Cause Of Childhood Blindness Research Articles

Portable wide-field digital imaging for screening of neonatal visual impairment causes in Rio de Janeiro, Brazil: a budget impact analysis

ObjectiveTo estimate the budget impact of portable wide-field digital imaging incorporation on screening neonatal causes of childhood blindness and visual impairment in Rio de Janeiro, Brazil.DesignBudget impact analysis.SettingRio de Janeiro,...

Case Report: A de novo Variant of CRYGC Gene Associated With Congenital Cataract and Microphthalmia

Background: Congenital cataract is one of the most common causes of blindness in children. A rapid and accurate genetic diagnosis benefit the patients in the pediatric department. The current study aims to identify the genetic defects in a congenital cataract patient without a family history. Case presentation: A congenital cataract patient with microphthalmia and nystagmus was recruited for this study. Trio-based whole-exome sequencing revealed a de novo variant (c.394delG, p.V132Sfs*15) in CRYGC gene. According to the American College of Medical Genetics and Genomics (ACMG) criteria, the variant could be annontated as pathogenic. Conclusion: Our findings provide new knowledge of the variant spectrum of CRYGC gene and are essential for understanding the heterogeneity of cataracts in the Chinese population.

Early Diagnosis and Quantitative Analysis of Stages in Retinopathy of Prematurity Based on Deep Convolutional Neural Networks.

PurposeRetinopathy of prematurity (ROP) is a leading cause of childhood blindness. An accurate and timely diagnosis of the early stages of ROP allows ophthalmologists to recommend appropriate treatment while blindness is still preventable. The purpose of this study was to develop an automatic deep convolutional neural network–based system that provided a diagnosis of stage I to III ROP with feature parameters.MethodsWe developed three data sets containing 18,827 retinal images of preterm infants. These retinal images were obtained from the ophthalmology department of Jiaxing Maternal and Child Health Hospital in China. After segmenting images, we calculated the region of interest (ROI). We trained our system based on segmented ROI images from the training data set, tested the performance of the classifier on the test data set, and evaluated the widths of the demarcation lines or ridges extracted by the system, as well as the ratios of vascular proliferation within the ROI on a comparison data set.ResultsThe trained network achieved a sensitivity of 90.21% with 97.67% specificity for the diagnosis of stage I ROP, 92.75% sensitivity with 98.74% specificity for stage II ROP, and 91.84% sensitivity with 99.29% sensitivity for stage III ROP. When the system diagnosed normal images, the sensitivity and specificity reached 95.93% and 96.41%, respectively. The widths (in pixels) of the demarcation lines or ridges for normal, stage I, stage II, and stage III were 15.22 ± 1.06, 26.35 ± 1.36, and 30.75 ± 1.55. The ratios of the vascular proliferation within the ROI were 1.40 ± 0.29, 1.54 ± 0.26, and 1.81 ± 0.33. All parameters were statistically different among the groups. When physicians integrated quantitative parameters of the extracted features with their clinic diagnosis, the κ score was significantly improved.ConclusionsOur system achieved a high accuracy of diagnosis for stage I to III ROP. It used the quantitative analysis of the extracted features to assist physicians in providing classification decisions.Translational RelevanceThe high performance of the system suggests potential applications in ancillary diagnosis of the early stages of ROP.

Normalization of Oxygen‐Induced Retinopathy in the Mouse Supplementation with Myo/Nog Cells

IntroductionRetinopathy of Prematurity (ROP) is the leading cause of blindness in children, affecting 50% of infants born prior to gestational week 32. ROP is the result of postpartum supplemental oxygen administered to compensate for underdeveloped lungs. However, hyperoxia inhibits proper development supplying the retina. When the infants are returned to ambient air, an imbalance is present between the oxygen concentration and metabolic demands of retinal neurons. This leads to a rapid induction of angiogenesis, leaky blood vessels, neovascular tuft formation, and cell death. Myo/Nog cells that express MyoD, Noggin, and brain‐specific angiogenesis inhibitor 1 (BAI1) exhibit neuroprotective properties in the eye and brain and are proposed to play a role in regulating angiogenesis in ROP.MethodsAn Oxygen‐induced retinopathy (OIR) protocol was implemented in neonatal C57BL/6J mice by exposing them on postnatal days 7‐12 (P7‐P12) to hyperoxia (75% oxygen) and then returning them to normal air (21% oxygen) from P12 until P21. On P15, groups receiving treatments were intravitreally injected with 1 µL of phosphate‐buffered saline (PBS) containing 2000 Myo/Nog cells isolated from the brain with the BAI1 antibody (BAI1+ group), 2000 unsorted brain cells (BAI1‐ group), or PBS alone (PBS group). Electroretinography (ERG) was conducted on P21 to assess retinal function. Eyes were extracted and either dissected for flat‐mount observation of vasculature and tufts, or processed for histology. The thickness of the retina and number of TUNEL+ apoptotic cells were quantified in tissue sections of eyes processed for histology. Adobe Photoshop (Adobe, San Jose, CA) was used to splice together 9 images that made up each whole retina from flat‐mounted eyes. The blood vessels were selected using the “Lasso tool” on photoshop, quantified by number of pixels, and then compared to the total number of pixels in the whole retina.ResultsOIR induced neovascular tuft formation. Exogenously added Myo/Nog cells normalized the retinopathy induced by the OIR model, reducing the number of tufts and improving the quality of the vasculature. The vasculature was most developed in retinas injected with brain derived Myo/Nog cells. ERG data shows a trend towards improvement of visual function with Myo/Nog cell injection.ConclusionMyo/Nog cell regulation of retinal vascularization may be related to the production of BAI1. Improved visual function seen with injection of Myo/Nog cells may be related to both a reduction of neovascular tufts and direct effects on retinal neurons. Therefore Myo/Nog cells have therapeutic potential in the prevention of ROP by normalizing the vasculature and preventing neuronal cell death.

Thioredoxin-1 Ameliorates Oxygen-Induced Retinopathy in Newborn Mice through Modulation of Proinflammatory and Angiogenic Factors.

Oxygen-induced retinopathy (OIR) is an animal model for retinopathy of prematurity, which is a leading cause of blindness in children. Thioredoxin-1 (TRX) is a small redox protein that has cytoprotective and anti-inflammatory properties in response to oxidative stress. The purpose of this study was to determine the effect of TRX on OIR in newborn mice. From postnatal day 7, C57BL/6 wild type (WT) and TRX transgenic (TRX-Tg) mice were exposed to either 21% or 75% oxygen for 5 days. Avascular and neovascular regions of the retinas were investigated using fluorescence immunostaining. Fluorescein isothiocyanate-dextran and Hoechst staining were used to measure retinal vascular leakage. mRNA expression levels of proinflammatory and angiogenic factors were analyzed using quantitative polymerase chain reaction. Retinal histological changes were detected using immunohistochemistry. In room air, the WT mice developed well-organized retinas. In contrast, exposing WT newborn mice to hyperoxia hampered retinal development, increasing the retinal avascular and neovascular areas. After hyperoxia exposure, TRX-Tg mice had enhanced retinal avascularization compared with WT mice. TRX-Tg mice had lower retinal neovascularization and retinal permeability during recovery from hyperoxia compared with WT mice. In the early stages after hyperoxia exposure, VEGF-A and CXCL-2 expression levels decreased, while IL-6 expression levels increased in WT newborn mice. Conversely, no differences in gene expressions were observed in the TRX-Tg mouse retina. IGF-1 and Angpt1 levels did not decrease during recovery from hyperoxia in TRX-Tg newborn mice. As a result, overexpression of TRX improves OIR in newborn mice by modulating proinflammatory and angiogenic factors.

Limited hyperoxia-induced proliferative retinopathy: A model of persistent retinal vascular dysfunction, preretinal fibrosis and hyaloidal vascular reprogramming for retinal rescue.

Retinopathy of prematurity (ROP) remains the leading cause for blindness in children. Limited hyperoxia induced proliferative retinopathy (L-HIPR) was recently introduced as a potential animal model for ROP and persistent fetal vasculature; however, the detailed pathological changes remain unclear. To model L-HIPR, we placed C57BL/6J mice in 65% oxygen from birth to post-natal day 7 (P7). We examined eyes at intervals between P12 and P30. Retinal morphometry, thickness, and preretinal fibrosis were quantified at different time points on histological sections stained with hematoxylin and eosin (H&E) and Masson Trichrome, respectively. Vascular development, angiogenesis, inflammation, and pericyte coverage were analyzed using immunohistochemistry staining in retinal flat mounts and cross sections. In L-HIPR, the hyaloidal vessels persisted until the latest time point in this study, P30 and began to invaginate the peripheral then central retina starting at P12. Central retinal distortion was noted beginning at P17, while the peripheral retina demonstrated a trend of thinning from P12 to P30. We found that L-HIPR was associated with delayed and abnormal retinal vascular development with subsequent retinal inflammation, pericyte loss and preretinal fibrosis. Our study presents a detailed analysis of the L-HIPR animal model demonstrating vitreoretinal pathologic changes, preretinal fibrosis and persistent hyaloidal vessels into adulthood. Based on our findings, we suggest that the persistence and peculiar stepwise migration of the hyaloidal vessels into the retina may provide a potential rescue mechanism for inner retinal development that deserves further study.

Elabela promotes the retinal angiogenesis by inhibiting ferroptosis during the vaso-obliteration phase in mouse oxygen-induced retinopathy model.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness associated with retinal vaso-obliteration in phase 1 and pathological neovascularization (NV) in phase 2; however, effective and safe treatments for ROP definitive treatment are yet to be determined. Anti-vascular endothelial growth factor (VEGF) therapy mainly focuses on reducing abnormal NV in phase 2 but with high risks of late recurrence and systemic side effects. Previous studies have established that the severity of vaso-obliteration in phase 1largely influences subsequent stages, suggesting that prevention of vessels loss may be a potential therapeutic target for ROP. Herein, the therapeutic potential and safety of early Elabela intervention treatment in treating phase 1 ROP and the possible underlying mechanisms were investigated using an oxygen-induced retinopathy (OIR) mouse model. It was observed that intraperitoneal injection of Elabela remarkably reduced the avascular retinal area and increased the vascular density in phase 1 of OIR mice. Further investigation revealed that mitochondrion-dependent ferroptosis was involved in oxidative stress-mediated vascular protection loss in phase 1 OIR. Furthermore, we demonstrated that Elabela could rescue mitochondria-dependent ferroptosis via mediating the xCT/GPX4 axis. Collectively, our study revealed that ferroptosis may play a significant role in early ROP, while Elabela may be a safe and promising strategy for the early intervention of ROP.

The protective effect of L-carnitine supplementation on retinopathy of prematurity: A retrospective cohort study

Background/Aim: Retinopathy of prematurity (ROP) is important morbidity in premature infants and is the most common preventable cause of blindness in childhood. Carnitine is a key molecule in energy metabolism and in oxidation of fatty acids, which are the main structural component of phospholipid membrane of the brain and retinal cells. Premature babies are born with insufficient carnitine pools. This study aimed to evaluate the effect of carnitine replacement on ROP in premature infants aged < 34 gestational weeks. Methods: Premature infant records between 2014 and 2019 were retrospectively examined. All premature infants at gestational ages < 34 weeks were included. Data from the two groups who received/did not receive carnitine supplementation in total parenteral nutrition (TPN) over two consecutive time periods and whose ROP examination was complete were recorded retrospectively. Fifty-eight out of 125 infants were in the carnitine group, and 67 formed the non-carnitine group (CG and NCG, respectively). The morbidity data from subjects, especially those with ROP, who received (CG) and did not receive carnitine (NCG), were compared. Results: Of the 125 infants enrolled, no significant differences in gestational age (P = 0.323) or birth weight (P = 0.597) between the groups was found. The Cox regression analysis revealed that carnitine replacement in the premature infant was a protective factor for ROP (P=0.045, B= −0.933, hazard ratio 0.393, 95% confidence interval 0.158–0.978). Conclusion: Carnitine supplementation may offer protection from developing ROP during exposure to oxygen in premature infants.

Hand-held optical coherence tomography: Advancements in detection and assessment of optic nerve abnormalities and disease progression monitoring

Introduction Developmental abnormalities of the optic nerve (ON) and pediatric optic neuropathies such as glaucoma, are leading causes of childhood blindness. The recent development of hand-held spectral domain optical coherence tomography (HH-OCT) has enabled noncontact, high-resolution scanning in non-sedated newborns, infants and young children and has provided for the first time, in vivo visualization of the retina and ON in these patient groups. Areas covered This review will address the applications, recent advances and future potential of HH-OCT in diagnosis and monitoring of pediatric optic neuropathies. We will provide an update on the use of HH-OCT in pediatric glaucoma, congenital optic disc anomalies, optic pathway gliomas, optic atrophy and papilledema. Expert opinion HH-OCT could offer particular utility in children with optic neuropathies, by providing noninvasive, high-resolution characterization of the optic nerve head. Optic nerve parameters, such as retinal nerve fiber layer thickness, could serve as biomarkers to assess the severity of optic nerve disease qualitatively and quantitatively. Hence, HH-OCT is emerging as a powerful imaging tool to facilitate early diagnosis, identify prognostic biomarkers, monitor disease progression and assess response to treatment.

Clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters.

Purpose:Congenital ocular anomalies are rare but important cause of childhood blindness. This study aimed to observe the clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters.Methods:Hospital-based cross-sectional study done on all pediatric patients in the 0-to-5-year age group presenting with congenital ocular anomalies to the Ophthalmology department of a tertiary care hospital in Eastern India between October 2018 and October 2020. Thorough clinical history was obtained, and comprehensive ocular examination was done in each case.Results:A total of 5686 patients in the 0 to 5 years age group attended the eye OPD during the study period. Congenital ocular anomalies were seen in 140 patients. The prevalence of ocular anomalies was 2.46%. Average age of patients was 3.32 ± 1.42 years. There were 74 (52.9%) males and 66 (47.1%) females. Unilateral and bilateral involvement was seen in 100 (71.45%) and 40 (28.6%) cases, respectively. Antenatal period was uneventful in 92.14% cases. Decreased vision was the most common presentation (40%). Congenital nasolacrimal duct obstruction was the most common anomaly seen in 29 (20.71%) cases followed by congenital cataract in 21 (15%) cases.Conclusion:Few of the congenital ocular anomalies can be prevented by increasing community awareness. Findings of the study can act as a reference guide for clinicians and health professionals for counseling and health planning.

Visual Outcome Of Paediatric Traumatic Cataract In Paediatric Ophthalmology Department Of A Tertiary Care Hospital.

Paediatric traumatic cataract is one of leading treatable cause of childhood blindness. The purpose of this study is to analyse number of avoidable blindness in children and to access final visual outcomes, causative factors, strategies for the prevention and management. One hundred and twenty patients of ocular traumatic cataract age between 2 months to 14 years were treated in Department of Paediatric Ophthalmology from April 2019 till April 2020wasprospectivelyreviewed. Data included age, gender, time of presentation, type of injury, anterior segment with fundus examination, time and type of surgery, visual outcome at presentation and final visual outcome. Visual acuity was assessed by fixation and following, Snellen's chart according to patient's age. Some patients underwent for lens aspiration and rest underwent for lens aspiration, posterior capsulotomy and anterior vitrectomy followed by intraocular lens implantation under general anaesthesia. Patients who lost follow ups for two months were not included in study. Analysis of data was done using SPSS for window version 24.0. One hundred and twenty eyes operated for traumatic cataract among which 64 (53.34%) patients were males and 56 (46.66%) were females. The average age of patients was 7.8 years with traumatic cataract. Initial Uncorrected visual out come at the time of presentation ranged from 6/60 to light perception. 15 %of children with traumatic cataract had post-operative final visual outcome of better than 6/18. The commonest cause of ocular injuries in our pediatric ophthalmology department was domestic, mostly in 5-9 years of age with greater number in males. In traumatic cataract extraction final visual outcome depends on initial visual outcome, source and type of injury, duration of presentation, duration of surgery and complications.

Childhood Blindness and Visual Impairment in a Local Government Area in North-Central Nigeria: A Key Informant Survey.

To use the Key Informant survey to estimate the magnitude and to identify the major causes of blindness and severe visual impairment in children of Nassarawa Eggon Local Government Area of Nasarawa State, Nigeria. Twenty-eight trained Key Informants traced and referred children believed to be blind or visually impaired. Biodata record, history and eye examination were based on the operational definitions in the WHO/PBL coding instruction manual for childhood blindness. Data were entered and analyzed in the WHO/PBL Childhood Blindness Software (CBS) V 1.2.75 by an ophthalmologist and a statistician. The Key Informants identified 51 children of which 50 (98%) were examined. Eight (16%) of the children examined were blind, another 8 (16%) had severe visual impairment, 16 (32%) were visually impaired, 7 (14%) had monocular blindness and 11 (22%) were normal. The estimated crude prevalence of childhood blindness was 0.01% and of moderate-severe visual impairment was 0.03%. The major causes of blindness and severe visual impairment were cataract, corneal opacity, and refractive errors. Ninety-four percent of the causes of blindness and moderate-severe visual impairment in children were avoidable. It was estimated that some 415 children in Nasarawa state are blind or have moderate to severe visual impairment. The estimated magnitude of blindness and visual impairment in Nassarawa Eggon LGA is 8 and 24 children respectively with a crude blindness prevalence of 0.01% (1 per 10,000). Cataract was the commonest cause of childhood blindness and severe visual impairment in Nassarawa Eggon local government area with 93.8% of the causes of blindness and visual impairment being avoidable.

Pattern of congenital eye anomalies in children: A study from rural tertiary care hospital

Background: Congenital eye anomalies are an important cause of childhood blindness. Worldwide, there are a lot of variations in the spectrum of congenital eye anomalies. The key to preventing childhood blindness is early detection and intervention of the congenital eye anomalies. Aims and Objectives: This study aims to describe the type and frequency of congenital eye anomalies in children. Materials and Methods: This cross-sectional study was done on children attending pediatric OPD and the newborn babies born in the hospital in the period of 1 year from June 2019 to May 2020. They were screened for any ocular abnormality and then detailed ocular examination was done by the ophthalmologist. The data were collected for demographic characteristics, clinical diagnosis, age of presentation of anomaly, laterality, involvement of one or both eye, and type of anomaly. Variables were expressed as proportions or percentages. Results: A total of 32,858 children were screened for ocular abnormalities. Out of these, 1571 (0.047%) children had ocular abnormalities. Among them, 1011 (64.35%) presented in the 1st year of life, 381 (24.25%) in the 2nd year of life, and the remaining 179 (11.4%) were diagnosed after 2 years of life. Among various anomalies, congenital nasolacrimal duct obstruction was the most common anomaly (65%) followed by coloboma of iris and choroid (13.8%). Congenital ectropion and anopthalmos were found in five and three children, respectively. Conclusion: The most common anomaly was congenital nasolacrimal duct blockage followed by coloboma of iris, choroid, and cataract. Early detection and intervention of the congenital eye anomalies is necessary to prevent blindness.

Collaborative Research and Development of a Novel, Patient-Centered Digital Platform (MyEyeSite) for Rare Inherited Retinal Disease Data: Acceptability and Feasibility Study.

BackgroundInherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care.ObjectiveThis study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study.MethodsQualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases.ResultsOur IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom’s NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app.ConclusionsThis study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases.

Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity.

Background: Retinopathy of prematurity (ROP) is a major cause of childhood blindness. Antenatal corticosteroids (ACS) exposure is known to ameliorate the risk of and mortality of neonatal morbidities. However, the effect of ACS on ROP development is currently unknown. We conducted a meta-analysis with up-to-date evidence to assess the association between ACS exposure and the development of ROP in at-risk preterm infants. Methods: PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library were systematically searched from inception to May 2021, supplemented with manual search from reference lists. Studies with a control group reporting ROP rate in ACS-exposed infants were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated utilizing a random-effects model. The Newcastle-Ottawa Scale was used for assessment of risk of bias in the included studies. Meta-regressions were performed to explore the predictive role of confounders for between-study variance. Results: A total of 63 studies, involving 196,264 infants, were included. Meta-analysis showed ACS exposure was not associated with ROP occurrence (uOR 0.92, 95% CI 0.80–1.07; aOR 0.87, 95% CI 0.7–1.08). Results from extremely immature subgroups revealed significant reduced risks of ROP occurrence in ACS-exposed infants. ACS exposure was associated with significantly lower odds of ROP progression in adjusted analysis (aOR 0.48, 95% CI 0.26–0.89) instead of unadjusted analysis (uOR 0.86, 95% CI 0.68–1.08). Meta-regression showed birth weight and patent ductus arteriosus of the cohort were associated with ROP occurrence, sample size and study design strongly associated with ROP progression in ACS-exposed infants. Conclusion: ACS treatment may decrease, but not prevent, the severity of ROP. Findings from severe ROP should be interpreted with caution owing to limited studies and the possibility of false-positive results. Considering the particular benefits in extremely immature infants, we recommend routine usage of ACS in mothers with threatened delivery to this particular birth cohort to prevent ROP occurrence. Future studies adjusting for major confounders are warranted to mitigate risk of bias in such observational evidence.

Disruption of PIKFYVE causes congenital cataract in human and zebrafish.

Congenital cataract, an ocular disease predominantly occurring within the first decade of life, is one of the leading causes of blindness in children. However, the molecular mechanisms underlying the pathogenesis of congenital cataract remain incompletely defined. Through whole-exome sequencing of a Chinese family with congenital cataract, we identified a potential pathological variant (p.G1943E) in PIKFYVE, which is located in the PIP kinase domain of the PIKFYVE protein. We demonstrated that heterozygous/homozygous disruption of PIKFYVE kinase domain, instead of overexpression of PIKFYVEG1943E in zebrafish mimicked the cataract defect in human patients, suggesting that haploinsufficiency, rather than dominant-negative inhibition of PIKFYVE activity caused the disease. Phenotypical analysis of pikfyve zebrafish mutants revealed that loss of Pikfyve caused aberrant vacuolation (accumulation of Rab7+Lc3+ amphisomes) in lens cells, which was significantly alleviated by treatment with the V-ATPase inhibitor bafilomycin A1 (Baf-A1). Collectively, we identified PIKFYVE as a novel causative gene for congenital cataract and pinpointed the potential application of Baf-A1 for the treatment of congenital cataract caused by PIKFYVE deficiency.

Pre- and Post-Operative Intraocular Pressure of Pediatric Cataract Surgery

Introduction: Cataract is an eye lens opacification which prevents clear vision. It is the leading cause of blindness and vision impairment worldwide, including Indonesia. It can also be occurred in children that leads to a major cause of childhood blindness. The prevalence of childhood cataract ranges from 3 to 6 per 10,000 children. The main treatment for cataract is surgery, although pediatric cataract surgery has several complications. One of the most severe complication is glaucoma due to increased intraocular pressure (IOP). This study aimed to determine pre- and post-operative IOP in pediatric cataract surgery.Methods: This was a cross-sectional observational analytic study. Secondary data were collected from medical records of Department of Ophthalmology, Dr. Soetomo General Hospital Surabaya from January 2017 to August 2019. Age, gender, pre- and post-operative IOP, and intraocular lens implantation data were taken. Calculation was performed using the Saphiro-Wilk for data less than 50 samples. The Saphiro-Wilk test results showed that the data were normally distributed (p = 0.628). Data processing were then performed using the parametric t-pair test with a confidence level ofResults: 32 eye samples were obtained from 16 pediatric cataract surgery patients. The mean of pre-operative IOP was 13.05 mmHg and the mean of post-operative IOP was 13.36 mmHg. There was an increase in post-operative IOP with an average increase of 0.31 mmHg. There was no significant difference between pre- and post-operative IOP of pediatric cataract surgery patients (p = 0.711).Conclusion: There was no difference between pre- and post-operative IOP of pediatric cataract surgery patients at Dr. Soetomo General Hospital Surabaya for the period of January 2017 - August 2019.

Bilateral Keratomalacia in a Patient with Vitamin A Deficiency: A Case Report

Keratomalacia refers to an ocular destructive dryness of cornea that results from severe vitamin A deficiency. It is an ocular condition, usually affecting both eyes. It affects infants, children and women at reproductive age group. In developing countries, vitamin A deficiency in the diet and associated keratomalacia are a major cause of childhood blindness. Here we describe the case of two-year-old female child presenting with bilateral keratomalacia due to severe vitamin A deficiency in diet.

Anesthesia in retinopathy of prematurity.

Retinopathy of prematurity (ROP) remains among the leading causes of childhood blindness. It affects mainly premature infants who tend to be systematically and clinically unstable and are more prone to complications and anesthesia related adverse effects when undergoing examination or treatment. A better comprehension of different analgesic and anesthetic methods used during screening and treatment may help in choosing a suitable option for ROP screening and treatment. An electronic search was done using MEDLINE, PubMed, and Embase databases. Search terms used included ROP, ROP, ROP screening, ROP treatment, analgesia, and anesthesia. All randomized clinical trials, large case series, and surveys were included in the review. Topical proparacaine is the most commonly used anesthesia during ROP screening and may significantly ease pain during ROP screening. Different comfort measures during screening may help infants recover faster but do not abolish pain. Topical tetracaine seems an effective pain-relieving option during intravitreal injections for ROP treatment. Photocoagulation of the peripheral retina under general anesthesia is considered the most common practice in the treatment of ROP. Further work is necessary to better understand the options of anesthesia methods offered for the treatment of ROP patients. This is a comprehensive review highlighting the available anesthetic methods for ROP patients to aid ophthalmologists in determining the most common and current anesthetic and analgesic practices.

Effectiveness of developmentally supportive education program on nursing knowledge of retinopathy of prematurity in neonatal intensive care unit

Background:Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. India accounts for nearly 10% of the worldwide estimate of blindness and visual impairment due to ROP. Nurses are pillars of neonatal intensive care units (NICUs) and play a critical role in the prevention and management of ROP. The primary aim of this study was to evaluate the effect of developmentally supportive education program on knowledge regarding prevention and management of ROP among nurses working in NICU.Materials and Methods:A hospital based pre-experimental, one group pre-test–post-test study was carried out among 32 staff nurses working in the NICU of a tertiary care center during January to February 2019. Knowledge regarding the prevention and management of ROP was assessed before and after the implementation of developmentally supportive education program using a structured knowledge questionnaire.Results:Pre-test knowledge score was mean (Standard Deviation [SD]) 9.00 (3.68) and after the educational program post-test knowledge score was found to be mean (SD) 14.53 (2.39). Paired t-test was used to evaluate the effect of developmentally supportive education program and was found to be statistically significant (t32= 10.09, p < 0.001).Conclusions:Developmentally supportive educational program can be used as an effective intervention for improving the knowledge regarding ROP among nurses in NICU.