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BACKGROUND AND OBJECTIVE: Dilation and examination during retinopathy of prematurity (ROP) screening can cause systemic complications and even life-threatening adverse events (AEs). The main objective of this study is to assess the prevalence and significance of AEs and changes in vital signs during ROP screenings, and to correlate birth weight, gestational age, and length of exam as possible predictors of these changes. PATIENTS AND METHODS: This is a prospective, observational study that includes 1,360 screening exams from 680 premature infants in two neonatal intensive care units. Systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation were monitored from the time that dilating drops were administered until 4 hours after the examination was completed. Any clinical deterioration or complication was documented. RESULTS: Of 1,360 infant screening exams, 153 (11%) screening exams resulted in at least one change in vital sign that alerted the monitor. There was one serious AE requiring bag valve mask resuscitation 30 minutes after dilating drops were placed. Gestational age, birth weight, and length of ROP exam were not significant predictors of AEs. There were statistically significant changes when comparing pre- and post-vital signs following dilation and funduscopy exam. CONCLUSIONS: Although ROP screening exams are essential for at-risk neonates, mydriatic drops and retinal exams can result in changes to vital signs and AEs. It is important to closely monitor neonates during these examinations. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:458–463.]

To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy.Retrospective, nonconsecutive, noncomparative, multicenter case series.Three hundred sixty-three eyes of 186 patients.Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings.Rate of RDs and factors conferring a higher risk of RDs.The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009).Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.

Background Oral topical corticosteroid gels are widely used in dental medicine. Case studies of central serous retinopathy have been reported following administration of corticosteroids, but none so far coinciding with the use of topical fluocinonide gel. This case report further contributes to the database of potential risks of corticosteroid use. Case presentation A 40-year-old South Asian woman presented with decreased vision, pigment epithelial detachments, and serous retinal detachments in both eyes 1 month after starting treatment with topical fluocinonide 0.05%, a topical oral corticosteroid gel. Her condition resolved 6 months after discontinuing the use of the steroid. Conclusions To the best of our knowledge, this is the first case of idiopathic central serous retinopathy associated with the use of oral fluocinonide gel. Discontinuing the use of the steroid may result in resolution of the serous retinal detachment and improvement of visual symptoms. Patients and their doctors who prescribe this medication should be aware of this association.

Objectives To evaluate the characteristics and comorbidities associated with ROP in micro-premature infants and their results. Methods This is a retrospective chart review involving multiple intensive care units in Central Texas from 2011 to 2016. Infants were included if birth weight (BW) was≤750 g with confirmed ROP by the International Classification of Retinopathy of Prematurity (ICROP). Neonates were examined and treated with laser ablation or intravitreal ranibizumab (IVR) with subsequent laser treatment, guided by fluorescein angiography, if met treatment criteria defined as type 1 ROP by the Early Treatment of Retinopathy of Prematurity standards. Time to regression was defined clinically. Results were analyzed using chi-squared test. Results 100 neonates were included in the study. Mean BW was 599 grams and mean gestational age was 24.2 weeks. Forty neonates were classified as type 1 ROP and therefore required intervention; of them 21 received laser alone and 19 required IVR with subsequent laser. Only 2 patients received more than one IVR injection. None of the patients progressed to stage 4 or 5 ROP. Conclusions Despite such low birth weights, none of these neonates progressed to stage 4 or 5 ROP likely because of prompt examination and treatment with laser or with IVR and subsequent laser. IVR might serve as a bridge to laser in type 1 ROP allowing some retinal vessel development prior to definitive laser treatment.

Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury in the United States. Retinal findings in NAT are common and well described, including extensive retinal hemorrhages in multiple layers, retinoschisis, perimacular retinal folds, vitreous and optic nerve hemorrhage. Management keystones include a multidisciplinary approach to the patient’s multiple comorbidities, careful photographic and angiographic documentation of ophthalmic findings, amblyopia prevention and visual development, as well as interventions including photocoagulation and vitrectomy.

Purpose: To describe a case of Multi-drug resistant Mycobacterium chelonae scleral buckle infection. Observations: A 56 year-old male with history of retinal detachment repair with scleral buckle 20 years prior presented with 8 months of intermittent pain and redness in the left eye. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed multi-drug resistant Mycobacterium chelonae. The postoperative course included orbital cellulitis treated with systemic linezolid, clarithromycin, and imipenem. All systemic antibiotics were discontinued on post-operative day 25, visual acuity improved to 20/25, the retina remained attached, and no recurrence occurred over 3 years of follow-up. Conclusions and importance: NTM infections are typically chronic and often require lengthy treatment. SB infection is rare, but often associated with biofilm and antibiotic resistance. In spite of removing the SB, anchoring sutures, sheath surrounding the buckle and associated biofilm, a prolonged course of systemic antibiotics may be necessary in some patients. Keywords: Non-tuberculous mycobacterium, Scleral buckle, Orbital cellulitis

Purpose: To report two patients with giant retinal tear (GRT) associated retinal detachment in the setting of baseball trauma. Observations: Two patients presented with retinal detachment associated with GRT following blunt trauma with a baseball. The first was a superotemporal GRT detachment treated with scleral buckling, pars plana vitrectomy, endolaser, and silicone oil injection. He subsequently underwent cataract surgery with silicone oil removal and at two year follow up the retina with attached with best-corrected visual acuity of 20/20. The second case was an inferotemporal GRT detachment treated initially with laser demarcation, however the tear progressed to a retinal detachment that was then treated with pars plana vitrectomy and lensectomy, endolaser, perfluoro-octane (PFO), and silicone oil injection. At the one year follow up, the retina was attached and the best-corrected visual acuity was 20/30. Conclusions and importance: GRTs are an uncommon cause of retinal detachment. While pars plana vitrectomy with tamponade is standard in GRT management, there is variability in the use of scleral buckling and PFO in these cases. This is in contrast to retinal dialysis where scleral buckle alone can yield favorable results. Though a baseball ocular trauma is common, retinal involvement is rare compared to other sports injuries such as those occurring with tennis, soccer and golf. Sports trauma remains an important cause of retinal injury and patients should be counseled on the need for eye protection.

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the “capture rate.” RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274–e277.]

PURPOSE To evaluate angiographic findings in neonates up to 150 weeks postmenstrual age who received intravitreal ranibizumab for primary treatment of Type 1 retinopathy of prematurity. METHODS Retrospective evaluation of fluorescein angiogram findings was completed for 30 eyes of 16 neonates who received intravitreal ranibizumab as primary treatment for Type 1 retinopathy of prematurity between April 2013 and January 2015. Outcome measures included maturity to Zone III, vascular blunting, vascular loops, vascular dilatation, capillary dropout, and vascular fluorescein leakage. RESULTS Mean gestational age was 24 weeks and mean postmenstrual age at time of intravitreal ranibizumab treatment was 35 weeks. Fluorescein angiograms performed at 44 weeks to 150 weeks postmenstrual age showed only 50% of eyes reached vascularization to Zone III; 40% had persistent vascular leakage; and ≥90% exhibited vascular blunting, vascular dilatation, and/or capillary dropout. CONCLUSION Although intravitreal ranibizumab is effective in initial cessation of Type 1 retinopathy of prematurity, vascularization to Zone III was only achieved in 50% of eyes in our series and most eyes had fluorescein angiography evidence of vascular anomalies. If future studies are performed comparing treatment with laser photocoagulation to anti-vascular endothelial growth factor, fluorescein angiographic studies should be considered to assess the status of the peripheral retinal vasculature to determine treatment effect.

Acute macular neuroretinopathy (AMNR) is a rare condition that primarily affects young women in their reproductive years. Many of the affected young women are on oral contraceptives. Patients report a sudden decrease in visual acuity, usually a few days after the onset of a febrile illness, with paracentral scotomas either unilaterally or bilaterally. Although AMNR was initially thought to be an inner retinal pathology, with the publication of 84 case reports in the English medical literature and the advent of new imaging modalities, it is now thought to be a disease of the outer retina. In 2003, Turbeville et al published a review of more than 41 AMNR cases reported from 1975 to March 2002, which summarized the available literature and suggested potential fields of research to be explored. This article summarizes the 43 case reports that were published in the English literature from April 2002 to October 2012 and also presents a unique case of AMNR. [ Ophthalmic Surg Lasers Imaging Retina. 2015;46:114–124.]

Ocular manifestations related to atopic dermatitis include keratoconus, keratoconjunctivitis, cataract, and retinal detachment. The authors report three cases of retinal detachment associated with atopic dermatitis. Although the pathogenesis is poorly understood, chronic blunt trauma may play a role in the development of retinal detachment. In addition, retinal detachments associated with atopic dermatitis may have lower rates of successful retinal detachment repair. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:513–517.]

Familial exudative vitreoretinopathy (FEVR) is a hereditary condition characterized by failure of vascular development of the temporal retina causing peripheral retinal ischemia, exudation, neovascularization, temporal dragging, and tractional retinal detachment.

Shaken baby syndrome (SBS) is a vitreo-chorioretinopathy secondary to nonaccidental trauma that occurs in children younger than 3–5 years old, and most frequently in infants less than 6–12 months old.

ROP is a disorder of the development of the retina in low birthweight premature infants. Incomplete retinal vascularization and resulting ischemic retinopathy causes abnormal proliferation of developing blood vessels at the junction of vascular and avascular retina in these babies.

PURPOSE To correlate the clinical course of sympathetic ophthalmia with the histological and immunohistochemical characteristics of the enucleated inciting eye. METHODS A consecutive case series with baseline clinical features and subsequent histopathologic findings. RESULTS Evaluation of the 16 enucleated inciting eyes (blind and painful) disclosed that 9 of the 16 had typical histology, fulfilling the criteria for sympathetic ophthalmia of diffuse granulomatous inflammation. Among the 16, 11 sustained previous penetrating trauma, 4 underwent previous eye surgery, and 1 patient presented with an unknown etiology. Patients with atypical histology (7 of 7) were taking corticosteroids at the time of enucleation. Only 2 of 9 patients with typical histology were taking corticosteroids at the time of enucleation. At 6 months after enucleation of the inciting eye, 4 of the 7 patients with atypical histology had a visual acuity of ≥20/40 compared with 8 of 8 patients (100%) with typical histology. On a 4-point scale (0-3+), the choroidal infiltrate of the 9 histopathologically typical eyes showed an average of 2.5+ CD68 (macrophages), 2.5+ CD20 (B cells), and 1.5+ CD3 (T cells). CONCLUSION Histopathologic findings had minimal correlation with the clinical course of sympathetic ophthalmia. Corticosteroid treatment before enucleation may influence the pathologic confirmation of sympathetic ophthalmia. The predominance of B lymphocytes and macrophages over T lymphocytes may represent different stages of the disease process.

BACKGROUND AND OBJECTIVE: To clinically correlate and evaluate the screening and treatment patterns of retinopathy of prematurity by a single physician at a tertiary care center between 2002 and 2012. PATIENTS AND METHODS: A group of 10,924 newborns screened for ROP between 2002 and 2012 were retrospectively analyzed in a consecutive case series. Records of the neonatal intensive care unit (NICU) at Jackson Memorial Hospital/Bascom Palmer Eye Institute were reviewed to identify patients clinically diagnosed with retinopathy of prematurity who underwent treatment. RESULTS: Laser photocoagulation was used to treat 231 of 10,924 (2.1%). Of these 231 patients, 176 (76.2%) were included in the study (55 infants were excluded because they were referred from outside institutions for advanced ROP). Of the 176 treated patients, 89 (50.6%) were male and 87 (49.4%) were female. The average birth weight was 687.3 g. The mean gestational age was 24.8 weeks. The mean time between birth and treatment was 3 months. Of the 176 patients, 31 required re-treatment with laser photocoagulation. The rates of treatment and retreatment significantly declined with the experience of the treating physician ( P < .01). Retinal detachment occurred in two of 176 patients (1.1%). CONCLUSION: Experience is essential in delivering optimal care in a complex disease such as ROP. Between 2002 and 2012, the rate of treatment and retreatment significantly decreased. Possible reasons include improvements in neonatal care, but it is more likely that the rate of treatment and re-treatment is inversely proportional to the ophthalmologist’s experience with and comfort in managing ROP. [ Ophthalmic Surg Lasers Imaging Retina. 2015;46:752–754.]