Pediatric Ophthalmology

Ultra Low Dose Anti VEGF for ROP

From being generally considered a controversial therapeutic option for retinopathy of prematurity, Intravitreal bevacizumab (IVB) has emerged as an effective treatment modality where the disease is severe and posterior. There is evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate and the optimal dose is unknown. This original paper shares the experience of the authors of using ultra-low-dose (0.16 mg) IVB, one-quarter of the ‘standard’ dose in the treatment of ROP. A retrospective observational case series of 15 consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP showed primary success in 23/29 eyes (79.3%). Secondary success (where additional treatment was required) was observed in 27/29 eyes (93.1%). Retreatment was required in 20% cases at a mean of nearly 10 weeks after the first injection. 0.16 mg IVB was found to be effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in the series.

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Hillier RJ, Connor AJ, Shafiq AE. Ultralow- dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series. Br J Ophthalmol. 2017 Jun 27.

Ocular Morbidity among Indian School going children

In a study closer to home, Singh V et al performed school-based crosssectional study in Uttar Pradesh to find out the epidemiology of ocular morbidity among the children. They examined 4838 children aged 5-15 years in randomly selected urban and rural schools of West Uttar Pradesh over 2 years. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural). Refractive error (17.36%), convergence insufficiency (2.79%), blepharitis (2.11%), Vitamin A deficiency (2.09%), allergic conjunctivitis (1.92%), bacterial conjunctivitis (0.95%), amblyopia (0.41%), stye (0.31%) and squint (0.27%) formed the common causes for ocular morbidity. An increase in ocular morbidity was noted with age. Vitamin A deficiency showed a significantly higher prevalence in the rural as compared to the urban sector. The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. Since most of this morbidity is either preventable or treatable, the authors emphasized that school screening has an important role to play in reducing this load.

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Singh V, Malik KPS, Malik VK, Jain K. Prevalence of ocular morbidity in school going children in West Uttar Pradesh. Indian J Ophthalmol. 2017 Jun;65(6):500-508.

Pars Plana Vitrectomy in Pediatric Intermediate Uveitis

Pars plana vitrectomy is a mode of treatment for resistant vitritis and intermediate uveitis. A recent study evaluated the efficacy of this procedure as an antiinflammatory therapy in pediatric recurrent intermediate uveitis. This retrospective study evaluated the long-term results of PPV indicated for intermediate uveitis with a mean observation period of 10.3 years (range 7-15.6 years) in 6 children (mean age 8 years, range 6-12 years). Pars plana vitrectomy was performed on 10 eyes in the standard manner and was initiated by vitreous sampling for laboratory examination. Perioperative or postoperative vitrectomy complications, anatomic and functional results, and preoperative and postoperative best-corrected Snellen visual acuity were recorded. The study found that no perioperative or postoperative complications were observed. Bacteriologic, virologic, mycotic, and cytologic analysis of the vitreous was negative in all tested children. Five eyes developed significant cataract for which they were subsequently operated. Visual acuity improved in all patients. The authors recommended early PPV in the case of systemic immunosuppressive treatment failure in pediatric uveitis, particularly in eyes with cystoid macular edema.

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Darsová D, Pochop P, Štěpánková J, Dotřelová D. Long-term results of pars plana vitrectomy as an anti-inflammatory therapy of pediatric intermediate uveitis resistant to standard medical treatment. Eur J Ophthalmol. 2017 Aug 17:0