Ophthalmology

Do we need India-specific retinopathy of prematurity screening guidelines?
Santosh G Honavar

Indian Journal of Ophthalmology 2019 67(6):711-716

The changing scenario of retinopathy of prematurity in middle and low income countries: Unique solutions for unique problems
Anand Vinekar, Mangat Dogra, Raj Vardhan Azad, Clare Gilbert, Lingam Gopal, Michael Trese

Indian Journal of Ophthalmology 2019 67(6):717-719

Children – Not just small adults!
Lingam Gopal

Indian Journal of Ophthalmology 2019 67(6):720-721

The Indian Retinopathy of Prematurity (iROP) society: Challenges ahead
Anand Vinekar, Raj Vardhan Azad

Indian Journal of Ophthalmology 2019 67(6):722-722

Imaging the pediatric retina – Where are we headed?
Sabyasachi Sengupta

Indian Journal of Ophthalmology 2019 67(6):723-724

Retinal elevation in an infant
Antonio N Yaghy, Lauren A Dalvin, Carol L Shields

Indian Journal of Ophthalmology 2019 67(6):725-725

India to gear up to the challenge of “third epidemic” of retinopathy of prematurity in the world
P Sai Kiranmayee, Viswanath Kalluri

Indian Journal of Ophthalmology 2019 67(6):726-731

Many of the causes of childhood blindness are avoidable, being either preventable or treatable. Retinopathy of prematurity (ROP) remains one of the most preventable causes of childhood blindness worldwide. Currently, India is facing the third epidemic of ROP. In India, the health system involving the mother and child health services needs to be strengthened with a policy to cover the existing inadequacies in neonatal care and implementation of program covering newborn, especially premature. The access, availability, and affordability of services related to the care of premature babies need strengthening in India. ROP-trained ophthalmologists and neonatal care pediatricians and a professional togetherness is a big issue. Inadequacies in awareness of ROP among the parents, health care workers, counsellors add up to the problem. Community-based health workers such as Accredited Social Health Activist are a good dependable force in India and are needed to be trained in awareness and establishing a proper identification for prompt referral. ROP prevention needs a multidisciplinary team approach. ROP management stands as a good example of all the strategies for prevention, which includes primary prevention (improving obstetric and neonatal care), secondary prevention (screening and treatment programs), and tertiary prevention (treating complications and rehabilitation to reduce disability). Given its demographic and cultural diversity, India faces numerous challenges, with significant rural–urban, poor–rich, gender, socioeconomic, and regional differences. So, we need to gear up to face the present challenge of the third epidemic of ROP and prevent ROP-related childhood blindness as it is the need of the hour.

Pediatric vitreous hemorrhage: A narrative review
Anmol U Naik, Ekta Rishi, Pukhraj Rishi

Indian Journal of Ophthalmology 2019 67(6):732-739

Vitreous hemorrhage is one of the most common causes of sudden, painless loss of vision in adults. This is probably one of the reasons why it has been extensively studied and reported in literature. However, the same cannot be said when it comes to vitreous hemorrhage in the pediatric age group. The causes of vitreous hemorrhage in children tend to differ from those of adults. Not much data exist regarding their presentation and management. In addition to trauma, certain spontaneous causes such as pediatric tumors and congenital conditions assume importance while considering the differential diagnosis of vitreous hemorrhage in the pediatric age group. However, it is natural that the treating ophthalmologist is faced with challenges when a child presents with vitreous hemorrhage. In this narrative review, we have attempted to analyze the retrospective observational studies regarding pediatric vitreous hemorrhage reported in English literature till date. The article sheds some light on the prevailing epidemiology, management strategies employed and the visual outcome among different regions of the world.

Intra-arterial chemotherapy in retinoblastoma – A paradigm change
Fairooz P Manjandavida, Christina Stathopoulos, Jing Zhang, Santhosh G Honavar, Carol L Shields

Indian Journal of Ophthalmology 2019 67(6):740-754

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the history, technique, indications, contraindications, and outcome of IAC. We have also identified the strengths, weaknesses, opportunities and threats (SWOT analysis) of the technique in this review.

Intraocular medulloepithelioma – A review of clinical features, DICER 1 mutation, and management
Sameeksha H Tadepalli, Carol L Shields, Jerry A Shields, Santosh G Honavar

Indian Journal of Ophthalmology 2019 67(6):755-762

Intraocular medulloepithelioma is a nonhereditary neoplasm of childhood arising from primitive medullary epithelium. It most often involves the ciliary body. Most patients present between 2 and 10 years of age with loss of vision, pain, leucocoria, or conjunctival congestion. The mass appears as a grey-white ciliary body lesion with intratumoral cysts. Presence of a neoplastic cyclitic membrane with extension to retrolental region is characteristic. Secondary manifestations like cataract and neovascular glaucoma may be present in up to 50% and 60% patients, respectively. These could be the first signs for which, unfortunately, about 50% patients undergo surgery before recognition of the hidden tumor. Systemic correlation with pleuropulmonary blastoma (DICER1 gene) has been documented in 5% cases. Histopathology shows primitive neuroepithelial cells arranged as cords closely resembling the primitive retina. Histopathologically, the tumor is classified as teratoid (containing heteroplastic elements) and nonteratoid (containing medullary epithelial elements), each of which are further subclassified as benign or malignant. Retinoblastoma-like and sarcoma-like areas may be seen within the tissue. The treatment modality depends on tumor size and extent of invasion. For small localized tumors (≤3-4 clock hours), conservative treatments with cryotherapy, plaque radiotherapy, or partial lamellar sclerouvectomy (PLSU) have been used. Plaque brachytherapy is generally preferred for best tumor control. Advanced and extensive tumors require enucleation. Rare use of intra-arterial and intravitreal chemotherapy has been employed. Systemic prognosis is favorable, but those with extraocular extension and orbital involvement show risk for local recurrence and metastatic disease, which can lead to death.

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Ophthalmology

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