Expression of IGFBP-6 in a proliferative vitreoretinopathy rat model and its effects on retinal pigment epithelial cell proliferation and migration

AIM: To investigate the expression of insulin-like growth factor binding protein-6 (IGFBP-6) in a proliferative vitreoretinopathy (PVR) model and its effects on proliferation and migration in retinal pigment epithelial (RPE) cells.METHODS: A PVR Wistar rat model was established by the intravitreal injection of RPE-J cells combined with platelet-rich plasma (PRP). The expression levels of IGFBP-6 were tested by ELISA. ARPE-19 cell proliferation was evaluated by the MTS method, and cell migration was evaluated by wound healing assays.RESULTS: The success rate of the PVR model was 89.3% (25/28). IGFBP-6 was expressed at higher levels in the vitreous, serum and retina of rats experiencing advanced PVR (grade 3) than in the control group (vitreous:152.80±15.08ng/mL vs 105.44±24.81ng/mL, P>0.05; serum:93.48±9.27ng/mL vs 80.59±5.20ng/mL, P<0.05; retina:3.02±0.38ng/mg vs 2.05±0.53ng/mg, P<0.05). In vitro, IGFBP-6 (500ng/mL) inhibited the IGF-II (50ng/mL) induced ARPE-19 cell proliferation (OD value at 24h:from 1.38±0.05 to 1.30±0.02; 48h:from 1.44±0.06 to 1.35±0.05). However, it did not affect basal or VEGF-, TGF-β- and PDGF-induced cell proliferation. IGFBP-6 (500ng/mL) reduced the IGF-II (50ng/mL)-induced would healing rate [24h:from (43.91±3.85)% to (29.76±2.49)%; 48 h:from (66.09±1.67)% to (59.88±3.43)%].CONCLUSION: Concentrations of IGFBP-6 increased in the vitreous, serum, and retinas only in advanced PVR in vivo. IGFBP-6 also inhibited IGF-II-induced cell proliferation in a not dose or time dependent manner and migration. IGFBP-6 participates in the development of PVR and might play a protective role in PVR.     

Postnatal weight gain in very low birth weight infants in Beijing and the risk of retinopathy of prematurity

AIM: To analyze the low weight gain (WG) from birth to 4 and 6wk of life to predict the development of retinopathy of prematurity (ROP) among very low birth weight (VLBW) preterm babies. METHODS: Three hundred and three newborns with VLBW were analyzed. Body weight measurements were recorded weekly. In all patients, the proportion of the WG was defined as the preterm weight measured at the 4th and 6th weeks of life minus the birth weight (BW) divided by the BW. Other risk factors for ROP were also analyzed. RESULTS: Mean gestational age and mean BW of the whole cohort were 29.56±1.44wk and 1270.58±176.18g respectively. WG proportion at 4wk postnatal age (18.89%±13.58%) were significantly lower in infants with ROP (P=0.003). WG proportion at 6wk was not different between ROP and no ROP group (42.48%±20.36% vs 46.43%±15.65% P=0.118). When all the other risk factors signi?cant for ROP were included in the logistic regression poor WG did not arise as an independent risk factor. Area under the ROC curve was 0.591 (95%CI: 0.515-0.666; P=0.016). For ROP, the best discriminative cutoff of 18.06% of the proportional WG at the 4th week over the BW, sensitivity and specificity values were 67.3% and 50.0% respectively. CONCLUSION: Low WG proportion in the first 4wk of life is maybe an additional predictor of ROP in very low BW infants. Preterm babies with low BW and low WG proportion should be followed closely for ROP.     

Analysis of prenatal and postnatal risk factors of retinopathy of prematurity in a tertiary care hospital in South India

Context:

Recent advances in neonatology have influenced the incidence and severity of ROP in a dichotomous fashion.

Aims:

To determine the incidence of ROP and to analyse its risk factors.

Settings and Design:

Prospective clinical case series.

Materials and Methods:

282 preterm infants with birthweight < 1500g and/or gestational age ≤ 32 weeks and also those with gestational age > 32 weeks, with birthweight between 1500-2000 g, who were at risk for ROP were selected. Weight gain proportion was measured as weight at 6 weeks minus birthweight divided by birthweight.

Statistical Analysis:

Univariate and multivariate logistic regression.

Results:

Incidence of any ROP was 21.6% while severe ROP was 6.7%. Prenatal factors like multiple gestation (P = 0.510) and antenatal steroids (P = 0.104) were not significantly associated with ROP. On multivariate analysis, postnatal factors like weight at birth < 1250 g (P = 0.01) and gestational age between 31-32 weeks (P = 0.02) were independent risk factors for any ROP, while intraventricular hemorrhage (P = 0.03) was the only independent risk factor for severe ROP. Mean birthweight of infants with severe ROP was 1056 ± 207 g (P = 0.004), which was significantly low. After logistic regression, the mean weight gain proportion at 6 weeks, of those neonates with severe ROP was 30%.

Conclusions:

Low birthweight and prematurity were the most important risk factors for developing any ROP, while intraventricular hemorrhage was the independent risk factor for developing severe ROP. The mean postnatal weight gain at 6 weeks was not statistically significant in neonates with severe ROP.     

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.     

Evaluating the change in central corneal thickness in neonates (term and preterm) in Indian population and the factors affecting it

Background and Aim:

Central corneal thickness (CCT) of term and preterm infants in Indian population is not known. We did a prospective noninterventional study to measure the CCT in term and preterm infants.

Materials and Methods:

An ultrasonic pachymeter was used. The data regarding the date of birth, expected date of delivery, birth weight were recorded. The preterm and the term infants were followed up at 8 weeks, 20 weeks and at 1-year.

Results:

A total of 85 (170 eyes) children were included in the study. The mean age was 264.6 ± 21.8 days postconception. The mean birth weight and CCT were 1834.4 ± 512.1 g and 595.8 ± 72.4 μ respectively. A comparison of CCT on the basis postgestational age showed a mean thickness of 620.7 ± 88.8 and 574.4 ± 78.3 μ in the <260 days and >260 days age groups respectively. The difference was statistically significant (Student''s test, P = 0.002). The CCT of preterm infants (<260 days) decreased from a mean value of 620.7 ± 88.8 μ to 534.1 ± 57.6 μ at the end of 1-year.

Conclusion:

We present the data of CCT in term and preterm infants in Indian population. We believe that the premature babies have slightly thicker corneas than mature term babies.     

The association between respiratory tract Ureaplasma urealyticum colonization and severe retinopathy of prematurity in preterm infants ≤1250 g

Aim

To evaluate the association between respiratory tract Ureaplasma urealyticum (Uu) colonization and development of retinopathy of prematurity (ROP) requiring treatment.

Methods

The infants with birthweight (BW) ≤1250 g born in a third-level neonatal intensive care unit between March 2009 and May 2010 were prospectively identified. Nasopharyngeal swabs for Uu colonization were taken in postnatal first 3 days. Culture-positive patients were reevaluated on the twelfth day by nasopharyngeal swabs for Uu. The primary outcome was to define whether there was an association between respiratory tract Uu colonization and severe ROP requiring treatment. Independent sample''s t-test or Mann–Whitney U-test was used to compare continuous variables and Chi-square test or Fisher''s exact test for categorical variables. Multivariate (backward) logistic regression analysis was performed to simultaneously measure the influence of the independent variables with ROP as the dependent variable.

Results

A total of 25 (12.1%) infants developed severe ROP requiring treatment among 206 infants who underwent ROP screening. Mean BW and gestational age of total cohort were 1013±159 g and 27.9±1.6 weeks, respectively. Multivariate analysis demonstrated that BW (OR: 0.64 (95% Cl 0.47–0.88); P=0.006), duration of mechanical ventilation (OR: 1.17 (95% Cl 1.06–1.28); P=0.001), premature rupture of membrane >18 h (OR: 3.83 (95% Cl 1.2–12.2); P=0.02), and Uu positivity in both cultures (OR: 5.02 (95% Cl 1.8–13.9); P=0.002) were independent risk factors for the development of severe ROP requiring treatment.

Conclusions

Respiratory tract colonization with Uu was independently associated with severe ROP requiring treatment.     

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection

Aims

To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases.

Settings and Design

Ege university hospital ophthalmology department. Retrospective case series.

Materials and Methods

Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated.

Statistical analysis used

Paired Student''s t-test.

Results

Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001).

Conclusions

Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.     

A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas

Background

Endoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas.

Aim

To evaluate the safety and efficacy of ECP in the management of refractory glaucomas.

Settings and Design

Prospective interventional non-comparative study.

Materials and Methods

Fifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP ≤ 22 mmhg, with or without use of medications.

Statistical analysis used

Student''s t test and repeated measures ANOVA were used to evaluate change in IOP and Student''s t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications.

Results

Patients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 ± 9.16 mmHg to 13.96 ± 7.71 mmHg at last follow-up (P<0.001, student''s t test). BCVA was significantly improved in the postoperative period (P<0.001, student''s t test). The average number of antiglaucoma medications decreased from 2.51 ± 0.97 to 1.09 ± 1.16 (P<0.001, Wilcoxon signed rank test). ECP had a success rate of 82.2%.

Conclusion

Endoscopic cyclophotocoagulation is an effective procedure in this subset of refractory glaucomas.     

Effect of pan-retinal laser photocoagulation on plasma VEGF, endothelin-1 and nitric oxide in PDR

AIM: To study plasma levels of vascular endothelial growth factor (VEGF), endothelin-1(ET-1) and nitric oxide (NO) in patients with proliferative diabetic retinopathy (PDR) before and after pan-retinal photocoagulation (PRP). · METHODS: Forty patients (23 females and 17 males, mean age 48.5±12.2 years) with PDR without previous PRP therapy were studied. Blood samples were obtained before and 3 months after the last PRP session. Baseline (prelaser) plasma levels of VEGF, ET-1 and NO were compared with their levels in 30 healthy age- and sex- matched controls and also with plasma levels 3 months post-PRP. · RESULTS: Patients with PDR had significantly raised plasma VEGF (375±89ng/L), ET-1(20±5ng/L) and NO (135±53μmol/L) when compared with healthy control group (P <0.01). After PRP, there was a significant reduction in plasma VEGF (179±66ng/L), ET-1 (11±5ng/L) and NO (91±49μmol/L) levels at 3 months' follow-up but still significantly higher than healthy controls. · CONCLUSION: Patients with PDR demonstrate elevated VEGF, ET-1 and NO, which decrease after successful laser treatment.     

Laser in-situ keratomileusis for refractive error following radial keratotomy

Aim:

To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK).

Design:

Retrospective study.

Materials and Methods:

A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively.

Statistical Software:

STATA-9.0.

Results:

The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 (P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen''s acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was –5.37 ± 4.83 diopters (D) and –0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK.

Conclusion:

LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.     

Serum cortisol and testosterone levels in idiopathic central serous chorioretinopathy

Context:

The preferential occurrence of idiopathic central serous chorioretinopathy (ICSC) in males with a typical Type A personality and behavior and a relative absence in females is a possible indicator towards the role of serum cortisol and /or the male sex hormone testosterone.

Aims:

To study levels of cortisol and testosterone in ICSC.

Settings and Design:

Case-control study in a tertiary care teaching hospital.

Materials and Methods:

The study was conducted on 23 cases of ICSC. Twelve patients with unilateral sudden painless loss of vision of less than one month duration served as controls. Serum cortisol and testosterone levels at 8.00 a.m. were estimated by radioimmunoassay in both groups.

Statistical analysis used:

Statistical analysis was done using SPSS 13.0 software. Independent Sample t-test was applied to analyze statistical significance between the two groups.

Results:

Mean age of patients with ICSC was 37.1 ± 9.7 years and 96% of the patients were males. Mean serum cortisol levels were significantly higher (P=0.002) in patients with ICSC i.e., 495.02 ± 169.47 nano moles/liter (nmol/L) as compared to controls i.e., 362.25 ± 51.54 nmol/L. Mean serum testosterone levels were 3.85 ± 1.81 nano grams/ml (ngm/ml) and 4.23 ± 1.89 ngm/ml in cases and controls respectively and the difference was not statistically significant (P=0.58).

Conclusions:

ICSC is associated with elevated 8.00 a.m. serum cortisol levels. However, mean serum testosterone levels in both patients of ICSC and controls were within normal range.     

Morphological and functional changes in spectral domain optical coherence tomography and microperimetry in macular microhole variants: spectral domain optical coherence tomography and microperimetry correlation

Purpose:

To evaluate the relationship between the morphology and retinal function of macular microhole (MMH) variants.

Materials and Methods:

We evaluated 12 eyes of 11 patients with defects in the IS/OS junction of photoreceptor layer with SD-OCT. All patients underwent comprehensive ophthalmic examination including spectral domain optical coherence tomography (SD-OCT) and microperimetry.

Results:

The mean logMAR visual acuity in the affected eye was 0.15 ± 0.17 (range 0.00–0.5). Mean horizontal diameter of the MMH was 163 ± 99 μm; the mean retinal sensitivity in the area corresponding to the MMH was 13.79 ± 4.6 dB. Negative correlation was found between the MMH diameter and the retinal sensitivity (r = -0.65, p = 0.02). Three morphological patterns of MMH variants were recognized on SD-OCT, which did not differ in retinal sensitivities.

Conclusion:

We described and classified the MMH variants and made an assessment on the physiological functions using microperimeter.     

A comparative study between intravitreal triamcinolone and bevacizumab for macular edema due to central retinal vein occlusion with poor vision

Aim:

To compare the effect of intravitreal bevacizumab and triamcinolone in patients with macular edema after central retinal vein occlusion (CRVO), presenting with poor visual acuity.

Materials and Methods:

It was a retrospective, comparative case series of 38 consecutive eyes, with macular edema secondary to CRVO, with 20/200 or worse vision, which were treated primarily either with intravitreal bevacizumab (1.25 mg; 24 eyes) or intravitreal triamcinolone (4 mg; 14 eyes). During follow-up, 3.6 ± 0.8 re-injections of bevacizumab and 2.4 ± 0.5 re-injections of triamcinolone were administered (P = 0.080). The main outcome measures were the best-corrected visual acuity and the central macular thickness by optical coherence tomography during 12 months of follow-up.

Results:

At 12 months, visual acuity (logMAR) was changed from 1.03 ± 0.39 (baseline) to 0.92 ± 0.39 (P = 0.374) and the central macular thickness was reduced from a baseline of 713.6 ± 179.3 µm to 310.8 ± 205.2 µm (P = 0.000). Neither the bevacizumab nor triamcinolone groups varied significantly in visual acuity and central macular thickness at 1, 3, 6, and 12 months after treatment. Neovascular glaucoma developed in two of the 14 eyes (14%) in the triamcinolone group.

Conclusion:

In patients with CRVO and poor vision, intravitreal bevacizumab and intravitreal triamcinolone were associated with a reduction in macular edema; however, neither treatment achieved significant visual acuity improvement by the 12-month follow-up.     

A co-twin study of the relative effect of birth weight and gestational age on retinopathy of prematurity

Purpose

To determine the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP) using preterm twin pairs discordant for birth weight.

Methods

This study was a retrospective cohort study including 55 consecutive twin pairs of 110 preterm infants (gestational age ≤33 weeks). The outcomes of ROP including occurrence (any stage), severe ROP (stage 3 or more), and clinically significant ROP requiring laser treatment were compared between twins with the lower birth weight from each pair and their co-twins with the higher birth weight. Using twin pairs having different birth weight and identical gestational age, the independent effects of prematurity and intrauterine growth on ROP could be evaluated. Other perinatal morbidities related to prematurity were also compared between twin pairs.

Results

No significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis while analysis on individual infants showed strong association between small birth weight and ROP outcomes. However, in both the larger and smaller infant groups, gestational age of <28 weeks was significantly associated with ROP outcomes. No differences were found between twin pairs regarding other perinatal morbidities including bronchopulmonary dysplasia, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, and periventricular leukomalacia.

Conclusions

Birth weight is not associated with ROP, while gestational age is in the twin-paired study, suggesting that gestational age is a better predictor of ROP than birth weight. This indicates that maturity is more important in the pathogenesis of ROP than intrauterine growth.     

Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique

Aim:

To evaluate the clinical outcomes of Keraring segment implantation in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique.

Materials and Methods:

Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted after dissection of the tunnel using Tunc''s specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed.

Results:

The mean preoperative UDVA for all eyes was 1.28 ± 0.59 logMAR. At 12 months, the mean UDVA was 0.36 ± 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 ± 0.3 logMAR, which improved to 0.15 ± 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from –5.29 ± 2.47 diopters (D) and –5.54 ± 5.04 D preoperatively to –1.47 ± 0.71 D and –0.74 ± 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K- readings improved from 47.93 ± 4.84 D to 40.87 ± 2.36 D (P=0.002), and the mean ISAI improved from 5.34 ± 3.05 to 2.37 ± 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or after surgery.

Conclusion:

ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.     

Impact of early rise of intraocular pressure on visual outcome following diabetic vitrectomy

Objective:

The objective was to study the incidence and risk factors for an early rise in intraocular pressure (IOP) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) and to correlate its impact on visual outcome.

Materials and Methods:

This was a longitudinal prospective study. IOP and best corrected visual acuity (BCVA) for 73 cases of PDR (52 males and 21 females) who underwent PPV were recorded at day 1, week 1, and months 1, 3, and 6. Risk factors for the early IOP rise, defined as IOP ≥ 30 mmHg at day 1, were evaluated using cross-tabulation and the t-test.

Results:

Mean IOP at day 1 was 21.8 ± 9.8 mmHg with 15 cases (20.5%) having an early rise in IOP. Risk factors for the early IOP rise included intraoperative fibrovascular frond removal (P = 0.003), lens removal (P = 0.043), and intraoperative vitreous bleed (P = 0.008). The early rise in IOP was also associated with consistently raised IOP (P = 0.02), defined as IOP > 21 mmHg during first three consecutive follow-up visits. Further, difference in BCVA at 6 months among the two groups, i.e., with and without an early IOP rise was statistically significant (3.11 ± 1.52 logMAR vs. 2.11 ± 1.49 logMAR; P = 0.025).

Conclusion:

An early rise in IOP is a significant risk factor which compromises the visual outcome of patients undergoing diabetic vitrectomy.     

Spontaneous regression of retinopathy of prematurity:incidence and predictive factors

AIM:To evaluate the incidence of spontaneous regression of changes in the retina and vitreous in active stage of retinopathy of prematurity(ROP) and identify the possible relative factors during the regression.METHODS: This was a retrospective, hospital-based study. The study consisted of 39 premature infants with mild ROP showed spontaneous regression (Group A) and 17 with severe ROP who had been treated before naturally involuting (Group B) from August 2008 through May 2011. Data on gender, single or multiple pregnancy, gestational age, birth weight, weight gain from birth to the sixth week of life, use of oxygen in mechanical ventilation, total duration of oxygen inhalation, surfactant given or not, need for and times of blood transfusion, 1,5,10-min Apgar score, presence of bacterial or fungal or combined infection, hyaline membrane disease (HMD), patent ductus arteriosus (PDA), duration of stay in the neonatal intensive care unit (NICU) and duration of ROP were recorded.RESULTS: The incidence of spontaneous regression of ROP with stage 1 was 86.7%, and with stage 2, stage 3 was 57.1%, 5.9%, respectively. With changes in zone Ⅲ regression was detected 100%, in zoneⅡ 46.2% and in zoneⅠ 0%. The mean duration of ROP in spontaneous regression group was 5.65±3.14 weeks, lower than that of the treated ROP group (7.34±4.33 weeks), but this difference was not statistically significant (P=0.201). GA, 1min Apgar score, 5min Apgar score, duration of NICU stay, postnatal age of initial screening and oxygen therapy longer than 10 days were significant predictive factors for the spontaneous regression of ROP (P＜0.05). Retinal hemorrhage was the only independent predictive factor the spontaneous regression of ROP (OR 0.030, 95%CI 0.001-0.775, P=0.035).CONCLUSION:This study showed most stage 1 and 2 ROP and changes in zone Ⅲ can spontaneously regression in the end. Retinal hemorrhage is weakly inversely associated with the spontaneous regression.     

Efficacy of bimatoprost 0.03% in reducing intraocular pressure in patients with 360° synechial angle-closure glaucoma: a preliminary study

Context:

Peripheral anterior synechiae (PAS; synechiae anterior to functional trabecular meshwork) formation in primary angle-closure glaucoma (PACG) hampers access to uveoscleral outflow. Thus, the role of bimatoprost in such patients with 360° synechiae was evaluated.

Aims:

To assess efficacy and safety profile of bimatoprost 0.03% in lowering intraocular pressure (IOP) in 360° synechial angle-closure glaucoma patients.

Settings and Design:

This was a prospective, non-randomized, non-comparative, selective analysis, single-center pilot study.

Materials and Methods:

A total of 23 eyes of 20 Indian chronic angle-closure glaucoma (CACG) patients with IOP greater than 21 mmHg, 360° PAS and no visual potential in the study eye underwent detailed eye examination. Baseline IOP was measured and YAG peripheral iridotomy was performed for complete angle-closure reconfirmation. Bimatoprost 0.03% was administered for 8 weeks as once-daily evening dose. IOP reduction within treatment group was determined with “paired t-test”.

Results:

The mean reduction in IOP from baseline to 8 weeks of bimatoprost therapy was 15.3 ± 9.5 mmHg (P < 0.001). The most commonly observed adverse event was conjunctival hyperemia (35%). Bimatoprost was well tolerated in the study.

Conclusions:

In this study, exclusively involving patients with 360° synechial angle-closure glaucoma and no visual potential, bimatoprost 0.03% treatment demonstrated a statistically significant IOP reduction. Hence, it can be inferred that bimatoprost 0.03% is an efficacious treatment modality in this subgroup of patients for reducing IOP.     

Birth weight and gestational age on retinopathy of prematurity in discordant twins in China

AIM:To assess the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP) using preterm twin pairs discordant for birth weigh in a tertiary neonatal intensive care unit in China.METHODS: Fifty-six discordant twin pairs of 112 preterm infants were retrospectively analyzed. The twin pairs were divided into two subgroups based on birth weight in each pair. The occurrence of ROP and severe ROP requiring treatment were compared between the lower birth weight infants and their co-twins with the higher birth weight. Some neonatal morbidities related to prematurity and neonatal characteristics were also compared between the twin pairs.RESULTS: Based on the univariate analysis, gestational age and birth weight were significantly associated with the occurrence and progression of ROP. But no significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis. The incidence of neonatal morbidities regarding respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), sepsis and neonatal characteristics regarding gender distribution, one- and five-minute Apgar score, postnatal steroid treatment, blood transfusion, supplemental oxygen therapy, and mechanical ventilation were not different between the twins. However, gestational age of ≤28wk was significantly associated with significantly higher rates of ROP and severe ROP.CONCLUSION: Gestational age is a better predictor of ROP than birth weight in the twin-paired study.     

Safety and efficacy of Intacs in Indian eyes with keratoconus: An initial report

Context

In contact lens-intolerant keratoconus patients, intrastromal placement of Intacs is becoming a promising new modality of treatment.

Aims

To study the safety and efficacy of implantation of microthin corneal inserts (Intacs) in Asian-Indian keratoconus patients.

Settings and Design

Retrospective interventional case series, in the cornea and refractive surgery service, at a tertiary care eye hospital in South India, between May 2006 and July 2007.

Materials and Methods

Intacs (Addition Technology, USA) were successfully implanted by mechanically creating tunnels, in 12 eyes of 12 keratoconus patients, who were contact lens-intolerant. The patients (mean age 25.58 years, nine male and three female) had a minimum follow-up of six months. Five patients had severe keratoconus (mean K > 53 D) and nine had central cones.

Results

All patients improved or retained visual acuity. The uncorrected visual acuity (UCVA) improved from a mean value of 0.06, (SD ± 0.08) to 0.19 postoperatively (SD± 0.15) (P= 0.01). The change in mean best corrected visual acuity (BCVA) was from 0.51, (SD ± 0.24), to 0.69, (SD ±0.00) (P = 0.01) postoperatively. The average central keratometry reading was 52.55 D. The change in mean K from 52.84 to 49.16 and 49.15 at one and six months respectively, was statistically significant. We did not have any major intra- or early postoperative complications. Eight of 12 eyes became contact lens-tolerant post-surgery.

Conclusion

The procedure of Intacs implantation appears to be safe and effective in a small group of Indian population at an intermediate follow-up.