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Retinopathy of prematurity (ROP) is an eye disorder that mainly affects fundus vasculature of immature infants. The effect of this disease can be mild with no observable impairments or may become severe with neovascularization, leading to retinal detachment and possibly childhood blindness. A vital sign for initiating treatment for ROP is the detection of Plus disease, which is clinically diagnosed by identifying certain morphological changes to the blood vessels present in the retina of preterm infants. The main goal of this study is to develop a diagnostic method that can distinguish between Plus-diseased and healthy infant retinal images. This work utilizes a fully convolutional deep learning architecture for achieving the desired objective. We use a semi-supervised learning technique for training the network. The proposed technique accurately predicts bounding boxes over the tortuous vessel segments present in an infant retinal image. The count of bounding boxes serve as a measure to quantify tortuosity. We also compare the proposed technique with a recently introduced ROP diagnostic method employing U-COSFIRE filters. We show the efficacy of the proposed methodology on a proprietary data set of 289 infant retinal images (89 with ROP, and 200 healthy), obtained from KIDROP Bangalore, India. We obtain sensitivity (true positive rate) and specificity (true negative rate) equal to 0.99 and 0.98, respectively in the experimented data set. The results obtained in this study show the robustness of the proposed pipeline, as a computer aided diagnostic tool, that can augment medical experts in the early diagnosis of ROP.

Patients with chorioretinal colobomas are at a risk of rhegmatogenous retinal detachment as a consequence of retinal breaks that occur in the abnormally thin colobomatous or extra colobomatous reti...

The expected trend in serum beta-human chorionic gonadotropin (β-hCG) following treatment of an undesired heterotopic pregnancy with uterine aspiration and systemic methotrexate is not known. Thus, monitoring for treatment success is challenging. We describe an undesired heterotopic pregnancy treated with aspiration and two-dose methotrexate and report the observed β-hCG trend.

To describe the foveal avascular zone (FAZ) and vessel density (VD) in the superficial and deep capillary plexus in children with a history of prematurity on optical coherence tomography angiography (OCTA) and their correlation with gestational age (GA) and birth weight (BW). We enrolled 81 preterm- and eight term-born children in this prospective observational study. The Optovue RTVue AVANTI (Optovue Inc., Fremont, CA) was used to procure the OCTA images. The 3 × 3 mm scan protocol centered on the fovea and the central 1 mm of the grid along with the FAZ of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was acquired. The mean SCP-VD was comparable between the preterms and term controls (p = 0.315) in the central fovea (1-mm grid). However, the SCP-VD of the 3-mm grid was lower in the preterms born without ROP, with type 1 ROP, and with type 2 ROP (47.61, 47.90, and 48.82 respectively) compared to that in the term group (51.38; p = 0.031). The FAZ in the SCP (p = 0.003) and DCP (p = 0.003) was significantly smaller in the preterms compared to that in the controls. Based on the GA sub-analysis, the FAZ was significantly smaller in the SCP and DCP of preterms born 31 weeks GA (p < 0.000, p < 0.035, respectively). Based on the BW, the difference between the FAZ in the SCP (p = 0.002) and DCP (p = 0.003) was significant. There was no association between the visual acuity and FAZ. Optical coherence tomography angiography findings in this study show an altered foveal morphology and vascularity in preterms with and without ROP.

Background: Foveal cysts have been associated with vitreous traction due to a taut posterior hyaloid. These eyes may progress to become a full-thickness macular hole, remain stable, or resolve after a posterior vitreous detachment. A foveal cyst in an eye with a complete posterior vitreous detachment and no other obvious pathology is unusual. Case presentation: A 21-year-old male presented with blurred vision in the left eye of 1-month duration. On examination his left-eye vision was 20/60, and anterior segment examination was normal. Fundus examination showed internal limiting membrane folds with a suspected lamellar macular hole. A spectral domain optical coherence scan showed a thin dome-like cyst in the sub foveal region involving the outer retinal layer with a detached posterior hyaloid face. A trial of intravitreal dexamethasone implant was given, following which there was improvement in vision and resolution of the foveal cyst. At the third-month follow-up, the patient presented with a stellate pattern of hyporeflectivity in the macular area both on spectral domain optical coherence scan and multicolor imaging with no change in visual acuity. Conclusion: The presence of a foveal cyst in a young male without any risk factors is peculiar, and the rapid response to intravitreal dexamethasone implant raises questions about the pathogenesis. The stellate pattern of hyporeflectivity on spectral domain optical coherence scan imaging with an intraretinal “filling defect”–like picture on fluorescein angiography suggests a possible ongoing ischemic pathology.

Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world. India leads all nations with the highest number of premature infants born each year. Asia has the highest estimated incidence, where visual loss from ROP is over twice as high per million live births compared to established market economies. The problems of ROP management in these countries are compounded by a large cohort of babies who require screening, relatively few ROP specialists, and more recently medico-legal challenges. The authors share the Indian jurisprudence literature from the past decade relating to ROP, summarizing key clinical lessons learned from these legal judgments. The authors endeavor to enlist good clinical practices for various key steps involved in ROP care to help mitigate future litigations as well as protect the clinical interest of the infants who require ROP screening and treatment.

Purpose To report the results of the survey for the role of anti-VEGF in the management of retinopathy of prematurity (ROP) among the members of Indian ROP (iROP) society. Methods A questionnaire was designed in English using Google forms and its link was circulated to the members of the iROP society on their mobile numbers. The survey included questions pertaining to demographics, anti-VEGF agents, injection technique, post-injection follow-up, and documentation pertaining to their ROP practice. Anonymous responses were obtained and analyzed for individual questions. Results 226 members of the society were contacted and 157 responded (69.4%) to the survey. 137 (87.2%) respondents used anti-VEGF in the management of ROP. Aggressive posterior ROP (APROP) was the most common indication (78, 52.7%). The procedure was carried out in the main operation room (102, 70.3%) simultaneously for both the eyes (97; 68%) under topical anesthesia (134; 86.4%) by most of the respondents. One-hundred thirteen (77.9%) respondents used half of the adult dose, irrespective of the agent used; however, more than half of them preferred bevacizumab (85, 54%). 53 (36.3%) respondents followed up infants as per disease severity rather than a fixed schedule while only 33 (23%) performed photo documentation. 151 (96.2%) respondents felt the need for guidelines regarding the usage of anti-VEGF in ROP. Conclusion There is an increase in the trend towards the use of anti-VEGF in the management of severe ROP, particularly APROP. However, there are considerable variations among the ROP practitioners regarding the agent, dosage, follow-up schedule, and documentation, suggesting the need for uniform guidelines.

Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.早产儿视网膜病变的治疗: 在亚洲的展望: 早产儿视网膜病变 (ROP) 是一种影响早产儿视网膜血管发育的血管增生性疾病, 不加以干预会导致严重且不可逆的视力丧失。如今印度和其他一些亚洲国家正处于“第三次ROP流行”的中期。ROP所致的失明大多数可通过适当、到位的和可及的筛查计划的实施进行预防。筛查早产儿是ROP管理的第一步。随着远程筛查技术应用的增加, 越来越多的早产儿已被纳入了城市及农村地区的筛查网络。相较于西方国家, 在亚洲多使用表麻下间接检眼镜传输系统对无血管区的视网膜进行激光光凝作为治疗ROP的金标准。玻璃体腔内注射抗血管内皮生长因子 (VEGF) 虽然在ROP的治疗上有争议, 但在众多亚洲研究中被认为是有效的。印度和其他中等收入的亚洲国家ROP手术大多数只在少数的三级眼科治疗中心进行。视力预后差, 视网膜脱离严重时才就诊, 缺乏足够数量训练有素的儿童视网膜外科医生和儿童麻醉师也造成了这个问题。本文总结了亚洲在ROP管理方面的经验。.

Purpose: To use the extent of retinal immaturity at the first visit to predict progression to any stage and treatment-requiring retinopathy of prematurity (ROP). Methods: Retrospective, multicenter, nonrandomized, observational, clinical, validation study. In all, 601 Asian Indian preterm infants born

To analyze rubella retinopathy qualitatively and quantitatively in children diagnosed with congenital rubella syndrome (CRS) using a handheld spectral-domain (SD) OCT device.Prospective, cross-sectional, nonrandomized, comparative observational study in a tertiary eye care center in south India.Cases comprised 24 eyes of 13 children diagnosed with CRS based on seropositivity with rubella retinopathy. Controls comprised 26 eyes of 13 age-matched healthy children with normal retina.All participants underwent retinal imaging with RetCam fundus photography (Natus Medical Inc, Pleasanton, CA) and handheld SD OCT (Bioptigen, Inc., Durham, NC). The SD OCT images of both cases and controls were segmented. Retinal and choroid thickness parameters were computed.Qualitative and quantitative changes were observed in SD OCT images of rubella retinopathy compared with those from controls.Characteristic salt-and-pepper appearance was observed on fundus photography in children with rubella compared with the healthy children. The appearance of fovea and retinal features such as foveal dip, external limiting membrane, inner segment-outer segment boundary, outer segment-retinal pigment epithelium boundary, and retinal pigment epithelium were significantly different (P0.05) in eyes with rubella retinopathy compared with healthy eyes Furthermore, eyes with rubella retinopathy exhibited significantly reduced central foveal thickness (P = 0.025), subfoveal outer retinal thickness (P = 0.01), and subfoveal choroid thickness (P = 0.007) compared with healthy eyes.Distinct qualitative and quantitative differences were observed in the SD OCT images of eyes with rubella retinopathy compared with those from healthy eyes.

Retinopathy of prematurity (ROP) is a sight threatening disorder that primarily affects preterm infants. It is the major reason for lifelong vision impairment and childhood blindness. Digital fundus images of preterm infants obtained from a Retcam Ophthalmic Imaging Device are typically used for ROP screening. ROP is often accompanied by Plus disease that is characterized by high levels of arteriolar tortuosity and venous dilation. The recent diagnostic procedures view the prevalence of Plus disease as a factor of prognostic significance in determining its stage, progress and severity. Our aim is to develop a diagnostic method, which can distinguish images of retinas with ROP from healthy ones and that can be interpreted by medical experts. We investigate the quantification of retinal blood vessel tortuosity via a novel U-COSFIRE (Combination Of Shifted Filter Responses) filter and propose a computer-aided diagnosis tool for automated ROP detection. The proposed methodology involves segmentation of retinal blood vessels using a set of B-COSFIRE filters with different scales followed by the detection of tortuous vessels in the obtained vessel map by means of U-COSFIRE filters. We also compare our proposed technique with an angle-based diagnostic method that utilizes the magnitude and orientation responses of the multi-scale B-COSFIRE filters. We carried out experiments on a new data set of 289 infant retinal images (89 with ROP and 200 healthy) that we collected from the programme in India called KIDROP (Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity). We used 10 images (5 with ROP and 5 healthy) for learning the parameters of our methodology and the remaining 279 images (84 with ROP and 195 healthy) for performance evaluation. We achieved sensitivity and specificity equal to 0.98 and 0.97, respectively, computed on the 279 test images. The obtained results and its explainable character demonstrate the effectiveness of the proposed approach to assist medical experts.

Retinopathy of Prematurity (ROP) is a blinding disease affecting the retina of low birth weight preterm infants. Accurate diagnosis is essential to identify the severity and stage of ROP to prevent childhood blindness. Progression of ROP into various stages is identified through the properties of ridge present in the anterior pole of retina. Ridge detection is very challenging in infant fundus images due to their poor contrast and other artefacts. This work proposes an efficient segmentation algorithm to detect the ridge in the infant fundus images. An image dataset with 140 retinal fundus images of preterm infants was used for this work. The proposed algorithm gave a detection accuracy of 95.71 percent and sensitivity and specificity of 91.89 percent and 100 percent respectively, when tested on real images having wide variations in quality.

Nephrotic syndrome (NS) is a common disease of childhood but ophthalmic manifestations are seldom reported. We report a rare occurrence of bilateral combined central retinal artery and vein occlusion in a 3-year-old with NS. The child presented with bilateral painless loss of vision, central pallid retinae with cherry red spots, vascular tortuosity, and retinal hemorrhages. There was delayed filling of the arteriolar circulation and a delay in arteriovenous transit time on angiography and increased central retinal thickening on optical coherence tomography. She was treated with oral steroids, subcutaneous low molecular weight heparin, and oral acetylsalicylic acid. The central retinae showed resolution of the hemorrhages, tortuosity, edema, and pallor within 3 weeks. Visual acuity recovered bilaterally to 20/360, 20/190, and 20/40 at 1, 3, and 6 weeks, respectively. We discuss the possible reasons for good recovery in our patient. Though bilateral combined central retinal artery and vein occlusion is rare in pediatric NS, the treating physician should be aware of this entity as it can be successfully managed.

We report a patient with a history of venous thrombosis following oral contraceptive pills who was planned for in vitro fertilization (IVF)-intracytoplasmic sperm injection for male factor infertility. This article discusses the mechanisms for predisposition to thrombosis during assisted reproduction in patients at high risk. Assessment of risk before commencement of treatment, use of mild stimulation, antagonist protocol, avoiding ovarian hyperstimulation, use of gonadotropin-releasing hormone agonist trigger and avoiding exposure to human chorionic gonadotropin, frozen embryo transfer in a natural cycle, single embryo transfer, avoiding multiple pregnancy, and use of prophylactic or therapeutic anticoagulation are the various risk-reduction strategies that must be adopted during IVF treatment to reduce the risk of thrombosis to that of natural conception.

Pathology of Racism At our medical institutions, we immerse trainees in a two-tiered system. We teach them that some kinds of patients see residents and other kinds of patients see attendings. And ...

To characterize pediatricians' knowledge, attitudes, and self-efficacy around contraception.Cross-sectional survey.United States.National sample of pediatricians.Assessment of behaviors of providing contraception.Reproductive health practice score.Two hundred twenty-three usable surveys were received, from 163 contraceptive prescribers and 60 nonprescribers. The mean reproductive health practice score was 43.1 (SD, 8.2; total possible score, 84). Prescribers differed in their mean reproductive health score (46.0; SD, 7.0) from nonprescribers (34.0; SD, 4.5; P .001). Prescribers vs nonprescribers differed in their attitude and efficacy in providing contraception. More prescribers believed it was their responsibility to ask about patients' need for birth control, were confident in their ability to prescribe contraception options, and provided contraception to minors despite parental disapproval. Neither group was confident in their ability to place intrauterine devices or believed that the literature supports intrauterine device placement in adolescents. Only efficacy was related to prescribing contraception in a multivariate regression analysis (odds ratio, 1.7; P .001).In this study, we showed that most pediatricians are contraception prescribers but the overall reproductive health score was low for prescribers and nonprescribers. The odds of prescribing contraception increased with higher self-efficacy scores rather than knowledge alone. Many prescribers and nonprescribers would not prescribe birth control if parents disapproved and do not believe it is their responsibility to assess patients' need for birth control. In addition very few pediatricians have training in long-acting reversible contraception, despite being the recommended method for adolescents.

Purpose: To suggest a low cost, non-contact smartphone-based screening system in retinopathy of prematurity (ROP), and to illustrate its potential clinical application as a potential future tool for teleophthalmology. Methods: Neonatal intensive care unit (NICU)-based bedside ROP screening done between January 2018 and May 2018. Documentation of ROP was done by using a smartphone and +40D, +28D, or +20D indirect non-contact condensing lenses. By using the coaxial light source of the phone, this system works as an indirect ophthalmoscope that creates a digital image of the fundus. With smartphone-based camera we extracted high-quality still images extracted from the video clip. Results: Total of 228 eyes of 114 infants screened for ROP between January 2018 and May 2018. Incidence of total ROP was 23.68%, out of which incidence of type 1 ROP was 8.77%. After initial screening with indirect ophthalmoscope, we uesd smartphone imaging to document ROP in 28 eyes out of 55 eyes having ROP. Image quality was good in 89.28% eyes. Field of view vary from 46°, 53°, and 90° with +20D, +28D, and +40D indirect condensing lenses, respectively, which gives excellent images for bedside ROP documentation. Conclusion: The described technique of smartphone fundus photography is a light weight, cost-effective, user friendly, high-quality wide-field fundus photographs for bedside documentation of ROP in NICUs using readily available instruments that are handy and portable with simple power sources. Smartphones has the potential to be operated with only one hand. It can also be used as a future telescreening device.

Purpose: Trisomy 21, also known as Down syndrome (DS), is the most common trisomy worldwide. Although ocular associations have been reported, retinal anatomy and pathology remain uninvestigated. We evaluate the role of spectral domain optical coherence tomography (SD-OCT) in analyzing foveal morphology of children with DS. Methods: Nineteen consecutive DS children and eight controls were enrolled under a cross-sectional study in an institutional practice. All subjects underwent SD-OCT imaging on a hand-held device. The morphology and thickness of central fovea, inner retinal layers, outer retina, and photoreceptor layers were measured and compared with age-group sub-analysis. Results: Mean age of the cases was 24 months (3–78 months). All cases and controls had a normal fundus on ophthalmoscopy and foveal thickness was comparable (p = 0.718). Inner retinal fusion was complete in the foveal center in only three eyes (15.8%) of cases compared to all eyes (100%) of controls (p < 0.001). The outer plexiform layer was normal in 10 eyes of cases (52.6%) compared to all eyes (100%) of the controls. Only 10 eyes of DS (52.6%) had a normal external limiting membrane, compared to all eyes of controls (100%, p = 0.01). The interdigitation zone (outer segment) was normal in one (5.3%) case compared to eight (67%) controls (p = 0.001). On subgroup analysis, in older cohorts, cases had a greater proportion of abnormal layers compared to controls. Visual acuity was found to be lower in cases when compared to controls, although not significant (p = 0.19). Conclusion: DS babies have abnormal foveal morphology and persistence of inner retinal layers. This may assist our understanding of their visual development.

Objective To describe education on transgender health provided by obstetrics and gynecology residency programs and to identify the facilitators and barriers to providing this training. Methods We conducted a cross-sectional survey to evaluate transgender health education in residency among a representative sample of 100 of the 236 obstetrics and gynecology residency programs listed in the 2015 Electronic Residency Application Service catalogue. We compared programs that did and did not offer transgender education on demographics, presence and type of transgender education offered, and reasons for and barriers to offering transgender health education using χ or Fisher's exact testing. Results We found that 31 out of 61 (51%, 95% CI 38-64%) programs completing the survey offered transgender health education in residency. Compared with programs that offered no education, residency programs offering education were more likely to report that transgender health education was very important (19/31, 61% [95% CI 42-78%] vs 7/30, 23% [95% CI 9-42%]), resident interest (20/31, 64% [95% CI 45-81%] vs 11/30, 37% [95% CI 20-56%]), and the presence of a transgender population requesting services (28/31 or 90% [95% CI 74-98%] vs 16/30 or 53% [95% CI 34-72%]). Among the 31 programs that offered transgender health education, 30 (97%; 95% CI 83-99%) provided formal didactic sessions and 20 (64%; 95% CI 45-81%) offered health screening for both male-to-female and female-to-male transgender patients, but 17 (55%; 95% CI 36-73%) did not offer gender-affirming hormone therapy. Among the 30 programs that did not currently offer transgender health education, 24 (80%; 95% CI 61-92%) planned to establish a transgender education program in the next year. Conclusion Our survey of obstetrics and gynecology residency programs highlights the interest in transgender health education for a systemically underserved population of patients.

Purpose The purpose of this study was to evaluate the contrast threshold in Asian Indian preterm infants with and without retinopathy of prematurity (ROP) using Newborn Contrast Cards measured during the first ROP screening and to correlate with final outcome and visual acuity at 3 months of corrected age. Methods Preterm infants born ≤ 2000 grams birth weight (BW) and/or ≤ 34 weeks gestational age (GA) undergoing ROP screening were enrolled prospectively. Visual acuity was recorded using Teller Acuity Cards. Contrast threshold was measured with Newborn Contrast Cards at first screening visit and at the end of ROP screening at 40 weeks of postmenstrual age or older. Results Of the 173 study infants, 134 (77.5%) did not have any stage of ROP. Of the remaining 39 (22.5%), 34 (87%) had type 2 ROP and 5 (13%) had type 1 ROP requiring treatment. The mean contrast threshold at the first visit of the no ROP type 1 and type 2 groups was 0.36 ± 0.07, 0.65 ± 0.19, and 0.46 ± 0.09, respectively (P < 0.001). Contrast threshold had a significant correlation with BW (R = −0.291, P = < 0.001) and gestational age (R = −0.47, P = < 0.001). The contrast threshold at the first visit correlated with visual acuity measured at 3 months of corrected age in logMAR (R = 0.36, P = 0.01). Other than BW and GA, no other systemic risk factors correlated with contrast threshold measured at the first screening visit. Conclusions Newborn Contrast Cards are a viable tool to test contrast threshold in preterm infants. The association between contrast threshold and ROP, and its correlation with visual acuity, suggest that contrast threshold measurement may help predict the clinical vision outcome among prematurely born infants. Translational Relevance Contrast threshold measurement may prove to be a useful tool in the estimation of visual potential in preterm infants.

Anand Vinekar,1 Chaitra Jayadev,1 Siddesh Kumar,2 Shwetha Mangalesh,1,3 Mangat Ram Dogra,4 Noel J Bauer,5 Bhujang Shetty6 1Department of Pediatric Retina, Narayana Nethralaya Eye Hospital, Bangalore, 2Raichur Institute of Medical Sciences, Raichur, Karnataka, India; 3Department of Ophthalmology, Duke University, Durham, NC, USA; 4Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 5Department of Ophthalmology, Maastricht University of Health Sciences, Maastricht, the Netherlands; 6Department of Ophthalmology, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India Purpose: To report the reduction in the incidence and severity of retinopathy of prematurity (ROP) in rural India over a 4-year period following the introduction of improved neonatal care practices. Methods: The Karnataka Internet Diagnosis of Retinopathy of Prematurity program (KIDROP), is a tele-medicine network that screens for ROP in different zones of Karnataka state in rural India. North Karnataka is the most underdeveloped and remote zone of this program and did not have any ROP screening programs before the intervention of the KIDROP in 2011. Six government and eleven private neonatal centers in this zone were screened weekly. Specific neonatal guidelines for ROP were developed and introduced in these centers. They included awareness about risk factors, oxygen regulation protocols, use of pulse oxymetry, monitoring postnatal weight gain, nutritional best practices, and management of sepsis. The incidence and severity of ROP were compared before the guidelines were introduced (Jan 2011 to Dec 2012) and after the guidelines were introduced (July 2013 to June 2015). Results: During this 4-year period, 4,167 infants were screened over 11,390 imaging sessions. The number of enrolled infants increased from 1,825 to 2,342 between the two periods (P

Middle-income countries such as India are suffering from the third epidemic of retinopathy of prematurity (ROP). Improved survival and lower infant mortality rates have resulted in an increased number of preterm survivors in rural areas that unfortunately lack ROP specialists. We report our experience of a public-private partnership in rural India of an ongoing telemedicine program Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity program KIDROP that provides ROP screening by non-physicians. The analysis of 20,214 imaging sessions of 7106 from 36 rural centers in 77 months of activity are presented. The overall incidence of any stage and treatment requiring ROP was 22.39% and 3.57% respectively. We found a higher incidence of severe ROP in private (7.1%) vs government centers (1.7%). Fifty of the 254 babies (19.69%) who underwent treatment were outside the American screening guidelines cut-off. The report compares other "real-world" tele-ROP programs, summarizes the impact, and provides future strategies for outreach ROP screening in middle-income countries.

Purpose Universal eye screening of neonates is currently not standard of care. Early detection of abnormalities could offer prompt management and a reduction in visual morbidity. We report a pilot study using wide-field digital imaging to screen all infants at birth to explore its feasibility as a tool for universal screening. Methods Consecutively enrolled 1021 term infants in a public hospital were imaged within 72 hr of birth using the Retcam shuttle (Clarity MSI, USA). Anterior and dilated posterior segment images were obtained. Infants with abnormal images were examined clinically, and medical or surgical treatment was given when needed, at no cost to the family. Results Of the 1021 healthy full-term newborns, 48 babies had abnormal findings (4.7%). Retinal haemorrhages were the most common (52.1%) abnormality of which 24% were macular. A ‘ridge’ resembling retinopathy of prematurity in both eyes constituted 18.8% of all abnormalities. Nine infants (18.8% of abnormalities and 0.9% overall) had conditions meriting medical or surgical intervention and would have been missed otherwise. Seven of these nine babies (0.7%) needed medical attention with a systemic work-up for conditions such as posterior uveitis with linear perivasculitis, salt and pepper retinopathy or posterior synechia. Two of nine babies (0.2%) required surgical intervention for unilateral cataract and retinoblastoma. Conclusion Universal eye screening of all neonates using wide-field digital imaging is possible and safe. Extrapolating our results to the national scenario, we estimate that 226 950 infants requiring treatment would go undiagnosed annually. Universal infant eye imaging strategies must receive serious national consideration.

Purpose The purpose of this study was to characterize the association between pelvic examination and adolescent contraceptive method use in two time periods in the 2006–2010 National Survey of Family Growth (NSFG). Methods Using data from the 2006–2010 NSFG, we used descriptive statistics and multivariable regression models to examine the association between pelvic examination and/or Pap smear and use of effective or highly effective contraceptive methods during two time periods (2006–2008 and 2008–2010). We used the design characteristics of the NSFG to produce population estimates. Results More than half (57.3%) of our target population reported that they had a pelvic examination and/or Pap smear in the preceding 12 months. After considering health service use, pregnancy history, and demographic characteristics, receipt of pelvic/Pap remained significantly associated with use of effective or highly effective methods of contraception. Adjusted odds ratio = 1.86; 95% confidence interval (CI), 1.17–2.97. When we examined the relationship between pelvic/Pap and use of effective or highly effective methods within time periods, we found that the odds of effective contraception use were higher among adolescents who had received a Pap/pelvic examination in Period 1 (June 2006–May 2008) but not in Period 2 (June 2008–May 2010). Odds ratio = 3.05; 95% CI, 1.53–6.03 and odds ratio = 1.52; 95% CI, .88–2.62, Periods 1 and 2 respectively. Conclusions This finding provides some reassurance that although indications for pelvic examination and Pap smear among adolescents have decreased, the previously documented association between pelvic examination and effective or highly effective contraception appears to have decreased.

Purpose: To report the impact of transient, self-resolving, untreated "macular edema" detected on spectral domain optical coherence tomography in Asian Indian premature infants with retinopathy of prematurity (ROP) on visual acuity (VA) and refraction at 1-year of corrected age. Materials and Methods: Visual acuity and refraction of 11 infants with bilateral macular edema (Group A) was compared with gestational age-matched 16 infants with ROP without edema (Group B) and 17 preterms infants without ROP and without edema (Group C) at 3, 6, 9 and 12 months of corrected age using Teller Acuity Cards and cycloplegic retinoscopy. Sub-group analysis of the previously described pattern A and B macular edema was performed. Results: Visual acuity was lower in infants with macular edema compared with the other two control groups throughout the study period, but statistically significant only at 3 months. Visual improvement in these infants was highest between the 3 rd and 6 th month and plateaued by the end of the 1 st year with acuity comparable to the other two groups. The edema cohort was more hyperopic compared to the other two groups between 3 and 12 months of age. Pattern A edema had worse VA compared to pattern B, although not statistically significant. Conclusion: Macular edema, although transient, caused reduced VA as early as 3 months of corrected age in Asian Indian premature infants weighing

Optical coherence tomography (OCT) has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures.

Multiple pregnancy in in vitro fertilization (IVF) is on the decline with a reduction in number of embryos transferred. But the risk of monozygotic splitting persists. The risk of monozygotic twinning in women undergoing IVF is reported to be twice that of natural conception, and monochorionic triplets are even rarer at 100 times more than natural conception. We report a case of monochorionic triamniotic (MCTA) triplets following conventional IVF and blastocyst transfer without zona manipulation. This report highlights the possibility of zygotic splitting in IVF in young couples with no family history, in centers with good experience with blastocyst transfer. MCTA triplets carry a high risk of perinatal mortality and morbidity and need multidisciplinary care. Prevention and prediction of zygotic splitting ought to be realized with better reporting and identification of possible risk factors.

Retinopathy of Prematurity (ROP) is a disease of the eye affecting the prematurely — born babies. It results in unorganized growth of retinal blood vessels which may result in scarring and retinal detachment. The severity of the disease is measured[1] by the stage of the disease and the presence or absence of Plus disease leading to Aggressive Posterior Retinopathy of Prematurity-APROP. The tortuosity index which is indicative of the twisting of the blood vessel calculated. This facilitates in deciding if the new born has APROP or not. A higher value of the index suggests that the baby has developed Plus disease, leading to APROP. The major disadvantage lies in the fact that the number of specialists in Retinopathy are comparatively less. [2] Thus many times this disease goes unnoticed and the baby might be blinded for life. Main objective is to curb the distance between the specialists and the patients in remote area. The importance lies in the fact that the doctor is able to receive the results and can prioritize appointments as per requirements and patients in remote areas can channelize their travel to meet the doctor.

To study the structural visibility of the posterior vitreous cavity and vitreoretinal interface using Spectral Domain-Optical Coherence Tomography in patients with uveitis using conventional, Enhanced Depth Imaging (EDI), Combined Depth Imaging (CDI), and Enhanced Vitreous Imaging (EVI) techniques.It was an observational cross-sectional study of 59 eyes of 33 patients between age group 12-72 years (Median 43) diagnosed as uveitis with posterior segment manifestations underwent OCT using conventional, EDI, CDI, and EVI techniques. The visibility of posterior vitreous was graded in all the techniques.A statistically significant difference was seen in posterior vitreous visibility on comparing all four techniques. EVI showed better visibility of posterior vitreous cavity compared to all other techniques (P 0.001).EVI technique provides better structural visibility of posterior vitreous compared to conventional, EDI, and CDI techniques.

Purpose: The purpose of this study is to estimate the unknown burden of retinopathy of prematurity (ROP) blindness from nine states of India using demographic, incidence and treatment data from an ongoing statewide ROP program in Karnataka called the Karnataka Internet Assisted Diagnosis of ROP (KIDROP) and to calculate the fiscal quantum of preventable blindness in these states. Materials and Methods: The KIDROP model is an ongoing tele-ROP service providing screening and treatment for ROP in Karnataka since 2008. Using this index strategy, an impact assessment in nine other states was constructed, the number of potential blind babies enumerated, the fiscal quantum of blindness prevented in blind person-years (BPYs), and the increase in burden with improving survival and institutional deliveries calculated. Results: The total population in the ten study states is 681.5 million. The eligible babies for ROP screening annually are 467,664. The number of babies admitted to neonatal units is 188,561 of which 160,277 are likely to survive and require screening. Based on KIDROP data, ROP would develop in 35,886 of these infants, and 1281 babies would require treatment annually. The fiscal quantum of BPY saved in these ten states is USD 108.4 million annually, with a further increase of USD 106.8 million with improving infant survival and higher admission rates for delivery. Conclusion: A KIDROP like model can provide ROP screening in low-resource settings, remote centers, and regions with few ROP specialists. Expanding the model to other states with similar demographics can prevent over USD 100 million of blindness burden annually.

Purpose To evaluate aggressive posterior retinopathy of prematurity (AP-ROP) with regard to inter-expert diagnostic agreement and quantitative vascular features.

The prevalence of Retinopathy of Prematurity (ROP) among preterm infants in the developing countries like India has increased many fold during the past decades. The main cause of this problem is lack of awareness among people, improper diagnostic methods, inter expert variability while screening etc. Treatment of ROP, one of the leading causes of childhood blindness is warranted based on the diagnosis of Plus disease. Comparison of tortuosity of blood vessels with a gold standard image was one of the common techniques used for its screening. Quantitative assessment of the disease includes evaluation of blood vessel tortuosity and vascular dilation in the retinal image. We present a semi-automated computer-based method for the assessment of Plus disease in ROP. This method involves initial preprocessing of the image followed by evaluation of tortuosity and width of retinal blood vessels. Based on the implemented work two image databases, EIARG2 and KIDROP were quantitatively classified as plus, pre-plus or normal case with high accuracy.

Trauma is thought to interfere with normal grief by superimposing symptoms of posttraumatic stress disorder. This exploratory pilot study examined the association between traumatic grief and objectively measured physiological reactivity to a trauma interview in 73 children who lost relatives in the Oklahoma City bombing as well as a potential link between children and their maternal figures in physiological reactivity. Although the authors found no association between posttraumatic stress and objectively measured physiological reactivity among children, they found significant differences in objectively measured reactivity associated with loss and grief. Children who lost "close" relatives evidenced greater objectively measured reactivity than those who lost "distant" relatives. For the most part, children with higher levels of grief evidenced greater objectively measured reactivity than those with lower levels of grief. The most interesting of the findings was the parallel pattern in objectively measured physiological reactivity between children and their maternal figures along with a positive association between children's objectively measured physiological reactivity and maternal figures' self-reported physiological reactivity. Research using larger representative samples studied early and over time is indicated to determine the potential significance of these findings.

We describe the use of optical coherence tomography angiography (OCTA) in detecting and monitoring regression of the neovascular complex (NVC) in a case of aggressive posterior retinopathy of prematurity (AP-ROP). A premature Asian Indian girl with AP-ROP underwent laser photoablation at 26 days of life. Persistent NVC at the posterior border of the lasered retinal bed was detected clinically. On en face spectral domain optical coherence tomography (SD-OCT) and OCTA, the NVC appeared as an arborizing vascular net in the superficial capillary plexus. The deep capillary plexus and outer retinal layers showed corresponding flow outlines that suggested deeper extensions of the lesion. Supplemental laser treatment of the NVC was performed. Ten days later repeat en face SD-OCT and OCTA of the identical retinal location revealed that the vascular tortuosity and dilatation had reduced and that the flow lesions in the deeper layers were undetectable. Our findings in this case suggest that the NVC in AP-ROP extends beyond the superficial retina.

To report the incidence, spectrum and treatment outcome of Retinopathy of Prematurity (ROP) in a rural neonatal nursery.This Prospective, observational, non-randomized study was conducted in a level III Neonatal Intensive Care Unit (NICU) at district headquarters in South India. 118 babies with birth weight ≤2000 g and/or period of gestation (POG) ≤34 wk were included in the study. Eligible infants were screened with indirect ophthalmoscopy and wide-field digital imaging (Retcam) until retinal vascularization was complete or disease regressed. Early Treatment Retinopathy of Prematurity (ETROP) guidelines were followed for laser.The overall incidence of ROP was 41.5% and treatable ROP was 26.4% (24/91) of eyes diagnosed with ROP and 10.2% (24/236) of the overall eyes screened. The mean birth weights and periods of gestation with and without ROP were 1555.9 vs. 1672.5 g (P 0.005) and 32.2 vs. 34.6 wk, respectively (P0.001). Half of the treated eyes had aggressive posterior ROP in Zone 1. All treated eyes had a favorable outcome. Respiratory distress syndrome, oxygen therapy, neonatal Jaundice and sepsis were higher in the ROP group but was not statistically significant. Of the overall infants screened, 68 (57.6%) were heavier and older than the American screening cut-off. Of these, 36.8% had some stage ROP and 8% required treatment.This is the first prospective ROP study from a district NICU in India and compares with previously published urban data. If Western-screening guidelines are used in the rural scenario, we risk a significant proportion of infants being missed who may require treatment.

The purpose of this study was to report the successful management of a case of choroidal neovascular membrane secondary to persistent fetal vasculature syndrome in an infant using intravitreal pegaptanib sodium (Macugen).A 14-month-old male infant developed a peripapillary choroidal neovascular membrane 10 months after lens-sparing vitrectomy that he underwent for persistent fetal vasculature syndrome and confirmed on angiography and optical coherence tomography. A single dose of intravitreal pegaptanib sodium (0.3 mg) was administered after informed consent was obtained. Angiography and optical coherence tomography scans were performed at 6 and 14 weeks after the injection to determine the result.Six weeks after the single injection, the lesion reduced in size and exhibited less leakage on angiography. At 14 weeks, leakage was absent, and the lesion had involuted.Choroidal neovascular membrane in a case of persistent fetal vasculature syndrome is rare. This report shows that intravitreal pegaptanib sodium is highly effective in treating this lesion even in an infant.

PURPOSE: The purpose of this study was to report the possible role of thrombocytopenia in the pathogenesis of aggressive posterior retinopathy of prematurity (APROP). METHODS: The index case described in this study showed spontaneous resolution of APROP with plus disease within 3 days of correcting thrombocytopenia and did not require laser treatment. The retrospective cohort of nine consecutive Asian Indian infants with APROP with similar stage and plus disease as the index case was studied. The mean platelet count of these infants before laser treatment was compared with 21 age- and birth weight-matched control subjects. Correlation of platelet count with APROP is discussed. RESULTS: The mean birth weight of the 10 cases with APROP was 1,030 g (+/-178 g), and the mean period of gestation was 29.4 weeks (+/-2.0 weeks). The mean platelet count of the cases was 82,870/mm3 (+/-58,702/mm3) and that of the control subjects was 178,285 +/- 57,051/mm3 (P = 0.0002). Five of the 10 cases (50%) and 1 of the 21 control subjects (4.8%) had a platelet count of

Background: India leads all nations in the number of preterms born annually. With over 3.5 million infants, a reducing infant mortality rate and an expanding base of rural neonatal intensive care units, the number of infants requiring retinopathy of prematurity (ROP) screening has dramatically increased. The number of ROP specialists in the country is currently inadequate. Leading ROP specialists of the country initiated the Indian ROP (IROP) society to address these challenges. Methods: In 2016, the IROP society was conceived and registered as a professional body with a mission to prevent needless blindness from ROP by promoting standards of excellence. A national online membership drive was carried out. The data collected in this survey was analyzed to collate information on past training, practice patterns, ease of screening and treatment, use of wide-field imaging and willingness to be certified. Results: Of the 113 members at the time of submission, 67.3% were male. 88.5% were formally trained for ROP and 85.8% were vitreo-retinal specialists. Of the practicing members, 96% were “comfortable” with screening and 86% with ROP treatment and this correlated with training (P=0.001 and P=0.002 respectively). Only 25.7% performed vitreous surgery for ROP. Wide field imaging was used by 33% of members in their practice and 52% of those who did not, wanted to use it in the future. Members who used imaging performed more number of laser treatments than those who did not (P=0.008). Laser was the preferred modality of treatment for 98% of members. A majority of the members (92.5%) were willing to be audited. Conclusions: The IROP society is a novel platform for ROP specialists to collaborate. The society has setup short, mid and long-term goals to make ROP care more accessible and affordable with appropriate use of technology.

Background: Poor postnatal weight gain is a well-known risk factor for developing retinopathy of prematurity (ROP). Algorithms that predict ROP based on serial weight gain have not been generalizable in non-Caucasian populations. The duration taken to regain the lost weight is culturally important among Indian mothers. We report the correlation between this duration and the risk of developing ROP. Methods: Sixty-eight Asian Indian infants born Results: The mean BW of the cohort was 1,270±340 grams and mean gestational age (GA) was 31±2 weeks. Thirty-three infants (48.5%) developed no ROP, 20 infants (29.4%) developed type 2 ROP and 15 infants (22.1%) developed type 1 ROP. The mean number of days to regain the lost weight was 11.9+4.6, 17.9+7.9 and 26.6+12.9 days for the No ROP, type 2 and type 1 groups respectively (P Conclusions: The date when a child regains its lost BW is culturally important and easily recalled by mothers. We report the use of this simple estimate as a predictor of ROP. This method could be useful in stratifying risk and predicting the development of “treatment requiring ROP” even before 21 days of life, which is the first mandated screening visit in India.

Purpose To report the surgical outcome, histopathology, immunohistochemistry, and optical coherence tomographic findings in a case of bilateral combined hamartoma of retina and retinal pigment epithelium. Method Bilateral heterologous plasmin-assisted lens-sparing vitrectomy was performed. The surgical specimen underwent histopathological and immunohistochemical analysis. Patient An 18-month-old male child with bilateral combined hamartoma of the retina and retinal pigment epithelium. Results After surgery, structural improvement (optical coherence tomography) and improved visual function were noted. Immunohistochemistry was positive for astrocytic markers and negative for others. Discussion Plasmin-assisted vitrectomy and membrane peeling in this child with bilateral combined hamartoma resulted in a marked improvement in the clinical and topographical appearance in both eyes and significantly improved visual function. The prospect of hamartoma recurrence is not a contraindication to surgical management. Immunohistochemically, the peeled epiretinal tissue showed characteristics of astrocytic origin providing insight into the possible source and structure of these membranes.

Purpose:To study the structural sequelae and refractive outcome in eyes with a favorable structural outcome following laser treatment for threshold retinopathy of prematurity (ROP).Methods:Premature infants with threshold ROP had laser treatment with a minimum follow-up of 1 year. Complete ocular examination and refraction was done. Analysis and correlation of structural sequelae and refractive outcome was done.Results:One hundred eighty-four eyes of 93 pre-term infants were followed up. Structural changes such as vascular tortuosity, narrowing of arcades, temporal crescent, disc drag, and macular heterotopia were seen. Mean refractive error observed was −4.71 D spherical equivalent. Myopia was seen in 80.43% of eyes.Conclusions:The study revealed various structural sequelae and their correlation with refractive outcome.

BACKGROUND Respiratory and diarrheal diseases are leading causes of morbidity and mortality among children younger than 5 years in developing countries. Data on the burden of these diseases in Haiti are scarce. METHODS We conducted a retrospective review of hospital admission registries during January 1, 2011-December 31, 2013 for children younger than 5 years in 6 hospitals in Haiti. We recorded the number of all-cause, respiratory and diarrheal disease admissions and deaths by epidemiologic week and age. RESULTS A total of 31,565 hospital admissions and 1763 deaths were recorded among children aged