Nasrin N. Tehrani

Pediatric eye injuries in a Canadian emergency department.

OBJECTIVE This study assesses the descriptive epidemiology of children with eye injuries presenting to the emergency department of a major Canadian pediatric hospital. STUDY DESIGN A retrospective cohort study. PARTICIPANTS All pediatric patients (up to 18 years of age) presenting with ocular injuries to a tertiary care pediatric emergency department between January 1 and December 31, 2002. METHODS Chart review was conducted using Canadian Hospital Injury Reporting and Prevention Program forms. All injuries were classified by Birmingham Eye Trauma Terminology (BETT). RESULTS There were 149 patients who presented with eye injuries to the emergency department in 2002, and all of them were included in the study. Patient ages ranged from 3 months to 18 years with a median age of 8 years 8 months (interquartile range 4-11 years). Boys accounted for 73.2% of the patient total. Most of the cases (57.7%) needed some treatment and required follow-up. Eleven patients (7.3%) had vision-threatening eye injuries that required surgical management, and 3 of these required multiple surgeries. Seven of the 11 patients suffered open globe lacerations, 3 open globe ruptures, and 1 closed globe injury. CONCLUSIONS Most eye injuries occurred at home during the summer, and over 7% of children presenting to the emergency department with eye trauma had vision-threatening injuries that required surgical management. Increasing awareness of the serious nature of ocular injuries will help to develop a comprehensive plan for educating both parents and children to minimize preventable pediatric eye injuries.

Use of the Delphi process in paediatric cataract management

Purpose To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. Design A modified Delphi method. Participants International paediatric cataract experts with a publishing record in paediatric cataract management. Methods The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true–false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. Main outcome measure Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. Results Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. Conclusions Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions.

Anterior segment imaging in pediatric ophthalmology

&NA; Anterior segment imaging in the pediatric population using commercially available equipment is rewarding but can be challenging. Successful imaging requires familiarity with the imaging modality used, a positive attitude, and the ability to quickly develop rapport with children. In this review, we demonstrate how external and slitlamp photography, Scheimpflug imaging, handheld digital fundus camera, ultrasound biomicroscopy, and anterior segment optical coherence tomography can be valuable in the documentation, diagnosis, and management of pediatric anterior segment disease. Families understand their child’s disease process when it is demonstrated photographically and feel more motivated and involved in their care. Compliance with treatment is often enhanced through this process. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Computer-assisted image analysis of temporal retinal vessel width and tortuosity in retinopathy of prematurity for the assessment of disease severity and treatment outcome.

PURPOSE To quantify the severity of retinopathy of prematurity (ROP) through temporal retinal vessel diameter and tortuosity by the use semiautomated analysis and to evaluate the effects of laser treatment on retinal vessel measurements. METHODS A total of 176 RetCam digital fundus images from 63 infants diagnosed with ROP between January 2005 and December 2008 were retrospectively analyzed with Retinal Vessel Measurement V5.8 software. Patients were classified into 1 of 3 groups: stage 1 and 2 (Group 1), stage 3 not requiring treatment (Group 2), and stage 3 requiring treatment (Group 3). Diameter and tortuosity of the 4 major temporal retinal arteries and veins close to the optic disk were quantified. Tortuosity was measured as central (within 2 disk diameters from the center of the optic disk) and paracentral (from 2 to 4 disk diameters). For Group 3, measurements of vessels immediately before treatment and all follow-up post-treatment measurements of vessels were analyzed. RESULTS Differences in central and paracentral arteriolar tortuosity were pronounced. The average central arteriolar tortuosities were 1.12 ± 0.018 for Group 1, 1.13 ± 0.018 for Group 2, and 1.32 ± for Group 3; the paracentral arteriolar tortuosities were 1.11 ± 0.019 for Group 1, 1.12 ± 0.019 for Group 2, and 1.31 ± 0.02 for Group 3. In the post-treatment analysis of Group 3 patients, significant reductions in all vascular measurements were observed compared to pre-treatment, except for central and paracentral vein tortuosity. CONCLUSIONS Computerized systems can be used to objectively assess differences in vascular parameters between ROP stages.

Retinal haemorrhages in a preterm infant following screening examination for retinopathy of prematurity

Examination induced retinal haemorrhage in preterm infants is uncommon. It may occur independently of retinopathy of prematurity (ROP) associated neovascularisation. Retinal haemorrhages due to ROP tend to occur on the surface of the neovascular ridge, which represents an arteriovenous shunt formed by the anastomosis of primitive retinal vessels.1 However, ROP related retinal haemorrhages occurring posteriorly,2 as well as vitreous haemorrhage,3 have also been described in advanced disease. Other common causes of retinal haemorrhage in infancy such as birth4 and shaken baby syndrome should be excluded. Retinal haemorrhage in a premature infant after RetCam photography has been reported.5 We report retinal haemorrhages in a premature infant immediately following examination for ROP. A 1416 g, 33 week gestation infant was transferred to our centre after developing necrotising enterocolitis at 6 days old. Ventilatory support was required briefly following …

Using telemedicine to screen for retinopathy of prematurity

Telemedicine is increasingly being used in ophthalmology for diagnosis, education and research. Combined with digital imaging, telemedicine has been successful in screening for diabetic retinopathy and diagnosing macular diseases and glaucoma.[1][1] The introduction of the digital pediatric fundus

Does Bevacizumab Alter Vascularization Potential in Retinopathy of Prematurity

Off-label intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor agent, has been shown to be an effective treatment for type 1 retinopathy of prematurity (ROP) in zone I. One of the benefits of intravitreal bevacizumab (IVB) is continued peripheral retinal vascularization as opposed to the permanent ablation associated with laser. Still, the development of late recurrence and retinal detachment requires extended and careful follow-up. Reports on fundus fluorescein angiography (FFA) after bevacizumab treatment showed persistent avascular retina and abnormal vascular patterns indicating the possibility of long-term ocular effects. To specifically address the question of the extent of retinal vascularization, we compared 5 unilaterally treated infants with IVB monotherapy for type 1 ROP in zone I or posterior zone II to their untreated fellow eyes. To our knowledge, there are no other reports that compared the vascular extent between treated and untreated eyes after unilateral IVB treatment of the same infant. We performed a retrospective chart review of all infants treated for ROP with a single IVB injection of 0.625 mg (Avastin; Genentech Inc., San Francisco, CA) in 1 eye between March 2012 and April 2014. The research ethics board approved the study. Treatment was performed and structural outcomes were defined according to the Early Treatment for Retinopathy of Prematurity study criteria. Follow-up and examination under anesthesia were scheduled for each treated infant as described by our group previously. Vascular markings on color fundus and FFA images obtained with RetCam (Clarity Medical Systems, Pleasanton, CA) were reviewed to identify preand post-treatment vascularization extent in both eyes. A linear measurement, in disc diameters, of the extent of temporal vascularization was taken from the temporal edge of the optic disc through the foveal center to the border of vascular and avascular retina (Fig 1A and B, available at www.aaojournal.org).

Cost analysis of remote telemedicine screening for retinopathy of prematurity

OBJECTIVE To compare costs of 2 screening modalities for retinopathy of prematurity (ROP): telemedicine imaging with remote interpretation versus in-person binocular indirect ophthalmoscopy (BIO). DESIGN Retrospective chart review. PARTICIPANTS Infants from an existing telemedicine screening program at 2 cities in Ontario, Canada. METHODS We conducted a cost analysis comparison from the perspective of the Ministry of Health. Patient level data was used for the telemedicine group. A hypothetical control group consisted of the minimum number of BIO and interhospital transfers if the existing patients were screened in person. Costs included in-person examinations, transfers, setting up, and ongoing costs of telemedicine screening. Costs were compared using the Mann-Whitney U test and are reported in 2014 Canadian dollars. RESULTS A total of 102 and 72 infants were screened from Sudbury and Barrie, respectively; 3% and 2% of infants in the telemedicine group were transferred for BIO from Sudbury and Barrie, respectively. All infants in the control group would have required at least one transfer for BIO. The average total cost per eye examination was

Unmet eye care needs among a homeless youth population

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A curious case of growth failure and hypercalcemia: Answers

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