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AIMS: To evaluate retreatment rates, visual and anatomical outcomes at 1-year postnatal age in infants treated for retinopathy of prematurity (ROP) METHODS: Longitudinal national surveillance study of infants treated for ROP in the United Kingdom between December 2013 and December 2014, supported by the British Ophthalmic Surveillance Unit. Here we report retreatment rates, anatomical, visual and refractive outcomes at 1-year follow-up. RESULTS: One-year follow-up forms were completed for 168 children of the original cohort of 327 (51.4%). Twenty-two had at least one retreatment: 17/153 right eyes (REs, 11.1%) after initial diode laser, and 5/14 REs (35.7%) after initial injection of anti-vascular endothelial growth factor (VEGF) antibody. Median (interquartile range) RE best-corrected visual acuity was 0.6 (0.4-1.0) (n = 46 REs), and median acuity both eyes open 0.4 (0.3-0.7) logMAR (n = 89). Median spherical equivalent (RE) was 0.44 (-1.3 to 1.3) dioptre (D) (n = 116). Median astigmatism (RE) was 0.5 (0-1.0) D (n = 111), and median anisometropia 0.125 (0-0.75) D (n = 116). Twenty-four children (20.5%) had been prescribed glasses. Sight impairment certification eligibility information was available for 131 children: 11 (8.4%) were eligible to be certified as sight impaired, and 5 (3.8%) as severely sight impaired. CONCLUSIONS: Retreatment rates are in line with previous reports, and appear higher after initial anti-VEGF antibody than after initial diode laser. Refractive outcomes are in line with previous studies, with a trend towards early emmetropia and myopia following diode laser, particularly in more severe ROP.

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OBJECTIVES: To estimate the incidence of severe retinopathy of prematurity (ROP) requiring treatment and describe current treatment patterns in the UK. DESIGN: Nationwide population-based case ascertainment study via the British Ophthalmic Surveillance Unit and a national collaborative ROP special interest group. Practitioners completed a standardised case report form (CRF). SETTING: All paediatric ophthalmologists providing screening and/or treatment for retinopathy in the UK were invited to take part. PARTICIPANTS: Any baby with ROP treated or referred for treatment between 1 December 2013 and 30 November 2014, treated with laser, cryotherapy, vascular endothelial growth factor (VEGF) inhibitor or vitrectomy/scleral buckling, or a combination. MAIN OUTCOME MEASURE: Incidence of ROP requiring treatment. RESULTS: We received 370 CRFs; 327 were included. Denominator from epidemiological data: 8112 infants with birth weight of <1500 g. The incidence of ROP requiring treatment was 4% (327/8112, 95% CI 3.6% to 4.5%). Median gestational age was 25 weeks (IQR 24.3-26.1), and median birth weight 706 g (IQR 620-821). Median age at first treatment was 80 days (IQR 71-96). 204 right eyes (62.39%) had type 1 ROP, and 27 (8.26%) had aggressive posterior ROP. Infants were also treated for milder disease: 9 (2.75%) right eyes were treated for type 2 ROP, and 74 (22.63%) for disease milder than type 1 with plus or preplus, which we defined here as 'type 2 plus' disease. First-line treatment was diode laser photoablation of the avascular retina in 90.5% and injection of VEGF inhibitor in 8%. CONCLUSIONS: ROP treatment incidence in the UK is 2.5 times higher than previously estimated. 8% of treated infants receive intravitreal VEGF inhibitor, currently unlicensed. Research is needed urgently to establish safety and efficacy of this approach. Earlier treatment and increasing numbers of surviving premature infants require an increase in appropriate eye care facilities and staff. TRIAL REGISTRATION NUMBER: NCT02484989.

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BACKGROUND: The National Institute for Health and Care Excellence (NICE) recommends postpartum and annual monitoring for diabetes for females who have had a diagnosis of gestational diabetes mellitus (GDM). AIM: To describe the current state of follow-up after GDM in primary care, in England. DESIGN AND SETTING: A retrospective cohort study in 127 primary care practices. The total population analysed comprised 473 772 females, of whom 2016 had a diagnosis of GDM. METHOD: Two subgroups of females were analysed using electronic general practice records. In the first group of females (n = 788) the quality of postpartum follow-up was assessed during a 6-month period. The quality of long-term annual follow-up was assessed in a second group of females (n = 718), over a 5-year period. The two outcome measures were blood glucose testing performed within 6 months postpartum (first group) and blood glucose testing performed annually (second group). RESULTS: Postpartum follow-up was performed in 146 (18.5%) females within 6 months of delivery. Annual rates of long-term follow-up stayed consistently around 20% a year. Publication of the Diabetes in Pregnancy NICE guidelines, in 2008, had no effect on long-term screening rates. Substantial regional differences were identified among rates of follow-up. CONCLUSION: Monitoring of females after GDM is markedly suboptimal despite current recommendations.

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The objective of this study was to determine the rate of major omissions from documentation in a prehospital environment. Analysis of 251 competitor records, documented over 2 years from four consecutive UK outdoor endurance events (2006-2007), was performed. Eighty-two percent of case notes were found to be of adequate quality (n = 206), with 15% containing minor omissions (n = 37, i.e. omissions of some patient details) and 3% containing major omissions (n = 8, i.e. no details of diagnosis/treatment). Of the major omissions, first aiders and health-care professionals (doctors and nurses) made the same number of errors (n = 4 each, P = 0.7), but first aiders made significantly more minor omissions (n = 31 vs. 6, P<0.001). From 25 patients who needed medication, only one prescription error occured. In conclusion, accurate documentation is achievable at prehospital mass gathering events. First aiders made no more major documentation omissions than health-care professionals, but made more minor omissions. Standardized proformas may help reduce this rate and improve efficiency.

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OBJECTIVE: To assess the risk of severe retinopathy of prematurity (ROP) requiring treatment in different ethnic groups. DESIGN: Retrospective observational study on ROP screening and treatment. It involved a cross-sectional review of all eligible infants over a seven-year period. Statistical tests used were the Kruskal-Wallis test and Mann-Whitney U test. Logistic regression was used to control for any differences in birth weight and gestational age. SETTING: City Hospital and Birmingham Women's Hospital, Birmingham, UK. RESULTS: 1690 preterm infants underwent ROP screening. Birth weight was lower in black (1142.5 g) and Asian infants (1180 g) when compared to white infants (1196.5 g). Gestational age was lower in black infants (28.5 weeks) compared to Asian and white infants (both 29 weeks). Compared to white infants, the odds of severe ROP requiring treatment was higher in Asian infants (odds ratio (OR): 2.52; 95% CI 1.41 to 4.50) and black infants (OR: 2.51; 95% CI 1.30 to 4.86). The additional risk from ethnicity was present even after adjusting for birth weight and gestational age (adjusted OR for Asian vs white infants: 2.45; 95% CI 1.334 to 4.497); (adjusted OR for black vs white infants: 2.0; 95% CI 1.004 to 4.014). CONCLUSIONS: Ethnicity is a risk factor for severe ROP. Asian and black infants have a higher risk of developing threshold ROP compared to white infants.

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AIM: The purpose of this study was to investigate the incidence of postvitreoretinal surgery endophthalmitis in a UK tertiary referral centre. METHODS: Two cases that met the clinical criteria of endophthalmitis following conventional 20-gauge vitreoretinal surgery were included in this retrospective, noncomparative, consecutive case series. RESULTS: The incidence of endophthalmitis between 1 April 1997 and 30 November 2004 was 0.038% (n = 2/5,278). CONCLUSION: The incidence of endophthalmitis following pars plana vitrectomy remains low.

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PURPOSE: To investigate the incidence of endophthalmitis after cataract surgery, analyze the microbiologic spectrum of infecting organisms, and assess the diagnostic utility of an anterior chamber paracentesis and vitreous biopsy. SETTING: United Kingdom tertiary referral center used by 13 operating suites. METHODS: A retrospective noncomparative consecutive series comprised 105 postcataract endophthalmitis cases. RESULTS: The annual mean incidence of endophthalmitis over the study period was 0.099% (101/101 920) [corrected] and there was no significant increase in the incidence during the study. The culture-positive rate was 58.1% (61/105). Gram-positive microbes were isolated in 93.4% of cases (57/61), with coagulase-negative staphylococci accounting for 62.3% (38/61). Anterior chamber taps yielded positive cultures in 25.7% of cases, and vitreous biopsy was positive in 53.4%. CONCLUSIONS: The incidence of endophthalmitis in this region of the United Kingdom remained stable, with gram-positive microbes accounting for 93.4% of the isolates. A combination of anterior chamber tap and vitreous biopsy should be performed in suspected cases of endophthalmitis.

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