Ocular Outcomes Research Articles

Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial

Despite increasing worldwide use of anti-vascular endothelial growth factor agents for treatment of retinopathy of prematurity (ROP), there are few data on their ocular efficacy, the appropriate drug and dose, the need for retreatment, and the possibility of long-term systemic effects. We evaluated the efficacy and safety of intravitreal ranibizumab compared with laser therapy in treatment of ROP. This randomised, open-label, superiority multicentre, three-arm, parallel group trial was done in 87 neonatal and ophthalmic centres in 26 countries. We screened infants with birthweight less than 1500 g who met criteria for treatment for retinopathy, and randomised patients equally (1:1:1) to receive a single bilateral intravitreal dose of ranibizumab 0·2 mg or ranibizumab 0·1 mg, or laser therapy. Individuals were stratified by disease zone and geographical region using computer interactive response technology. The primary outcome was survival with no active retinopathy, no unfavourable structural outcomes, or need for a different treatment modality at or before 24 weeks (two-sided α=0·05 for superiority of ranibizumab 0·2 mg against laser therapy). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02375971. Between Dec 31, 2015, and June 29, 2017, 225 participants (ranibizumab 0·2 mg n=74, ranibizumab 0·1 mg n=77, laser therapy n=74) were randomly assigned. Seven were withdrawn before treatment (n=1, n=1, n=5, respectively) and 17 did not complete follow-up to 24 weeks, including four deaths in each group. 214 infants were assessed for the primary outcome (n=70, n=76, n=68, respectively). Treatment success occurred in 56 (80%) of 70 infants receiving ranibizumab 0·2 mg compared with 57 (75%) of 76 infants receiving ranibizumab 0·1 mg and 45 (66%) of 68 infants after laser therapy. Using a hierarchical testing strategy, compared with laser therapy the odds ratio (OR) of treatment success following ranibizumab 0·2 mg was 2·19 (95% Cl 0·99-4·82, p=0·051), and following ranibizumab 0·1 mg was 1·57 (95% Cl 0·76-3·26); for ranibizumab 0·2 mg compared with 0·1 mg the OR was 1·35 (95% Cl 0·61-2·98). One infant had an unfavourable structural outcome following ranibizumab 0·2 mg, compared with five following ranibizumab 0·1 mg and seven after laser therapy. Death, serious and non-serious systemic adverse events, and ocular adverse events were evenly distributed between the three groups. In the treatment of ROP, ranibizumab 0·2 mg might be superior to laser therapy, with fewer unfavourable ocular outcomes than laser therapy and with an acceptable 24-week safety profile. Novartis.

Risk factors and outcomes of patients with ocular involvement of candidemia.

BackgroundOcular involvement of candidemia can result in serious complications, including vision loss. This study investigated the risk factors for ocular involvement in patients with candidemia and the outcomes of treatment.MethodsEpisodes of candidemia in hospitalized adults who underwent ophthalmic examinations within 2 weeks of candidemia onset between January 2014 and May 2017 were retrospectively reviewed. Their demographic characteristics, antifungal treatments, and visual outcomes were evaluated.ResultsDuring the study period, 438 adults were diagnosed with candidemia, with 275 (62.8%) undergoing ophthalmic examinations within 2 weeks. Of these 275 patients, 59 (21.5%) had fundoscopic abnormalities suggestive of ocular involvement, including 51 with chorioretinitis and eight with Candida endophthalmitis. Eleven patients were symptomatic. Persistent candidemia (adjusted odd ratio [aOR], 2.55; 95% confidence interval [CI], 1.29–5.08; P = 0.01), neutropenia during the preceding 2 weeks (aOR, 2.92; 95% CI, 1.14–7.53; P = 0.03), and C. albicans infection (aOR, 2.15; 95% CI, 1.09–4.24; P = 0.03) were independently associated with ocular involvement. Among the 24 patients with neutropenia, 41.7% had ocular involvements at the initial examination. Ophthalmologic examination even before the neutrophil recovery was positive in one-third of neutropenic patients. Out of the 37 patients in whom ocular outcomes after 6 weeks were available, 35 patients showed favorable or stable fundoscopic findings. Two patients had decreased visual acuity despite the stable fundoscopic finding.ConclusionNeutropenia within two weeks of candidemia was a risk factor for ocular involvement. More than 80 percent of patients with ocular involvements were asymptomatic, emphasizing the importance of routine ophthalmic examinations. The median 6 weeks of systemic antifungal treatment resulted in favorable outcomes in 89.2% of patients.

Pathogenic variants in PLOD3 result in a Stickler syndrome-like connective tissue disorder with vascular complications

BackgroundPathogenic PLOD3 variants cause a connective tissue disorder (CTD) that has been described rarely. We further characterise this CTD and propose a clinical diagnostic label to improve recognition and diagnosis...

Two-year ocular and neurodevelopmental outcomes among infants treated for retinopathy of prematurity using a commercial claims database

Two-year ocular and neurodevelopmental outcomes among infants treated for retinopathy of prematurity using a commercial claims database

Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism.

Laser-assisted in situ keratomileusis (LASIK) is the most commonly performed laser refractive surgical technique worldwide for the treatment of myopia and myopic astigmatism. In recent years, small incision lenticule extraction (SMILE) has emerged as a promising alternative to LASIK, requiring only a single femtosecond laser to create an intrastromal lenticule, which is then removed via a small incision. The technique obviates the need for a corneal flap. A number of published studies have compared the two techniques in terms of visual, refractive and ocular surface outcomes. This review compares the clinical outcomes between LASIK and SMILE in treating myopia and myopic astigmatism based on studies published in the last 5 years. Twenty-two studies were included, all of which were observational in nature. Results suggest that the two techniques have comparable visual outcomes in terms of safety, efficacy and predictability, although recovery in visual acuity may be slower in SMILE-treated than LASIK-treated eyes. SMILE is found to result in less severe postoperative dry eye symptoms and faster recovery of corneal sensitivity than LASIK. It is important to note, however, that the SMILE technique is limited by the lack of a cyclotorsion-compensation system and option for customized treatment profile. The heterogeneity of results in this review may be attributable to the use of different LASIK platforms in different studies. Few studies compared the outcomes regarding severity of myopia. Future prospective randomized controlled trials with a larger sample size and longer follow-up period will be highly beneficial for progress in this field.

Tumor Control and Visual Acuity Outcomes in Vitreoretinal Lymphoma with and without Sub–Retinal Pigment Epithelium Infiltration: Analysis of 125 Eyes of 70 Patients at a Single Ocular Oncology Center

To investigate outcomes in vitreoretinal lymphoma (VRL) presenting with or without sub-retinal pigment epithelial (sub-RPE) infiltration. Retrospective, comparative analysis. Patients with VRL at a single center from January 1, 1984, through July 30,2018. Record review was conducted for clinical features, treatments, and outcomes of tumor control, visual acuity (VA), and death. Ocular tumor control and VA outcome. The study involved 168 eyes of 95 patients with VRL, of which 45 (27%) eyes of 32 patients had sub-RPE infiltration. Comparison (of patients with vs. without sub-RPE infiltration) showed similar presenting features of mean patient age (65 vs. 68 years, P= 0.30), percentage of males (53% vs. 56%, P= 0.83), white race (84% vs. 87%, P= 0.77), bilateral ocular involvement (78% vs. 75%, P= 0.80), and VA of 20/40 or better (40% vs. 50%, P= 0.30), 20/50 to 20/200 (42% vs. 31%, P= 0.20), or worse than 20/200 (18% vs. 19%, P= 0.99). Lymphoma subtype was diffuse large B cell (59% vs. 52%) or unspecified (41% vs. 44%, P= 0.85). Follow-up data were available for 125 eyes of 70 patients. Overall treatment included systemic chemotherapy (53% vs. 64%, P= 0.29), intravitreal chemotherapy (59% vs. 28%, P= 0.005), and external beam radiotherapy (59% vs. 94%, P < 0.001). Initial ocular tumor control occurred (91% vs. 94%, P= 0.68) with subsequent recurrence (35% vs. 17%, P= 0.07). Outcomes at final follow-up (mean 24 vs. 25 months, P= 0.82) revealed ocular tumor complete regression (68% vs. 86%, P= 0.03), partial regression (3% vs. 7%, P= 0.44), or active persistent or recurrent disease (29% vs. 7%, P= 0.002). Final VA was 20/40 or better (39% vs. 53%, P= 0.18), 20/50 to 20/200 (26% vs. 34%, P= 0.53), or worse than 20/200 (34% vs. 13%, P= 0.007). Vitreoretinal lymphoma was associated with central nervous system lymphoma (41% vs. 59%, P= 0.13) or systemic lymphoma (16% vs. 21%, P= 0.60). Death occurred (63% vs. 54%, P= 0.51) at mean age (69 vs. 69 years, P= 0.94). Sub-RPE infiltration in VRL is associated with more persistent or recurrent ocular tumor and poorer VA outcome, but no difference in frequency of central nervous system/systemic lymphoma or death. Further studies are required to determine whether earlier, more aggressive, or prolonged ocular therapy for patients with VRL presenting with sub-RPE infiltration could improve these factors.

Ocular biometry and refractive outcomes using two swept-source optical coherence tomography-based biometers with segmental or equivalent refractive indices

This study compared the axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), mean anterior corneal radius of curvature (Rm), and postoperative refractive outcomes obtained from two different swept-source optical coherence biometers, the ARGOS (Movu, Aichi, Japan), which uses the segmental refractive index for each segment, and the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany), which uses an equivalent refractive index for the entire eye. One hundred and six eyes of 106 patients with cataracts were included. The refractive outcomes using the Barrett Universal II, Haigis, Hoffer Q, and SRK/T formulas were evaluated. The mean AL, CCT, ACD, and Rm differed significantly (P < 0.001) with the IOLMaster 700 (25.22 mm, 559 µm, 3.23 mm, and 7.69 mm) compared with the ARGOS (25.14 mm, 533 µm, 3.33 mm, and 7.66 mm). The mean LTs did not differ significantly. The percentages of eyes within ±0.50 and ±1.00 diopter of the predicted refraction did not differ significantly (P > 0.05). The accuracy of the intraocular lens power calculations was clinically acceptable with both biometers, although the ocular biometry using these two biometers exhibited certain differences.

Clinical features of Streptococcus pyogenes keratitis: Case series

PurposeTo characterize the risk factors, clinical presentations, management, outcomes, and microbiological properties of Streptococcus pyogenes keratitis. MethodsEight culture-proven cases (eight eyes) of S. pyogenes keratitis were diagnosed and treated between 2008 and 2018 at the University of Pittsburgh Medical Center (UPMC). Medical records were available for six patients, and these were reviewed to identify demographic information, systemic and ocular history, clinical presentations, antibiotic sensitivity, treatments, and outcomes of S. pyogenes isolates. ResultsOf the six charts reviewed, the median patient age was 67 years and all patients were female. Four patients had a history of cataract extraction more than one year prior to presentation, one had a history of improper contact lens use, and one had basement membrane dystrophy. Two patients, who also happened to have the most serious medical comorbidities, presented with corneal perforation on initial examination. The median follow-up length was 90.5 days. Visual outcomes varied greatly between patients. Three patients had visual acuity ranging from 20/30 to 20/70, while the two patients with corneal perforation had a final visual acuity of light perception, and one patient was lost to follow-up. Five of six isolates were susceptible to fluoroquinolones and all isolates were susceptible to cefazolin. ConclusionsS. pyogenes represented an uncommon ocular pathogen at UPMC eye clinic. However, if left untreated, this infection resulted in severe ocular morbidity. The majority of patients had a benign ocular history, suggesting that S. pyogenes can infect healthy corneas in immunocompetent patients. The majority of isolates were susceptible to cefazolin and fluoroquinolones.

Neurodevelopmental Outcomes after Intravitreal Bevacizumab Therapy for Retinopathy of Prematurity: A Prospective Case-Control Study

To evaluate the neurodevelopmental and ocular developmental outcomes in premature children who have undergone intravitreal bevacizumab injection (IVB) for treatment of type 1 retinopathy of prematurity (ROP). Prospective case-control study. We enrolled 3 groups of premature patients: premature children who had no history of ROP (group 0), premature children with history of ROP without treatment (group 1), and premature children with ROP who had received a single IVB (0.625 mg; group 2). Ocular developmental assessment, including cycloplegic refractometry, axial length, Cardiff acuity, and neurodevelopmental assessment via the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), were performed at 1 to 3 years of age and were compared between groups. Ocular developmental outcomes and Bayley III scores. A total of 148 patients (85 boys and 63 girls) were included. The mean age at assessment was 1.49±0.59 years. Group 0 patients demonstrated significantly higher gestational age (GA), birth weight, and Apgar scores compared with group 1 and 2 patients. There were no significant differences between groups 1 and 2 in demographics or systemic risk factors except for lower GA in group 2. The cylindrical power was significantly larger in groups 1 and 2 compared with group 0. The spherical equivalent was significantly more myopic and the Cardiff acuity was significantly poorer in group 2 than in group 0. There were no significant differences between groups 1 and 2 in refractive status, axial length, or Cardiff acuity. Neurodevelopmental assessment using Bayley III showed no significant difference among the 3 groups in any aspect after adjusting for GA and other systemic risk factors. The risks for poor neurodevelopmental outcomes also were not significantly different. At the mean age of 1.5 years, children with prior history of IVB (group 2) showed similar refractive and visual outcomes and similar neurodevelopmental outcomes compared with premature patients with ROP without requirement of treatment (group 1), although there is a possibility that a small but clinically significant difference may not have been detected in the current study.

371 Retrospective Analysis of Ocular Involvement and Outcomes following a Novel Approach to Application of Amniotic Membrane Graft in the Management of Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis at a Level One Burn Center

371 Retrospective Analysis of Ocular Involvement and Outcomes following a Novel Approach to Application of Amniotic Membrane Graft in the Management of Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis at a Level One Burn Center

The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review.

Despite their established disinfection and safety benefits, the use of hydrogen peroxide (H2O2) lens care systems among today's wearers of reusable contact lenses remains low in comparison with multipurpose solution (MPS) use. Multipurpose solution systems, however, present several potential drawbacks that may impact patient outcomes, including the use of chemical preservatives for disinfection, biocompatibility issues, and challenges with respect to lens care compliance. Given their unique composition and mechanism of action, one-step H2O2 systems offer the opportunity to avoid many of the challenges associated with MPS use. This article reviews the evolution of H2O2 lens care systems and examines the current scientific and clinical evidence regarding the relative ease of use, lens and tissue compatibility, disinfection efficacy, and ocular surface safety of H2O2 systems. Evaluation of the available data indicates that in comparison with MPS, one-step H2O2 systems tend to promote more favorable compliance, efficacy, comfort, and ocular surface outcomes for a wide range of contact lens-wearing patients. Based on the current published evidence, the authors recommend that eye care practitioners consider making one-step H2O2 systems their first-line contact lens care recommendation for most wearers of reusable lenses.

Causes and surgical treatment of diplopia and strabismus secondary to myasthenia gravis

Abstract Objective To present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG). Material and method A retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Resolution of diplopia and/or ocular deviation in primary and reading gaze was considered a good outcome at the end of follow-up. Results A total of 14 cases were included. The mean age of the sample was 55.64 years, of which 9 were women, and 10 cases were bilateral. The diagnosis was made by ophthalmologists in 4 cases. The initial diagnoses were diverse: bilateral cranial third nerve palsy in 3, unilateral third nerve palsy in 1, superior or inferior rectus palsy in 3, sixth nerve palsy in 2, fourth nerve palsy in 1, exotropia in 3 and esotropia in 1. Diplopia was presented in 14 cases and 9 associated ptosis. The different types of strabismus were horizontal ocular deviation in 11 cases: 8 with exotropia, and 4 with vertical deviation. Strabismus surgery was performed in 4 cases that did not respond to medical treatment, with a good final outcome. Pharmacological treatment resolved diplopia in 6 cases, and prisms in one. Ptosis surgery was only necessary in one patient. Outcome was favorable in 78.57% at the end of follow-up. Conclusion Acute onset diplopia caused by strabismus with variable angle or oculomotor palsy, associated or not with a ptosis can indicate MG. There were favorable outcomes with strabismus surgery. Pharmacological treatment did not resolve the diplopia in all cases.

Ocular outcomes and comorbidities in preterm infants enrolled for retinopathy of prematurity screening: A cohort study from western India

BACKGROUND:Retinopathy of prematurity (ROP) is emerging as an important cause of childhood blindness in middle-income countries such as India. Although blindness can be prevented in most cases with timely screening and treatment, certain ocular comorbidities can lead to visual impairment. We evaluated and compared 1-year visual, refractive, and structural outcomes and comorbidities in three subsets of preterm infants enrolled for screening of ROP.SUBJECTS AND METHODS:Preterm children enrolled in the hospital's ROP screening program and with diagnosis of no ROP, mild ROP, or severe ROP were followed at 1 year of age to evaluate and compare visual, refractive, and structural outcomes as well as the presence of ocular comorbidities. Risk of poor outcome was calculated in children with mild and severe ROP reference population being children without ROP.RESULTS:Eyes with severe ROP were at highest risk of poor visual (risk ratio [RR]: 3.5, P < 0.001), refractive (RR: 45, P < 0.001), and structural (RR: 11, P = 0.006) outcome as well as ocular comorbidities (RR 11, P < 0.001). Eyes with mild ROP were at higher risk of myopia (RR: 11, P = 0.06) and ocular comorbidities (RR: 4, P = 0.04). Sixteen (16%) of the eyes without ROP developed poor visual outcome.CONCLUSION:Eyes with severe ROP are at highest risk of poor ocular outcomes and comorbidities and need a long-term follow-up. Eyes which do not develop ROP can have poor visual outcome and need to be assessed within the 1st year of life.

Ocular Manifestations, Treatment Outcome and Clinical Course of Infective Keratitis of Keratitis-Ichthyosis-Deafness Syndrome

Ocular Manifestations, Treatment Outcome and Clinical Course of Infective Keratitis of Keratitis-Ichthyosis-Deafness Syndrome

Causas y tratamiento quirúrgico de la diplopía y estrabismo en la miastenia gravis

ObjectiveTo present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG). Material and methodA retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Resolution of diplopia and/or ocular deviation in primary and reading gaze was considered a good outcome at the end of follow-up. ResultsA total of 14 cases were included. The mean age of the sample was 55.64 years, of which 9 were women, and 10 cases were bilateral. The diagnosis was made by ophthalmologists in 4 cases. The initial diagnoses were diverse: bilateral cranial third nerve palsy in 3, unilateral third nerve palsy in 1, superior or inferior rectus palsy in 3, sixth nerve palsy in 2, fourth nerve palsy in 1, exotropia in 3 and esotropia in 1. Diplopia was presented in 14 cases and 9 associated ptosis. The different types of strabismus were horizontal ocular deviation in 11 cases: 8 with exotropia, and 4 with vertical deviation. Strabismus surgery was performed in 4 cases that did not respond to medical treatment, with a good final outcome. Pharmacological treatment resolved diplopia in 6 cases, and prisms in one. Ptosis surgery was only necessary in one patient. Outcome was favourable in 78.57% at the end of follow-up. ConclusionAcute onset diplopia caused by strabismus with variable angle or oculomotor palsy, associated or not with a ptosis can indicate MG. There were favourable outcomes with strabismus surgery. Pharmacological treatment did not resolve the diplopia in all cases.

Optic Disc Coloboma in children – prevalence, clinical characteristics and associated morbidity

The aim of the study was to report prevalence, ocular outcome, neurological characteristics, cognitive and behavioural problems in children with optic disc coloboma (ODC). This was a population-based, cross-sectional study of 31 children between 2 and 18years of age diagnosed with ODC. The children were part of a larger cohort of 184 children with congenital optic disc malformations. Clinical ophthalmological examinations, neurological assessments, behavioural and developmental screening were performed. The prevalence of ODC was 8.9/100000 children. Of the 31 patients, 18 had unilateral ODC (p=0.21). The best-corrected visual acuity (BCVA) in the ODC eye ranged from blindness to 1.3 (median 0.3). BCVA was 0.82 in eyes with an isolated ODC (range 0.4-1.3) and 0.15 (range 0-0.5) in eyes with concurrent macular involvement (p<0.0001). Nystagmus was observed more often in patients with bilateral ODC (9/13 versus 3/17, p=0.004). Two patients had retinal detachment. Behavioural/psychological screening was performed in 21 patients with severe deficits identified in six cases. Intellectual disability was present in seven patients. Neurological dysfunction was diagnosed in 8/22 cases. All of the above children had already systemic diagnoses before the ODC diagnosis was made. ODC was the second most common optic disc malformation in this cohort after optic nerve hypoplasia. The children had a wide range of ocular comorbidity. An isolated ODC without macular involvement was not associated with profound vision loss. The ability of screening in the regular child care centres to diagnose extraocular comorbidities was very good and referral to a paediatrician appears redundant in cases of normal development.

NEW ULTRA-WIDE-FIELD ANGIOGRAPHIC GRADING SCHEME FOR RADIATION RETINOPATHY AFTER IODINE-125 BRACHYTHERAPY FOR UVEAL MELANOMA.

Radiation retinopathy remains incompletely characterized and may cause severe vision loss. Ultra-wide-field fluorescein angiography provides a pan-fundus view of vascular alterations caused by radiation treatment and may predict visual and ocular outcomes. We have developed a grading scheme to describe pan-fundus severity and to predict the progression of radiation retinopathy in patients treated for uveal melanoma with iodine-125 brachytherapy. A retrospective review of patients treated with standard iodine-125 brachytherapy for uveal melanoma at the Ophthalmic Oncology Center at the University of California, Los Angeles, who had undergone both baseline and postbrachytherapy ultra-wide-field fluorescein angiography. A grading scheme was devised based on observations of vascular leakage, retinal perfusion status, and retinal proliferation. The correlation of grade severity with patient characteristics, tumor features, visual acuity, optical coherence tomography findings, and neovascular glaucoma was measured with chi-square and one-way analysis of variance analyses. Sixty-seven patients were identified for review. Consistent wide-field angiographic patterns after brachytherapy were observed and graded as follows: Grade 0: normal; Grade 1: late foveal leakage; Grade 2: late peripheral leakage; Grade 3: presence of nonperfusion; and Grade 4: retinal neovascularization. Six eyes (8.9%) were Grade 0; 16 (23.8%) were Grade 1; 25 (37.3%) were Grade 2; 16 (23.4%) were Grade 3; and 4 (6.0%) were Grade 4. Higher grade radiation severity correlated significantly with duration of follow-up (P < 0.02); younger age (P = 0.035); worse visual acuity (P = 0.001); cystoid macular edema or atrophy on optical coherence tomography (P < 0.0001); and neovascular glaucoma (P = 0.003). Wide-field fluorescein angiography revealed distinct fundus-wide patterns of vascular damage, which were progressive in nature in eyes treated with iodine-125 brachytherapy for uveal melanoma and correlated with signs of progressive vascular injury. This grading scheme may have prognostic value to predict the progression of radiation retinopathy and to prognosticate visual outcomes in patients undergoing brachytherapy.

Clinical observation of Zhen’ai needling method in Nei Jing (Classic of Internal Medicine) on improving quality of life in patients with allergic rhinitis

To observe the effect of Zhen’ai needling method in Nei Jing (Classic of Internal Medicine) on quality of life in patients with allergic rhinitis (AR). A total of 99 patients with AR who met the inclusion criteria were randomized into a conventional needling group (51 cases) and a Zhen’ai needling group (48 cases). The conventional needling group was treated with acupuncture at Zusanli (ST 36), Hegu (LI 4), Juliao (ST 3), Yingxiang (LI 20), Yintang (GV 29), Shangxing (GV 23) and Baihui (GV 20). The Zhen’ai needling group added acupoints of Zhen’ai needling method {Lieque (LU 7), Shanglianquan [Extra, located at 1 cun above Lianquan (CV 23)] and Tianrong (SI 17)} in addition to points in the conventional needling group. The needles were retained for 30 min. The treatment was performed twice a week. All patients were assessed by total nasal symptom score (TNSS), total ocular symptom score (TOSS) and sino-nasal outcome test-20 (SNOT-20) before and after 15 treatments to evaluate the quality of life. The clinical efficacy was evaluated after 15 treatments. During the treatment, 8 cases dropped out in the conventional needling group and 7 cases in the Zhen’ai needling group. There were no significant differences in TNSS, TOSS and SNOT-20 scores between the two groups before treatment (all P>0.05). After treatment, the total effective rate of the Zhen’ai needling group was 92.7%, versus 88.4% in the conventional needling group. There was no significant difference between the two groups (P>0.05). After treatment, there were no significant differences between the two groups in TNSS and TOSS scores (both P>0.05). The SNOT-20 score of the Zhen’ai needling group was lower than that of the conventional needling group, and the difference was statistically significant (P<0.05). There were statistical differences between the two groups in the scores of cough and nasal reflux (to the throat) of the NOT-20 scale (both P<0.05). Both Zhen’ai needling method and conventional acupuncture are effective in the treatment of AR. Zhen’ai needling method has a better effect than conventional acupuncture in improving cough and nasal reflux (to the throat) in AR patients.

353 Comparison of Ocular Outcomes in Pediatric Posterior Fossa Tumors

353 Comparison of Ocular Outcomes in Pediatric Posterior Fossa Tumors

Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy

BackgroundThere is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era.MethodsChildren with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated.ResultsOf the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema.ConclusionOne third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data.