Major Cause Of Childhood Blindness Research Articles

Assessment of the Knowledge of Retinopathy of Prematurity (ROP) in a Cohort of Nurses in Ogun State, Nigeria

Background: Retinopathy of prematurity (ROP) is a major cause of childhood blindness that can be prevented by early detection and treatment. Nurses and midwives are important stakeholders in neonatal services who can help increase awareness to ensure early detection, thereby reducing the risk of blindness. Objectives: To determine the knowledge of a cohort of nurses in Ogun state about ROP and ROP screening. Methods: A cross-sectional study was conducted among nurses and midwives in Ogun State, Nigeria. A self-administered structured Google form (questionnaire) was used to obtain information on their knowledge and practice concerning ROP in their centres. Results: A total of 117 nurses participated in the study. These comprised 93.2% females, and the mean age was 38.5±3.5years. The majority of the participants were within the 41-50 years age group. A total of 70.9% had ever worked in a neonatal unit. Ninety-seven (82.9%) were aware of ROP, of which 76.1% could correctly define the condition. Sixty-nine per cent had a good knowledge score for ROP, while there was a poor knowledge score for screening in 62.4%. Conclusion: Though the participants had good knowledge about ROP, their knowledge of screening for early detection was poor. There is a need for intense dissemination of information on ROP, especially the need for screening of newborn infants among nurses and midwives.

A Narrative Review on Managing Retinopathy of Prematurity: Insights Into Pathogenesis, Screening, and Treatment Strategies.

Retinopathy of prematurity (ROP) is a rare proliferative ocular condition that can happen in premature babies (born preterm<36 weeks)or who weigh <1.5 kgat birth (low birth weight babies). ROP is a major cause of childhood blindness. It is a premature diseasesince retina vascularization is completed only by 40 weeks of life. The survivability for preterm infants has increased owing to recent improvements in neonatal care during the past decade. As a result, the prevalence of ROP has risen concurrently. The abnormal development of blood vessels in the retina is the cause of this illness. It occurs in two phases, phases 1 and 2. Most preterm infants weighing <1.5 kg need supplemental oxygen for respiratory support at birth. This leads to the initiation of phase 1 (vasoconstrictive phase). Phase 1 is characterized by loss of maternal-fetal connection and hyperoxia due to supplemental oxygen therapy.Oxygen's vasoconstrictive and obliterative action is primarily observed in developing retinal vessels. The inhibition of vascular endothelial growth factorfollows from this.Phase 2 (vasoproliferative phase) showsthe dilatation and tortuosity of the bigger existing vessels together with neovascularization and proliferation of new vessels into the vitreous when the baby is shifted from respiratory support to room air. Now, the retina gets hypoxic, where the retina becomes more metabolically active but is yetminimally vascularized, leading to VEGF-induced vasoproliferation, which might result in retinal detachment. Patients with ROP face the danger of loss of vision. If correct and quick treatment is not provided, they might land into permanent blindness. Yet, ROP remains one of themost preventablecauses of childhoodblindnessworldwide. Blindness caused by ROP can only be avoided if screening programs are readily available, pertinent, and appropriate.The initial stage in the therapy of ROP is the screening ofpremature neonates. Timely screening and management for ROP is important to avoidthis irreversible loss of vision. The treatment is based on the severity of the disease. Management may include pharmacological interventions like intravitrealand anti-vascular endothelial growth factor and non-pharmacological interventions like laser surgery, vitrectomy, and scleral buckling. We conducted athorough literature search of studies onpathogenesis, risk factors, classification, and various treatment options for retinopathy of prematurity in infants, using a mixture of pertinent keywords.Only those studies published in peer-reviewed journals between 2010 and 2023 and written in English were included.Duplicate studies, unavailable in full-text for free, or studies unrelated to our subject matter were excluded. After thoroughly evaluating the selected studies, the results were synthesized and presented narratively. This article sheds light on the pathogenesis of ROP, particularly its relation to oxygen use, screening, and potential therapeutic management of ROP. Today advances in screening techniques have improved the outcomes for infants with ROP. Still, ongoingresearch is needed to optimize management strategies and reduce the burden of this condition.

Genome-wide association identifies novel ROP risk loci in a multiethnic cohort

We conducted a genome-wide association study (GWAS) in a multiethnic cohort of 920 at-risk infants for retinopathy of prematurity (ROP), a major cause of childhood blindness, identifying 1 locus at genome-wide significance level (p < 5×10-8) and 9 with significance of p < 5×10-6 for ROP ≥ stage 3. The most significant locus, rs2058019, reached genome-wide significance within the full multiethnic cohort (p = 4.96×10-9); Hispanic and European Ancestry infants driving the association. The lead single nucleotide polymorphism (SNP) falls in an intronic region within the Glioma-associated oncogene family zinc finger 3 (GLI3) gene. Relevance for GLI3 and other top-associated genes to human ocular disease was substantiated through in-silico extension analyses, genetic risk score analysis and expression profiling in human donor eye tissues. Thus, we identify a novel locus at GLI3 with relevance to retinal biology, supporting genetic susceptibilities for ROP risk with possible variability by race and ethnicity.

Cell adhesion marker expression dynamics during fusion of the optic fissure

Tissue fusion is a critical process that is repeated in multiple contexts during embryonic development and shares common attributes to processes such as wound healing and metastasis. Ocular coloboma is a developmental eye disorder that presents as a physical gap in the ventral eye, and is a major cause of childhood blindness. Coloboma results from fusion failure between opposing ventral retinal epithelia, but there are major knowledge gaps in our understanding of this process at the molecular and cell behavioural levels. Here we catalogue the expression of cell adhesion proteins: N-cadherin, E-cadherin, R-cadherin, ZO-1, and the EMT transcriptional activator and cadherin regulator SNAI2, in the developing chicken embryonic eye. We find that fusion pioneer cells at the edges of the fusing optic fissure have unique and dynamic expression profiles for N-cad, E-cad and ZO-1, and that these are temporally preceded by expression of SNAI2. This highlights the unique properties of these cells and indicates that regulation of cell adhesion factors may be a critical process in optic fissure closure.

Mutation screening of the CYP1B1 gene reveals thirteen novel disease-causing variants in consanguineous Pakistani families causing primary congenital glaucoma.

BackgroundPrimary congenital glaucoma (PCG) is a heterogeneous rare recessively inherited disorder prevalent in regions with high consanguinity. Disease phenotype is associated with increased intra ocular pressure and is a major cause of childhood blindness. Sequence variations in Cytochrome P450 1B1 (CYP1B1) gene are a major cause of PCG. Current study was conducted to screen CYP1B1 gene in highly consanguineous PCG affected families from Pakistani population consistent with the autosomal recessive pattern of PCG inheritance.MethodsFor this study, patients and controls (clinically unaffected individuals of each family) from 25 consanguineous families belonging to Punjab, Baluchistan and Khyber Pakhtunkhwa, Pakistan were recruited through ophthalmologists. DNA was isolated from collected blood samples. Genetic screening of CYP1B1 gene was done for all enrolled families. In-silico analysis was performed to identify and predict the potential disease-causing variations.ResultsPathogenicity screening revealed sequence variants segregating with disease phenotype in homozygous or compound heterozygous form in eleven out of 25 analyzed families. We identified a total of sixteen disease causing variants among which five frameshift i.e., c.629dup (p.Gly211Argfs*13), c.287dup (p.Leu97Alafs*127), c.662dup (p.Arg222Profs*2), c.758_759insA (p.Val254Glyfs*73) and c.789dup (p.Leu264Alafs*63), two silent c.1314G>A, c.771T>G and six missense variations c.457C>G (p.Arg153Gly), c.516C>A (p.Ser172Arg), c.722T>A (p.Val241Glu), c.740T>A (p.Leu247Gln), c.1263T>A (p.Phe421Leu), and c.724G>C (p.Asp242His) are previously un reported. However two frameshift c.868dup (p.Arg290Profs*37), c.247del (p.Asp83Thrfs*12) and one missense variant c.732G>A (p.Met244Ile), is previously reported. Furthermore, six polymorphisms c.1347T>C, c.2244_2245insT, c.355G>T, c.1294G>C, c.1358A>G and c.142C>G were also identified. In the intronic region, a novel silent polymorphism i.e., g.35710_35711insT was found in homozygous state. All the newly detected disease-causing variants were negative in 96 ethnically matched controls.ConclusionAmong twenty-five screened families, eight families (PCG50, 52–54, 58, 59, 63 and 67) were segregating disease causing variants in recessive manner. Two families (PCG049 and PCG062) had compound heterozygosity. Our data confirms genetic heterogeneity of PCG in Pakistani population however we did not find molecular variants segregating with PCG in fifteen families in coding exons and intron-exon boundaries of CYP1B1 gene. Genetic counseling was provided to families to refrain from practicing consanguinity and perform premarital screening as a PCG control measure in upcoming generations.

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.

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.

Nongenetic risk factors for infantile cataracts: Systematic review of observational studies.

While infantile cataracts are a major cause of childhood blindness, risk factors remain unknown for approximately two-thirds of cases. We systematically searched electronic databases PubMed, Ovid MEDLINE, Web of Science, and Scopus, from inception through March 2018, to identify relevant cohort, case-control, cross-sectional studies, case reports, and case series. We also manually screened bibliographies and consulted with experts in the field to identify additional publications. We reviewed cross-sectional studies, case reports, and case series and provided a narrative summary of the reported potential risk factors. We evaluated methodological qualities of cohort and case-control studies, extracted relevant data, and described statistically significant associations with infant, maternal, and paternal characteristics. Quality assessment and data extraction were conducted by two reviewers independently. All discrepancies were discussed with the senior author and resolved by consensus. Overall, 110 publications were included in the review, 33 of which were cohort and case-control studies. Most of these studies (n= 32) used population-based data and had either excellent (n= 31) or good (n= 2) methodological quality. Nine studies reported statistically significant associations with infant characteristics (preterm birth, low birth weight), maternal occupations and diseases during pregnancy (untreated hypertension, infections), and paternal sociodemographics (younger age, employment in sawmill industry during pregnancy). This systematic literature review provided a comprehensive summary of the known nongenetic risk factors for infantile cataracts, identified gaps in the literature, and provided directions for future research. Studies identifying modifiable risk factors are warranted to design interventions aimed at primary prevention of infantile cataracts.

Evaluation of pro-oxidant antioxidant balance in retinopathy of prematurity.

Retinopathy of prematurity (RoP) is a vasoproliferative disorder caused by the abnormal development of retinal vessels in premature neonates. It is one of the major causes of childhood blindness, which is increasing with the increasing survival rate of low birth weight and premature neonates. This study has aimed to evaluate the role of oxidative stress and peroxidant antioxidant balance (PAB) in the pathogenesis and prediction of RoP. A total of 154 neonates weighing <1500 g admitted at the NICU of Ghaem Hospital, Mashhad, Iran, were enrolled in this cross-sectional study between 2018 and 2020. Blood samples were collected on the first day of birth to assess the peroxidant and antioxidant balance. The demographic, prenatal, and clinical course and postnatal problems were also recorded. The neonates were examined for RoP and divided into control (healthy) and affected (ROP) groups. There were significant differences between the two groups in gestational age, duration of oxygen therapy, and first and fifth minute Apgar score (P < 0.005). The mean PAB in infants without and with ROP was 19.79 HK (Hamidi-Koliakos) and 38.45 HK, respectively (P < 0.0001). Also, the mean PAB in neonates with ROP grade 1 and 2 was 36.69 HK and 45.53 HK, respectively (P = 0.002). According to our findings, the PAB level can be helpful in predicting ROP incidence. With increasing PAB, the possibility of ROP severity will increase.

Exome sequencing and electro-clinical features in pediatric patients with very early-onset retinal dystrophies: A cohort study.

Inherited retinal dystrophies (IRDs) are a major cause of childhood blindness. Timely diagnosis requires a high level of clinical suspicion from both neurologists and ophthalmologists and is increasingly important given recent advancements in gene therapy. We focused our study on genotype-phenotype associations in very early-onset forms of retinal dystrophy, the least well characterized and most challenging diagnostic subgroup. From January 12, 2015 to March 31, 2017, we prospectively performed whole exome sequencing targeted on the phenotype of non-syndromic IRDs and phenotype characterization in a cohort of 68 children affected by very early-onset inherited retinal dystrophies, defined by the onset before five years of age. Phenotype parameters included age at onset, clinical presentation, ophthalmic evaluation, electrophysiological patterns and clinical course. A genetically confirmed diagnosis was achieved in 50 out of 60 (83%) families. The median age at onset was 4 months (<6m in 70%, < 2y in 82% of the cases). Clinical presentation was associated with visual loss and nystagmus in the majority of patients. Three (CNGB3, CNGA3 and CACNA1F) out of 22 genes considered pathogenic in the cohort, accounted for 51% of all IRD's, all within the class of stationary IRDs. This study reports on the largest cohort of very early-onset retinal dystrophies, including a description of electroretinography patterns. The electro-clinical phenotype coupled with genetic diagnosis provided additional clues for child neurologists dealing with low vision and nystagmus in infancy. A high level of clinical suspicion improves the diagnosis with important implications for the future of the affected child.

Development of a quality improvement package for reducing sight-threatening retinopathy of prematurity

Purpose:With improving survival of preterm neonates, retinopathy of prematurity (ROP) is emerging as a major cause of childhood blindness. Incidence of sight-threatening ROP can be reduced by improving the quality of care provided to preterm neonates.Methods:This before-and-after study was designed to develop a need-based intervention package to improve knowledge, skills, and practices of those providing care for preterm neonates, and to evaluate the effectiveness of this package when combined with point-of-care quality improvement (POCQI) in improving survival of preterm neonates without sight-threatening ROP. The study had a formative component to assess baseline knowledge, skills, practices and attitudes, and to assess the needs of the healthcare staff to improve the care of preterm neonates. It was conducted in four special care neonatal units (SCNU) in the state of Madhya Pradesh in India.Results:A theory of change was developed to guide the development of study tools including needs assessment and educational package development. The educational package thus developed has been tested at the study sites in combination with POCQI projects driven by local teams of healthcare providers. The effectiveness of the interventions has been evaluated by collection of individual-level data on neonates admitted at the study sites.Conclusion:A multidimensional educational package integrated with system changes in the form of quality improvement (QI) endeavours driven by local context and needs were developed and evaluated in the project.

Epidemiology of childhood blindness: A community-based study in Bangladesh.

This study aimed to investigate the prevalence and causes of childhood blindness in a rural area of Bangladesh. We adopted a cross-sectional quantitative study design for this study, which was performed in three unions (sub-districts) located in Raiganj Upazila of the Sirajganj district in Bangladesh. Using a validated tool, a screening program was conducted at the household level. After initial screening, a team of ophthalmologists confirmed the diagnoses by clinical examinations. The prevalence of childhood blindness was observed to be 6.3 per 10,000 children, whereas the rate of uniocular blindness was 4.8 per 10,000 children. Congenital problems were the major causes of both uniocular and binocular blindness (uniocular blindness: 84% and binocular blindness: 92%). The whole globe was the site responsible for binocular blindness (28.0%, 95% confidence interval [CI]: 13.1, 47.7), whereas the cornea was responsible for uniocular blindness (57.8%, 95% CI: 35.3, 78.1). Childhood blindness is a public health problem in Bangladesh and is highly prevalent, regardless of sex. The major causes of childhood blindness are congenital.

Adenosine A2A receptor antagonists act at the hyperoxic phase to confer protection against retinopathy

BackgroundRetinopathy of prematurity (ROP) remains a major cause of childhood blindness and current laser photocoagulation and anti-VEGF antibody treatments are associated with reduced peripheral vision and possible delayed development of retinal vasculatures and neurons. In this study, we advanced the translational potential of adenosine A2A receptor (A2AR) antagonists as a novel therapeutic strategy for selectively controlling pathological retinal neovascularization in oxygen-induced retinopathy (OIR) model of ROP.MethodsDeveloping C57BL/6 mice were exposed to 75% oxygen from postnatal (P) day 7 to P12 and to room air from P12 to P17 and treated with KW6002 or vehicle at different postnatal developmental stages. Retinal vascularization was examined by whole-mount fluorescence and cross-sectional hematoxylin-eosin staining. Cellular proliferation, astrocyte and microglial activation, and tip cell function were investigated by isolectin staining and immunohistochemistry. Apoptosis was analyzed by TUNEL assay. The effects of oxygen exposure and KW6002 treatment were analyzed by two-way ANOVA or Kruskal-Wallis test or independent Student’s t-test or Mann-Whitney U test.ResultsThe A2AR antagonist KW6002 (P7-P17) did not affect normal postnatal development of retinal vasculature, but selectively reduced avascular areas and neovascularization, with the reduced cellular apoptosis and proliferation, and enhanced astrocyte and tip cell functions in OIR. Importantly, contrary to our prediction that A2AR antagonists were most effective at the hypoxic phase with aberrantly increased adenosine-A2AR signaling, we discovered that the A2AR antagonist KW6002 mainly acted at the hyperoxic phase to confer protection against OIR as KW6002 treatment at P7-P12 (but not P12-P17) conferred protection against OIR; this protection was observed as early as P9 with reduced avascular areas and reduced cellular apoptosis and reversal of eNOS mRNA down-regulation in retina of OIR.ConclusionsAs ROP being a biphasic disease, our identification of the hyperoxic phase as the effective window, together with selective and robust protection against pathological (but not physiological) angiogenesis, elevates A2AR antagonists as a novel therapeutic strategy for ROP treatment.

The cellular bases of choroid fissure formation and closure

Defects in choroid fissure (CF) formation and closure lead to coloboma, a major cause of childhood blindness. Despite genetic advances, the cellular defects underlying coloboma remain poorly elucidated due to our limited understanding of normal CF morphogenesis. We address this deficit by conducting high-resolution spatio-temporal analyses of CF formation and closure in the chick, mouse and fish. We show that a small ventral midline invagination initiates CF formation in the medial-proximal optic cup, subsequently extending it dorsally toward the lens, and proximally into the optic stalk. Unlike previously supposed, the optic disc does not form solely as a result of this invagination. Morphogenetic events that alter the shape of the proximal optic cup also direct clusters of outer layer and optic stalk cells to form dorsal optic disc. A cross-species comparison suggests that CF closure can be accomplished by breaking down basement membranes (BM) along the CF margins, and by establishing BM continuity along the dorsal and ventral surfaces of the CF. CF closure is subsequently accomplished via two distinct mechanisms: tissue fusion or the intercalation of various tissues into the inter-CF space. We identify several novel cell behaviors that underlie CF fusion, many of which involve remodeling of the retinal epithelium. In addition to BM disruption, these include NCAD downregulation along the SOX2+ retinal CF margin, and the protrusion or movement of partially polarized retinal cells into the inter-CF space to mediate fusion. Proximally, the inter-CF space does not fuse or narrow and is instead loosely packed with migrating SOX2+/PAX2+/Vimentin+ astrocytes until it is closed by the outgoing optic nerve. Taken together, our results highlight distinct proximal-distal differences in CF morphogenesis and closure and establish detailed cellular models that can be utilized for understanding the genetic bases of coloboma.

Outcome of Paediatric Cataract Surgery at Tilganga Institute of Ophthalmology, Nepal

Introduction: Paediatric cataract and aphakia are still a major cause of childhood blindness in developing world due to lack of advanced technology. In developing countries like Nepal, many children still present late due to lack of awareness and financial constraints.Objectives: The objective of this study was to determine the outcome of paediatric cataract surgery in a tertiary eye care centre in Nepal.Methodology: A hospital based prospective, observational study taking 42 patients (77 eyes) aged ≦15 years diagnosed with paediatric cataract were enrolled during a period of 1 year ( Jan 2011 - Jan 2012) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. The patients underwent either: a) Lens aspiration + Primary posterior capsulotomy (PPC) + Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + Intra-ocular lens (IOL); c) Lens Aspiration + IOL. Post-operatively optical ± amblyopia correction. Statistical analysis was carried out by using STATA 9.0. The association of changes in the vision of eyes before and after surgery was analyzed by using generalization of McNemar's test (Stuart-Maxwell test). A pvalue of &lt; 0.05 was considered for the statistical significance. Institutional Ethics Board approval was obtained from the institutional review committee (IRC) of National Academy Medical Sciences ( NAMS ).Results: Mean age of patients was 4.46 yrs ± 4.32(SD), range from (15 days -12 yrs); Male : Female: 22 (52%)/20 (48%); 35 (83%) patients had bilateral cataract and 7(17%) had unilateral cataract. Morphologically, the most common type of cataract was total cataract (27/32%). Post-operatively, a statistically significant improvement in vision was there in all the eyes ( p value : &lt; 0.0001) . Visual axis opacification was the most common post- operative complication seen in 20(26% ) of total eyes by the end of 6 months.Conclusion: Good visual outcome in paediatric cataract surgery can be obtained in developing countries like Nepal with minimal intra and post-op complications. BJHS 2018;3(1)5 : 331-337

Retinopathy of prematurity: A major review and situation analysis in Egypt

Retinopathy of prematurity (ROP) remains a major cause of childhood blindness in developing countries. As childhood and neonatal mortality in Egypt has shown tremendous improvement over the past two decades, it is expected to encounter an increasing number of cases of blindness from ROP in surviving infants unless strict guidelines and cooperation between different involved departments are explicitly set. In this review article, the author highlights the studies conducted and published risk factors, recommends protocols for early diagnosis, and describes management strategies to lessen or prevent blindness related to ROP.

Causes of childhood blindness in Ghana: results from a blind school survey in Upper West Region, Ghana, and review of the literature.

Data on childhood blindness in Ghana are limited. The objectives of this study were to determine the major causes of childhood blindness and severe visual impairment (SVI) at Wa Methodist School for the Blind in Northern Ghana, and to compare our results to those published from other studies conducted in Ghana. In this retrospective study, data from an eye screening at Wa Methodist School in November 2014 were coded according to the World Health Organization/Prevention of Blindness standardized reporting methodology. Causes of blindness/SVI were categorized anatomically and etiologically, and were compared to previously published studies. Of 190 students screened, the major anatomical causes of blindness/SVI were corneal scar/phthisis bulbi (CS/PB) (n=28, 15%) and optic atrophy (n=23, 12%). The major etiological causes of blindness/SVI were unknown (n=114, 60%). Eighty-three (44%) students became blind before age one year. Of four published blind school surveys conducted in Ghana, CS/PB was the most common anatomical cause of childhood blindness. Over time, the prevalence of CS/PB within blind schools decreased in the north and increased in the south. Measles-associated visual loss decreased from 52% in 1987 to 10% in 2014 at Wa Methodist School. In a blind school in northern Ghana, CS/PB was the major anatomical cause of childhood blindness/SVI. While CS/PB has been the most common anatomical cause of childhood blindness reported in Ghana, there may be regional changes in its prevalence over time. Being able to identify regional differences may guide future public health strategies to target specific causes.

Primary congenital and developmental glaucomas.

Glaucoma is the leading cause of irreversible blindness worldwide. Although most glaucoma patients are elderly, congenital glaucoma and glaucomas of childhood are also important causes of visual disability. Primary congenital glaucoma (PCG) is isolated, non-syndromic glaucoma that occurs in the first three years of life and is a major cause of childhood blindness. Other early-onset glaucomas may arise secondary to developmental abnormalities, such as glaucomas that occur with aniridia or as part of Axenfeld-Rieger syndrome. Congenital and childhood glaucomas have strong genetic bases and disease-causing mutations have been discovered in several genes. Mutations in three genes (CYP1B1, LTBP2, TEK) have been reported in PCG patients. Axenfeld-Rieger syndrome is caused by mutations in PITX2 or FOXC1 and aniridia is caused by PAX6 mutations. This review discusses the roles of these genes in primary congenital glaucoma and glaucomas of childhood.

Toward a severity index for ROP: An unsupervised approach.

Retinopathy of prematurity (ROP) is a disease affecting low birth-weight infants and is the major cause of childhood blindness. Although accurate diagnosis is important, there is a high variability among expert decisions mostly due to subjective thresholds. Existing work focused on automated diagnosis of ROP. In this study, we construct a continuous severity index as an alternative to discrete classification. We follow an unsupervised approach by performing nonlinear dimensionality reduction. Instead of extracting several statistics of image features, each image is represented by the probability distribution of its features. The distance between distributions are then used in manifold learning methods as the distance between samples. The experiments are carried out on a dataset of 104 wide-angle retinal images. The results are promising and they reflect the challenges of the discrete classification.