResultsThe mean difference in SE between non-cycloplegic and cycloplegic measurements was 0.68u2009±u20090.83xa0D (95xa0% CI, 0.64–0.72). Significantly greater differences were observed in hypermetropes than myopes (1.30u2009±u20090.90xa0D versus 0.46u2009±u20090.68xa0D, pu2009<u20090.001). Moderate hypermetropes (2 to 5xa0D) demonstrated significantly greater refractive error than mild (0.5 to 2xa0D) or severe (>5xa0D) hypermetropes (1.71u2009±u20091.18xa0D versus 1.19u2009±u20090.74xa0D and 1.16u2009±u20091.08xa0D respectively, pu2009<u20090.001).ConclusionsYoung hypermetropic adults possessed +1 to +2xa0D of latent hypermetropia. In contrast, young myopic adults revealed pseudomyopia of −0.5xa0D. Cycloplegic refraction should be performed in young hypermetropic adults complaining of various signs of asthenopia.

Positive results bias in pediatric ophthalmology scientific publications

Previous studies in several fields of medicine, including general ophthalmology, have revealed a positive results bias, demonstrating an association between the results of a trial and the impact factor (IF) of the journal in which it was published. We hypothesized that randomized clinical studies in pediatric ophthalmology with positive results have a greater chance of publication in journals with a higher IF than those with negative results. We analyzed 174 randomized, controlled trials conducted in the field of pediatric ophthalmology, which were retrieved from PubMed. Each study was classified as having either a positive or a negative result. A positive result was defined as a study in which there was a statistically significant difference between groups (Pxa0<xa00.05). No difference was found in IF between negative and positive outcomes, after statistically adjusting for the number of subjects and year of publication. We concluded that, unlike general ophthalmology, positive results bias probably does not occur in the field of pediatric ophthalmology.

Correction to: Current trends among pediatric ophthalmologists to decrease myopia progression—an international perspective

The published online version contains a mistake in the capturing of figures.

Endophthalmitis Following Strabismus Surgery: IPOSC Global Study

ABSTRACT Purpose: To examine the characteristics of patients with endophthalmitis after strabismus surgery (PSSE), the characteristics of the strabismus surgery, treatment, and prognosis as reported by pediatric ophthalmologists who are members of the American Association for Pediatric Ophthalmology and Strabismus (AAOPS) around the world. Methods: An email communication was sent to all members of AAPOS. The email included a web link to a survey that included 34 questions that examined the characteristics of patients with endophthalmitis after strabismus surgery. Results: Three hundred forty-nine ophthalmologists responded to the questionnaire. Two hundred sixty four (76%) had practiced pediatric ophthalmology for over 10 years. Twenty-seven cases of endophthalmitis were reported. The medial rectus muscle (MR) was the most common muscle undergoing surgery (55%). In 5 patients (21%), perforation was observed at the time of surgery. In all cases, endophthalmitis was diagnosed 3–7 days after surgery. The final visual acuity of 34% was no light perception (NLP). Discussion: This series is the largest existing series on PSSE. Our data suggest that PSSE can occur also in healthy patients and in patients without a visualized scleral perforation. The majority of PSSE occurs during the first week after surgery. Therefore, we believe that all patients that underwent strabismus surgery should be examined in this time frame. The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up.

Measuring recovery of visual function in children with papilledema using sweep visual evoked potentials

PURPOSEnTo assess visual function in children with papilledema using sweep visual evoked potentials (VEP) to determine whether vision function improved following treatment.nnnMETHODSnContrast sensitivity and grating acuity were prospectively measured by using sweep visual evoked potential testing in children with mild or moderate acute papilledema. A subset of children were tested longitudinally before and after treatment. Subject data was compared with that of age-matched controls using the Wilcoxon-Mann-Whitney test.nnnRESULTSnA total of 9 subjects (age range, 9-16xa0years) and 11 controls were included; 5 subjects were studied longitudinally. The control groups logMAR grating acuity (mean, 0.09; range, -0.13 to 0.36) was better than that of the papilledema group (mean, 0.36; range 0.15-0.59). Four patients showed recovery of contrast sensitivity following treatment of their raised intracranial pressure between first and last visit.nnnCONCLUSIONSnIn our study cohort, sweep VEP was able to detect early improvement in contrast sensitivity despite absence of apparent clinical change in disk edema in children undergoing treatment for raised intracranial pressure.