RESUMEN

BACKGROUND: The diagnosis of plus disease in retinopathy of prematurity (ROP) largely determines the need for treatment; however, this diagnosis is subjective. To make the diagnosis of plus disease more objective, semi-automated computer programs (e.g. ROPtool) have been created to quantify vascular dilation and tortuosity. ROPtool can accurately analyze blood vessels only in images with very good quality, but many still images captured by indirect ophthalmoscopy have insufficient image quality for ROPtool analysis. PURPOSE: To evaluate the ability of an image fusion methodology (robust mosaicing) to increase the efficiency and traceability of posterior pole vessel analysis by ROPtool. MATERIALS AND METHODOLOGY: We retrospectively reviewed video indirect ophthalmoscopy images acquired during routine ROP examinations and selected the best unenhanced still image from the video for each infant. Robust mosaicing was used to create an enhanced mosaic image from the same video for each eye. We evaluated the time required for ROPtool analysis as well as ROPtool's ability to analyze vessels in enhanced vs. unenhanced images. RESULTS: We included 39 eyes of 39 infants. ROPtool analysis was faster (125 vs. 152 seconds; p=0.02) in enhanced vs. unenhanced images, respectively. ROPtool was able to trace retinal vessels in more quadrants (143/156, 92% vs 115/156, 74%; p=0.16) in enhanced mosaic vs. unenhanced still images, respectively and in more overall (38/39, 97% vs. 34/39, 87%; p=0.07) enhanced mosaic vs. unenhanced still images, respectively. CONCLUSION: Retinal image enhancement using robust mosaicing advances efforts to automate grading of posterior pole disease in ROP.

RESUMEN

PURPOSE: To determine whether digital retinal images obtained using a video indirect ophthalmoscopy system can be accurately graded for zone, stage of retinopathy of prematurity (ROP), and plus or pre-plus disease, and used to screen for type 1 ROP. METHODS: Charts of 114 infants who had retinal video images acquired using the video indirect ophthalmoscopy system during routine ROP examinations were retrospectively reviewed. Two masked ophthalmologists (1 expert and 1 non-expert in ROP screening) graded the video images for image quality, zone, stage of ROP, and pre-plus or plus disease. The ophthalmologists' grades of the videos were compared to the clinical examination results, which served as the reference standard. The sensitivity and specificity of two predefined criteria for referral in detecting disease requiring treatment (ie, type 1 ROP) were then determined. RESULTS: Of images the expert considered fair or good quality (n = 68), the expert and non-expert correctly identified zone (75% vs 74% of images, respectively), stage of ROP (75% vs 40% of images, respectively), and the presence of pre-plus or plus disease (79% of images). Expert and non-expert judgment of pre-threshold disease, pre-plus disease, or plus disease had 100% sensitivity and 75% versus 79% specificity, respectively, for detecting type 1 ROP. Expert and non-expert judgment of pre-plus or plus disease had 92% versus 100% sensitivity and 77% versus 82% specificity, respectively, for detecting type 1 ROP. CONCLUSIONS: High-quality retinal video images can be read with high sensitivity and acceptable specificity to screen for type 1 ROP. Grading for pre-plus or plus disease alone may be sufficient for the purpose of ROP screening.

Asunto(s)

Asunto(s)

RESUMEN

PURPOSE: To evaluate, first, the feasibility of using Pictor, a new portable, noncontact digital fundus camera, to obtain high-quality retinal images of prematurely born infants and, second, the accuracy of grading these images for clinically significant posterior pole vascular changes, that is, pre-plus or plus disease, compared to indirect ophthalmoscopy. METHODS: Pictor retinal images were obtained on a convenience sample of prematurely born infants during routine examinations for retinopathy of prematurity (ROP). Images were reviewed and graded by two ROP experts, who were masked to demographic and clinical examination findings. RESULTS: A total of 96 eyes of 48 infants were included. The mean field of view was 5.0 × 6.1 disk diameters (DD). Grader 1 found quality to be fair or good in 96% of images; grader 2 in 97% of images. Grader 1 judged images as having at least 1 DD length of a major vessel in 3 or 4 quadrants in 80% of images; grader 2 in 86% of images. The sensitivity and specificity of grading pre-plus or plus disease on Pictor images was 100% and 79%, respectively, for grader 1, and 83% and 85%, respectively, for grader 2, compared to the reference standard of indirect ophthalmoscopy. CONCLUSIONS: The Pictor fundus camera can capture digital retinal images of prematurely born infants that have quality sufficient for accurate expert grading in comparison to clinical examination. Pictor shows promise as an ROP screening tool.

Asunto(s)

RESUMEN

PURPOSE: To determine whether digital retinal images obtained from an indirect ophthalmoscopy imaging system (Keeler) can be accurately graded for clinically significant retinopathy of prematurity (ROP) by masked experts. METHODS: The medical records of infants screened for ROP who had posterior pole images acquired using the Keeler system during routine ROP examinations were retrospectively reviewed. Two reviewers, masked to patient demographics and clinical examination findings, graded the images for: (1) quality (good, fair, poor); (2) number of gradable quadrants, from 0 to 4; and (3) posterior pole disease (none, pre-plus, plus). The accuracy of grading Keeler images for clinically significant ROP (defined as pre-plus or plus disease) was compared to results of clinical examination. RESULTS: One eye each of 253 infants was included. The mean postmenstrual age at examination was 35 weeks (range, 30-42). Grader 1 found the quality of 94% of images to be fair or good; grader 2, 83% of images. Grader 1 judged 87% of images to have ≥3 gradable quadrants; grader 2, 77% of images. The sensitivity and specificity of grading pre-plus or worse disease on Keeler images were 100% and 86%, respectively, for grader 1, and 94% and 89%, respectively, for grader 2. CONCLUSIONS: Digital retinal images obtained by the Keeler system can be read with high sensitivity and specificity to screen for clinically important ROP. The Keeler system may be a valuable tool for ROP screening at remote locations (ie, via telemedicine).

Asunto(s)

RESUMEN

PURPOSE: To evaluate the longitudinal reproducibility of optical coherence tomography (OCT) measurements in normal and glaucomatous eyes of children. METHODS: In this 2-setting prospective study, OCT-3 was used to obtain fast retinal nerve fiber layer (RNFL) and macular thickness scans. In the first study setting, the normal eyes of healthy children were scanned on presentation, at 2 weeks, and 3 years, with axial length measured at the first and last examinations. In the second setting, OCT scans of patients in the pediatric glaucoma clinic were performed over 4 years as clinically indicated. Eyes were classified as "normal" (normal eyes and those with physiologic cupping but normal intraocular pressure [IOP]); "mild glaucoma" (increased IOP and a normal optic nerve appearance); or "advanced glaucoma" (severe cupping or progressive glaucoma). Intraclass correlation coefficients were used to evaluate the reproducibility of measurements on the same day and over time. RESULTS: In the first setting, 8 normal eyes were included. Axial length increased 0.11 ± 0.04 mm/year over an average of 3.3 years (P = 0.03); there was no statistically significant change in RNFL thickness (P = 0.30). In our second setting, 27 normal eyes and 37 eyes with glaucoma were included. Intraclass correlation coefficients across the 3 visits for total macular volume were 0.80-0.91 and for average RNFL were 0.73-0.95. CONCLUSIONS: Global OCT measurements in children were reproducible over years and were not affected by normal increase in axial length. OCT shows promise as an objective tool for longitudinal assessment of children.

Asunto(s)

RESUMEN

PURPOSE: To report the unusual development of bilateral myelinated retinal nerve fibers (MRNF) adjacent to the optic nerve in a child after treatment of idiopathic intracranial hypertension (IIH) with unilateral optic nerve sheath fenestration (ONSF) and to discuss the etiology of acquired MRNF. METHODS: The patient's clinical history, including visual acuity, refractive error, ocular alignment, fundus examination, and optic nerve photographs, was retrospectively reviewed. A literature review was performed for acquired MRNF in children using PubMed. The results of the demographic and clinical findings of our patient were compared with those of previously reported cases. RESULTS: The child developed bilateral MRNF adjacent to the optic nerve 5 months after unilateral ONSF. In reviewing the literature, 8 of 10 cases of acquired MRNF in children had previous abnormalities of the optic nerve, 4 of 10 had associated bilateral optic nerve head drusen, 3 of 10 had associated optic nerve glioma, and 3 of 10 had a history of significant increased intracranial pressure requiring surgical intervention. CONCLUSIONS: Although the etiology of acquired MRNF is uncertain, this case plus a review of the literature suggest that it may be related to changes in the lamina cribosa combined with possible optic nerve injury caused by optic nerve head drusen, optic nerve glioma, or increased intracranial pressure and that it can occur months to years after intervention.

Asunto(s)

RESUMEN

PURPOSE: To compare Icare ONE tonometry by clinic examiner and parent/guardian to Goldmann applanation in children with known/suspected glaucoma; to evaluate the trend in intraocular pressure (IOP) with 4 repeated measurements using Icare ONE; and to evaluate the feasibility of instructing parents on the use of the Icare ONE device in the clinic setting. DESIGN: Nonrandomized, prospective clinical study. METHODS: Patients with known or suspected glaucoma were recruited from the Duke pediatric glaucoma clinic. Parent(s) of all subjects gave informed consent (and children gave assent) for participation in this research study. IOP was measured using Icare ONE by clinic examiner and parent/guardian, then using Goldmann applanation (masked physician). Each parent/guardian completed an ease-of-use survey. RESULTS: Sixty eyes (60 children) were included. Absolute value of mean IOP difference (ICare ONE clinic examiner vs Goldmann applanation) was 3.3 ± 4.0 mm Hg (P = .001). Icare ONE IOP by clinic examiner was within 3 mm Hg of Goldmann applanation in 68% (n = 41 eyes). In eyes with >3 mm Hg difference, Icare ONE was higher than Goldmann applanation in 84%. IOP demonstrated a statistically significant downward trend with repeated sequential measurements with Icare ONE (P = .0053, r(2) = 0.9894). All parents accomplished Icare ONE tonometry on at least 1 eye; 98% reported it was "easy to learn to use." CONCLUSION: Icare ONE tonometry appears accurate and well-tolerated compared to Goldmann applanation, and holds promise for clinic and home tonometry in children. IOP trends downward with successive measurements using Icare ONE, demonstrating a possible effect from presumed patient relaxation.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: To identify risk factors for infantile cataracts of unknown etiology. DESIGN: Case-control study. PARTICIPANTS: Case infants (n = 152) and control infants (n = 4205) enrolled in the National Birth Defects Prevention Study for birth years 2000-2004. METHODS: Multivariate analysis was performed exploring associations for risk factors for bilateral and unilateral infantile cataracts of unknown etiology. MAIN OUTCOME MEASURES: Infantile cataracts of unknown etiology. RESULTS: Maternal interviews were completed for 43 case infants with bilateral and 109 with unilateral infantile cataracts of unknown etiology. Very low birth weight (<1500 g) was associated with both unilateral (adjusted odds ratio [OR], 6.0; 95% confidence interval [CI], 2.2-16.3) and bilateral (OR, 13.2; 95% CI, 4.2-41.1) cataracts, whereas low birth weight (1500-2499 g) was only associated with bilateral cataracts (OR, 3.3; 95% CI, 1.3-8.1). Infants with unilateral cataracts were more likely to be born to primigravid women (OR, 1.6; 95% CI, 1.0-2.7) than women with > or =2 previous pregnancies, although this was of borderline significance. Although not significant, effect estimates were elevated suggesting a possible association between unilateral cataracts and maternal substance abuse during pregnancy, and between bilateral cataracts and urinary tract infection during pregnancy and aspirin use during pregnancy. CONCLUSIONS: Very low birth weight is associated with both bilateral and unilateral cataracts, whereas low birth weight is associated with bilateral cataracts and primigravidity with unilateral cataracts. Other associations, although not statistically significant, suggest risk factors that merit further research.

Asunto(s)

RESUMEN

OBJECTIVE: To report the clinicopathologic features of 2 patients with carcinosarcoma of the orbit. DESIGN: Case reports. PARTICIPANTS: Two patients with orbital carcinosarcoma were identified. METHODS: Retrospective chart review with clinicopathologic correlation and literature review. MAIN OUTCOME MEASURES: Clinical examination, imaging studies, and histopathologic findings. RESULTS: Two patients, a 56-year-old woman and a 91-year-old woman, with orbital carcinosarcoma were identified. Both tumors contained sarcomatous and carcinomatous components and invaded periorbital structures. CONCLUSIONS: Carcinosarcoma may arise in the orbit or extend into the orbit from the paranasal sinuses. This malignant neoplasm should be aggressively treated with a combination of surgical resection, chemotherapy, and radiation therapy.

Asunto(s)