1
|
Nayak S, Padhi TR, Mettla AL, Khanna RC. Universal eye screening: perinatal risk factors and ocular abnormalities in 1795 newborns not meeting retinopathy of prematurity criteria. Eye (Lond) 2024; 38:2216-2223. [PMID: 38971922 PMCID: PMC11269691 DOI: 10.1038/s41433-024-03162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 07/08/2024] Open
Abstract
OBJECTIVES This prospective cohort study aimed to investigate the ocular outcomes of universal eye screening in newborns and assess the relationship between different perinatal risk factors and various ocular abnormalities in infants who do not meet the criteria for retinopathy of prematurity (ROP) screening. METHODS An universal eye screening questionnaire was utilised to screen newborn babies who did not meet the ROP screening criteria within 72 h of birth at a public and private hospital between June 2016 and April 2018. The questionnaire covered demographic characteristics, neonatal history, and eye examination findings. A trained retina specialist conducted comprehensive anterior and posterior segment examinations utilising a binocular indirect ophthalmoscope. RESULTS Out of the 1795 newborns screened, 55.2% were male, and 44.8% were female. The most prevalent ocular abnormality observed was retinal haemorrhage (RH), with a prevalence of 10.64% (95% CI: 9.25-12.16%). The prevalence of non-RH abnormality was 7.5% (95% CI: 6.34-8.84%). The retinal haemorrhages were associated with normal vaginal deliveries (OR: 9.91; 95% CI: 6.71-14.64, p-value < 0.001), while non-RH abnormalities were associated with pre-term babies (OR: 4.87; 95% CI: 3.03-7.83, p < 0.001), consanguinity (OR: 2.20; 95% CI: 1.28-3.8, p < 0.001), low birth weight (OR: 0.22; 95% CI: 0.14-0.34, p < 0.001) and systemic abnormalities (OR: 3.08; 95% CI: 1.94-4.91, p < 0.001). CONCLUSIONS Sight-threatening ocular pathology in newborns may be linked to perinatal risk factors such as preterm birth, low birth weight, consanguinity, and systemic abnormalities. Accordingly, it may be prudent to consider specialized ocular screening protocols for neonates within this high-risk cohort in future prospective studies.
Collapse
Affiliation(s)
- Sameera Nayak
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (Kode Venkatadri Chowdary Campus), Vijayawada, Andhra Pradesh, India
- David Brown Children Eye Care Centre (DBCECC), L V Prasad Eye Institute (Kode Venkatadri Chowdary Campus), Vijayawada, Andhra Pradesh, India
| | - Tapas Ranjan Padhi
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
- Miriam Hyman Children's Eye Care Centre (MHCECC), L V Prasad Eye Institute (MithuTulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India.
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
| |
Collapse
|
2
|
Moshfeghi HP, Patel NA, Callaway NF. Neonatal Macular Hemorrhage in a Term Healthy Infant: 18-Year Follow-up. Ophthalmic Surg Lasers Imaging Retina 2024; 55:354-357. [PMID: 38648427 DOI: 10.3928/23258160-20240222-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Unobstructed binocular vision is required during the critical period of vision development to obtain optimal visual acuity in each eye and binocular stereopsis. In this article, we report 18-year follow-up of a full-term, otherwise healthy infant noted to have dense premacular hemorrhage occluding the visual axis in the left eye on retinal imaging performed 48 hours after birth. Serial examinations by the retina service were performed weekly for 10 weeks as the hemorrhage resolved spontaneously. Shortly thereafter, visual acuity revealed fixation was present, but the mother noted intermittent left eye esodeviation. At 90 days of life, the infant was seen by pediatric ophthalmology and started on 1 to 2 hours patching of the right eye daily for the esotropia, which was maintained through 24 months. At 18 years of age, the patient had orthophoria alignment, no spectacle correction, vision of 20/20 in the right eye and 20/25 in the left eye, and normal binocularity and stereopsis. Intermittent esodeviation on the left eye was observed when the patient was fatigued. Early identification of a visual axis occlusion led to prompt referral for the esotropia and initiation of patching therapy. This patient ultimately achieved a very favorable visual functional outcome that may not have been possible without early detection and management. This case report describes the longest-term published follow-up of a neonatal macular hemorrhage. [Ophthalmic Surg Lasers Imaging Retina 2024;55:354-357.].
Collapse
|
3
|
Lam MR, Yang CD, Colmenarez JA, Dong P, Gu L, Suh DW. The role of intrapartum fetal head compression in neonatal retinal hemorrhage. J AAPOS 2023; 27:267.e1-267.e7. [PMID: 37722620 DOI: 10.1016/j.jaapos.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE Neonatal retinal hemorrhage is a common finding in newborns, but the underlying mechanisms are not fully understood. A computational simulation was designed to study the events taking place in the eye and orbit when the head is compressed as the neonate passes through the birth canal. METHODS A finite element model of the eye, optic nerve sheath, and orbit was simulated and subjected to forces mimicking rises in intracranial pressure (ICP) associated with maternal contractions during normal vaginal delivery. Resulting changes in intraocular pressure (IOP), pressure in the optic nerve sheath, and stress within the sclera and retina were measured. RESULTS During contractions, increased ICP was transmitted to the orbit, globe, and optic nerve sheath. IOP rose by 2.71 kPa near the posterior pole. Pressure at the center of the optic nerve sheath rose by 7.31 kPa and up to 9.30 kPa at its interface with the sclera. Stress in the retina was highest near the optic disk and reached 10.93, 10.99, and 13.28 kPa in the preretinal, intraretinal, and subretinal layers, respectively. Stress in the sclera peaked at 12.76 kPa. CONCLUSIONS Increasing ICP associated with natural vaginal delivery increases intraorbital pressure, which applies stress to the retina. Associated retinal deformation may cause tearing of the retinal vasculature. Increased pressure within the optic nerve sheath may occlude the central retinal vein, resulting in outflow obstruction and subsequent rupture. Forces accumulated near the optic disk, likely accounting for the tendency of neonatal retinal hemorrhage to occur posteriorly.
Collapse
Affiliation(s)
- Matthew R Lam
- Creighton University School of Medicine, Phoenix, Arizona.
| | - Christopher D Yang
- Department of Ophthalmology and Visual Sciences, University of California, Irvine School of Medicine, Irvine, California; Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California
| | - Jose A Colmenarez
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Pengfei Dong
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Linxia Gu
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, Florida
| | - Donny W Suh
- Department of Ophthalmology and Visual Sciences, University of California, Irvine School of Medicine, Irvine, California; Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California
| |
Collapse
|
4
|
Christian CW, Binenbaum G. The eye in child abuse. Childs Nerv Syst 2022; 38:2335-2344. [PMID: 35871261 DOI: 10.1007/s00381-022-05610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Child physical abuse may result in a range of injuries to the globe and surrounding tissues. These injuries have varying degrees of specificity for abuse, and no pattern of injury is unique to abuse. Easily overlooked eye injuries in non-ambulatory infants often portend more severe abuse and require careful evaluation for occult injury when they are unexplained. Retinal hemorrhages are most often a sign of significant trauma and the severity of the hemorrhages generally parallels the severity of neurological trauma. Ophthalmologists contribute important data that more easily distinguish medical disease from trauma, but caution is needed in differentiating accidental from inflicted trauma. This distinction requires careful consideration of the complete clinical data and occasionally on additional law enforcement or child welfare investigation.
Collapse
Affiliation(s)
- Cindy W Christian
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA.
| | - Gil Binenbaum
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Ophthalmology, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
5
|
Yang T, Hu R, Chen J, Lu Y, Guo Y, Liu Y, Yu R, Jin G. Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13927. [PMID: 36360805 PMCID: PMC9654104 DOI: 10.3390/ijerph192113927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Neonatal retinal hemorrhage (RH) is the most common ocular fundus disease among newborns. Early detection and timely intervention are vital for reducing the risk of visual impairment caused by RH. However, little is known about the prevalence, characteristics, and risk factors of RH in southern China. Full-term infants born in Qingyuan City during the first 10 days of each month in 2021 were included in this study. All infants underwent RetCam III retinal examinations. Detailed information on retinal hemorrhage, including involved eyes, bleeding severity, and affected area (extrafoveal macula, fovea, or optic disc), and clinical information on the neonates and their mothers was collected. The results showed that among the 1072 eligible neonates, 266 (24.8%) had neonatal retinal hemorrhage. Consistent bilateral retinal hemorrhage severity was observed in 83.2% of the cases. The prevalence of optic disc involved RH, extrafoveal macular involved RH and foveal involved RH were 23.7%, 81.2% and 2.63%, respectively. Multivariate logistic regression analysis showed that lower birth weight (OR, 0.63; 95% CI, 0.40-0.99; p < 0.05) and vaginal delivery (OR, 20.6; 95% CI, 9.10-46.5; p < 0.001) were risk factors of neonatal RH. The area under the ROC curve of vaginal delivery, combined with birth weight, as predictors of neonatal RH was 0.73, with 85.3% sensitivity and 23.9% specificity. The birth weight cutoff was 3460 g. Our results suggested that neonatal RH is common in full-term neonates in southern China. It usually has the same severity in both eyes and mostly involves the extrafoveal macular region. Vaginal delivery and low birth weight are risk factors for neonatal RH.
Collapse
Affiliation(s)
- Tingting Yang
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, China
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Rongsheng Hu
- Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Jiansu Chen
- Institute of Ophthalmology, Medical College, Jinan University, Guangzhou 510632, China
| | - Yamei Lu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Yonglong Guo
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yao Liu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Ruixia Yu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China
| |
Collapse
|
6
|
Ozturk T, Durmaz Engin C, Karatas Yigitaslan E, Yaman A, Berk T. Accidentally diagnosed ocular abnormalities identified during close screening for retinopathy of prematurity. Eur J Ophthalmol 2022; 32:3267-3273. [PMID: 35261269 DOI: 10.1177/11206721221086252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the variety of ocular findings which have been identified serendipitously during the screening for retinopathy of prematurity (ROP) in a tertiary referral center during seven-year period. METHODS The charts of 1568 preterm infants who screened for ROP were reviewed retrospectively. Any ocular lesion except for ROP were noted. All infants had undergone routine ocular examination of the external eye, pupillary light reflex, anterior and posterior segment. Wide-angle digital retinal image acquisition system for any vitreoretinal pathology requiring a close follow-up had been utilized. RESULTS Abnormal ocular findings other than ROP were diagnosed in 296 infants (19.2%). Tunica vasculosa lentis was the most common finding (25%) followed by vitreous or retinal hemorrhages (17.2%) and retinal white lesions (16.6%). Retina was the most frequently involved anatomic site. Other frequent ocular findings included optic disc cupping, congenital cataract, optic nerve hypoplasia, choroidal nevus, persistent fetal vasculature, lid hemangioma, and tilted disc. However, life-threatening pathologies such as lipemia retinalis and even retinoblastoma were also diagnosed. CONCLUSION A duly ophthalmologic examination is mandatory in premature infants for ROP screening. During such examinations, ophthalmologists must be aware of coexisting ocular findings; which could be sight-threatening or even life-threatening.
Collapse
Affiliation(s)
- Taylan Ozturk
- Department of Ophthalmology, 37508Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ceren Durmaz Engin
- Department of Ophthalmology, 64073Karadeniz Eregli State Hospital, Zonguldak, Turkey
| | | | - Aylin Yaman
- Department of Ophthalmology, 37508Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tulin Berk
- Department of Ophthalmology, 37508Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
7
|
Vaslow DF. Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants. Neuroradiol J 2022; 35:53-66. [PMID: 34167377 PMCID: PMC8826291 DOI: 10.1177/19714009211026904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the "consensus" opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson's syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.
Collapse
Affiliation(s)
- Dale F Vaslow
- Department of Radiology, Harry S.
Truman Veterans Administration Hospital, Columbia, MO, USA,Dale F Vaslow, 2504 Lenox Place, Columbia,
MO 65203, USA.
| |
Collapse
|
8
|
Wood EH, Capone A, Drenser KA, Berrocal A, Hubbard GB, Callaway NF, Kychenthal A, Ells A, Harper CA, Besirli CG, Baumal CR, Vavvas DG, Chang EY, Nudleman ED, Tsui I, Sears J, Vajzovic L, Hartnett ME, Shapiro MJ, Quiram PA, Ozdek S, Kusaka S, Wu WC, Trese MT. Referable Macular Hemorrhage-A Clinically Meaningful Screening Target in Newborn Infants. Position Statement of the Association of Pediatric Retina Surgeons. Ophthalmic Surg Lasers Imaging Retina 2022; 53:3-6. [PMID: 34981999 DOI: 10.3928/23258160-20211214-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Universal newborn eye screening facilitates early diagnosis of ocular abnormalities and mitigates vision loss. "Referral warranted" eye disease is present at birth in about 5.5% of term infants, with "macular hemorrhage impinging on the fovea" representing about 50% of referral warranted disease. The Association of Pediatric Retina Surgeons held a symposium on February 9, 2021 that culminated in a position statement on "referable macular hemorrhage" (RMH) in newborn infants. RMH is meaningful in that in can cause amblyopia through deprivation, can be readily captured with wide-angle photography in a safe and efficient manner, and may lead to early intervention with mitigation of vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:3-6.].
Collapse
|
9
|
Kumm J. Newborn Eye Screening as an Application of AI. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S17-S22. [PMID: 34908492 DOI: 10.3928/23258160-20211115-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Artificial intelligence (AI) applications are diverse and serve varied functions in clinical practice. The most successful products today are clinical decision tools used by physicians, but autonomous AI is gaining traction. Widespread use of AI is limited in part because of concerns about bias, fault-tolerance, and specificity. Adoption of AI often depends on removing cost and complexity in clinical workflow integration, providing clear incentives for use, and providing clear demonstration of clinical outcome. Existing wide-angle photographic screening could be integrated into the clinical workflow based on prior implementations for premature babies and linked with AI interpretation with existing technology. Incidence of retinal abnormality, clinical considerations, AI performance, grading variation for AI-augmented human grading, and cost and policy aspects play a significant role. Improved outcomes for newborns and a relatively high estimated incidence of abnormality have been named as benefits to counterweigh costs in the long term. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S17-S22.].
Collapse
|
10
|
Azad AD, Al-Moujahed A, Ludwig CA, Vail D, Callaway NF, Rosenblatt TR, Kumm J, Moshfeghi DM. The Utility of Universal Newborn Eye Screening: A Review. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S6-S16. [PMID: 34908491 DOI: 10.3928/23258160-20211115-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Universal newborn eye screening can identify ocular abnormalities early and help mitigate long-term visual impairment. Traditional neonatal and infant eye screening is administered by neonatologists and pediatricians using the red reflex test. If this test identifies an ocular abnormality, then the patient is examined by an ophthalmologist. Notably, the red reflex test may be unable to detect amblyogenic posterior segment pathology. Recent studies using fundus imaging and telemedicine show reduced cost of human resources and increased sensitivity compared with traditional approaches. In this review, the authors discuss universal newborn eye screening pilot programs with regard to disease prevalence, referral-warranted disease, and cost-effectiveness. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S6-S16.].
Collapse
|
11
|
Cho IH, Kim MS, Heo NH, Kim SY. Birth-related retinal hemorrhages: The Soonchunhyang University Cheonan Hospital universal newborn eye screening (SUCH-NES) study. PLoS One 2021; 16:e0259378. [PMID: 34752467 PMCID: PMC8577753 DOI: 10.1371/journal.pone.0259378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI). Methods Newborns who underwent WFDRI at 61 obstetrics/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns’ eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and/or optic nerve (ON) involvement were compared. Results Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277–21.393; P < 0.001) on multivariate analysis. Bilateral RHs (8414/13026; 64.59%) were more common than unilateral RHs (4612/13026; 35.41%); however, unilateral RHs (2383/4217; 56.51%) were more common than bilateral RHs (1834/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (P = 0.493). Most RHs were intraretinal (18678/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072/7090; 99.75%), mild (4953/4960; 99.86%), and moderate (2013/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843/7355; 65.85%); and RHs in zone III were rare (7/21440; 0.03%). Most RHs showed no macular and/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111/7355; 96.68%). Conclusions Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs.
Collapse
Affiliation(s)
- In Hwan Cho
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Min Seong Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University, Cheonan, Korea
| | - So Young Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
- * E-mail:
| |
Collapse
|
12
|
Retinal abnormalities in universal eye screening of healthy, full-term newborn infants in Jakarta. The incidence and its risk factors: a pilot study. Int J Retina Vitreous 2021; 7:67. [PMID: 34732253 PMCID: PMC8564954 DOI: 10.1186/s40942-021-00337-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Aim To screen for ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 h after birth using the RetCam shuttle (Natus Medical Incorporated, USA). Retinal findings were documented and analyzed according to obstetric and neonatal risk factors. Results Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common finding (88%) in which 2.67% involved the macula, followed by chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18–0.41, p < 0.001) was a protective factor against RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24–2.72, p = 0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19–0.44, p < 0.001), while other risk factors were not. Conclusions Our study showed that universal eye screening in healthy neonates is beneficial in the early diagnosis, monitoring and treatment of ocular abnormalities such as retinal hemorrhage, chorioretinitis and retinoblastoma. Retinal hemorrhage is the most common ocular abnormality and is associated with the delivery method and the duration of labor. Universal eye screening is visual-saving and life-saving for neonates with chorioretinitis, retinoblastoma as well as other abnormalities and should be mandatory in newborn screening.
Collapse
|
13
|
Cunha LP, Cavalcante Costa MAA, Miranda HA, Reis Guimarães J, Aihara T, Ludwig CA, Rosenblatt T, Callaway NF, Pasricha M, Al‐Moujahed A, Vail D, Ji MH, Kumm J, Moshfeghi DM. Comparison between wide-field digital imaging system and the red reflex test for universal newborn eye screening in Brazil. Acta Ophthalmol 2021; 99:e1198-e1205. [PMID: 34032022 DOI: 10.1111/aos.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. METHODS Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. CONCLUSION While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.
Collapse
Affiliation(s)
| | | | | | | | - Teruo Aihara
- Irmandade Santa Casa de Misericórdia de São Paulo São Paulo Brazil
| | - Cassie A. Ludwig
- Stanford University Byers Eye Institute Palo Alto CA USA
- Retina Service Department of Ophthalmology Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | | | | | | | | | - Daniel Vail
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Marco H. Ji
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Jochen Kumm
- Stanford University Byers Eye Institute Palo Alto CA USA
| | | |
Collapse
|
14
|
A meta-analysis of prognostic biomarkers in neonatal retinal hemorrhage. Int Ophthalmol 2021; 42:677-688. [PMID: 34623569 DOI: 10.1007/s10792-021-02055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Neonatal retinal hemorrhage (RH) is a frequently occurring neonatal fundus condition and a very common ocular abnormality in neonates. Some of the key factors that influence the rate of RH are the mode of delivery, examination techniques, and time of examination after birth. The prognostic markers of severe RH are poorly known, making it difficult for an efficient diagnosis, prognosis, and treatment. Hence, to better understand the mechanism of disease, its study at the molecular level is required. Prognostic biomarkers are an essential tool for understanding the pathogenesis of the disease. In this paper, we present a meta-analysis of biomarkers to understand disease pathogenesis and support better diagnosis, prognosis, and treatment of neonatal RH. METHODS The meta-analysis was carried out by following the recommendation of PRISMA. The relevant articles were crawled using a systematic keyword using MeSH terms from the MEDLINE, PubMed, and Scopus databases, which were subjected to manual screening for reported biomarkers by two independent reviewers. The obtained biomarkers were further analyzed for gene-disease association and functional enrichment analysis. RESULTS Our meta-analysis suggests that genes ABCC6, Beta-APP, COL2A1, COL4A1, DNM2, ENPP1, IKBKG, ITGB2, IL-6, SELE, TREX1, and VEGFA are potential prognostic biomarkers associated with the neonatal RH. The gene-disease association and functional enrichment analysis suggest that few genes are associated with disease class "Vision"; however, some genes in the list are associated with the disease class "Pharmacogenomic," "Immune," "Renal." CONCLUSION The identified prognostic gene biomarkers may help to understand disease pathogenesis and provide a better diagnosis, prognosis, and treatment of neonatal RH.
Collapse
|
15
|
Fowler BJ, Simon L, Scott NL, Negron CI, Berrocal AM. Case report: Vitreous hemorrhage as the presenting sign of retinal cavernous hemangioma in a newborn. Am J Ophthalmol Case Rep 2021; 23:101174. [PMID: 34381923 PMCID: PMC8332665 DOI: 10.1016/j.ajoc.2021.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To report a case of vitreous hemorrhage as the presenting sign of retinal cavernous hemangioma (RCH) in a newborn. Observations A five-week-old full-term male with a history of seizures and birth trauma underwent ophthalmology screening. Initial eye examination revealed vitreous hemorrhage. Subsequent examination under anesthesia with multi-modal imaging revealed vitreous hemorrhage and an intra-retinal mass with numerous sac-like aneurysmal dilatations, consistent with RCH. Conclusions and importance Vitreous hemorrhage in a neonate is an atypical presentation of RCH. Clinicians should be aware that birth trauma may lead to vitreous hemorrhage from RCH. This is the first description of RCH, a rare retinal vascular tumor, in a newborn.
Collapse
Affiliation(s)
- Benjamin J Fowler
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilla Simon
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Nathan L Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Catherin I Negron
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
16
|
Hemalatha BC, Kalpana BN, Shilpa YD, Ravi B, Bhavana G, Meghana S, Basumatary J. Retinopathy of prematurity screening and retinal hemorrhages - Our experience among Indian babies. Indian J Ophthalmol 2021; 69:2147-2150. [PMID: 34304198 PMCID: PMC8482916 DOI: 10.4103/ijo.ijo_3616_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the clinical characteristics of intraocular hemorrhages among babies screened for retinopathy of prematurity (ROP) and thereby their additional risk to the progression of ROP. Methods A descriptive study was conducted at a tertiary referral hospital, which included 108 eyes of 60 neonates who were discovered to have retinal hemorrhages on retinal screening of 540 babies at risk for ROP. Maternal, obstetric, and neonatal risk factors were assessed in neonates with retinal hemorrhages. Retinal hemorrhages were assessed in terms of type, area, and relation to different retinal zones. Results Among 540 neonates who were screened, retinal hemorrhages were found in 11.2% (n = 60 babies). Elderly primigravida mothers and spontaneous vaginal deliveries with prolonged second stage of labor were a common maternal risk factors for retinal hemorrhages. Low birth weight and preterm were fetal risk factors with neonatal retinal hemorrhages. These hemorrhages were more often bilateral (no. of babies = 48, 80%). Flame-shaped hemorrhages were more common than dot and blot ones. The majority of cases (no. of eyes = 74, 65%) resolved within 4 weeks, whereas four babies (8 eyes, 7.4%) progressed to ROP were treated with laser. Conclusion Retinal hemorrhages in neonates are commonly associated with prolonged duration of second stage of labor, advanced maternal age, and anemia. Although not all progress to ROP, recognizing preterm and low birth weight babies with junctional hemorrhages is crucial not to delay the treatment. Regular follow-up until the clearance of hemorrhages and monitoring systemic conditions in these babies of amblyogenic age-group are required.
Collapse
Affiliation(s)
- B C Hemalatha
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - B N Kalpana
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Y D Shilpa
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - B Ravi
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - G Bhavana
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - S Meghana
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Jessica Basumatary
- Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| |
Collapse
|
17
|
Mehner LC, Singh JK. Ocular Disorders in the Newborn. Neoreviews 2021; 22:e461-e469. [PMID: 34210810 DOI: 10.1542/neo.22-7-e461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Visual development begins at birth and continues throughout childhood. Ocular pathology can lead to permanent visual impairment and subsequent problems in overall development and school performance as well as signify serious systemic disease or even life-threatening malignancies. Prompt identification of congenital or early acquired ocular pathology via regular bedside ocular examinations and assessments of visual behaviors by neonatal clinicians is a critical component of newborn care. The goal of this article is to review the components of the newborn eye examination, describe key ocular findings and diagnoses that are common or critical to identify in the newborn period, and offer guidance on necessity and timing of ophthalmology referral.
Collapse
Affiliation(s)
- Lauren C Mehner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
18
|
Sun L, Jiang Z, Li S, Liu J, Su M, Lu Y, Li Z, Ding X. What Is Left After Resolution of Neonatal Retinal Hemorrhage: The Longitudinal Long-term Outcome in Foveal Structure and Visual Function. Am J Ophthalmol 2021; 226:182-190. [PMID: 33556380 DOI: 10.1016/j.ajo.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Neonatal retinal hemorrhage (NRH) is one of the most common neonatal fundus conditions. Hemorrhage resolves spontaneously; however, its long-term outcome is unknown yet. The current study explores the long-term role of NRH in foveal structure and visual function. DESIGN Cohort study (a prospective longitudinal study, in which the participants were followed up for 4-6 years). METHODS A total of 125 healthy newborns during 2013-2015, including 50 newborns with NRH and 75 newborns without NRH, were enrolled. The eyes with NRH were further categorized into the foveal hemorrhage (FH) group and non-FH group. A comprehensive ophthalmic examination including best-corrected visual acuity (BCVA) measurement, slit-lamp examination, refractive error measurement, scanning laser ophthalmoscopy, and spectral-domain OCT was performed. Total retinal thickness (TRT) and the inner and outer retinal layers in the fovea were measured and compared. RESULTS The NRH was absorbed within 2.1 ± 0.98 weeks (median: 3 weeks). No difference was noted in the demographic characteristics between the groups; there was no significant difference in the logMAR BCVA (P = .83) or in the TRT. Subgroup analysis showed that TRT at the fovea in the FH group was significantly thicker (P = .005). Segmentation analysis showed a significantly thicker foveal outer nuclear layer (ONL) in the FH group (P = .017). CONCLUSIONS Birth-related retinal hemorrhage, even FH, might not lead to obvious visual abnormalities at the age of 4 years, at least according to this study with relatively small sample size. However, a thicker fovea, mainly attributed to a wider ONL and a shallower foveal pit, is noted in our study.
Collapse
|
19
|
Fei P, Liu Z, He L, Li N, Xu L, Zhang M, Zhou Y, Li F, Wang H, Zhang Q, Huang Q, Li Y, Chen S, Guo W, Li Y, Liu Y, Lu J, Wang Y, Zhu X, Wang L, Wang Y, Xian J, Xu Y, Ji X, Liang T, Ren J, Zhang X, Li J, Zhao P. Early detection of ocular abnormalities in a Chinese multicentre neonatal eye screening programme-1-year result. Acta Ophthalmol 2021; 99:e415-e422. [PMID: 32930484 PMCID: PMC8246721 DOI: 10.1111/aos.14586] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Early detection of ocular abnormalities in newborns is essential for timely diagnosis and treatment. This study aimed to assess the 1-year result of a multicentre prospective neonatal eye examination programme with wide-field digital imaging system in China. METHODS A multicentre collaborative prospective study group for neonatal eye screening was established in nine hospitals, including eight Maternal and Children's Hospitals, and one general hospital across China from July 2016 to June 2017. Ocular examinations were performed on newborns within 28 days after birth using a wide-field digital imaging system. Data were reviewed and analysed. The primary outcome was the prevalence of ocular abnormalities in neonates. RESULTS We detected 13 514 (20.91%) abnormal cases in 64 632 newborns. The most frequent abnormality was retinal haemorrhage (RH; 11.83%). Most of mild RH resolved spontaneously. Among those who were beyond retinopathy of prematurity (ROP) screening criteria of China (gestational age ≥32 w and birthweight ≥2000 g), the total number of neonates with ocular abnormality was 12 218/62 799(19.45%). 59.44% of neonatal ocular abnormalities detected (accounting for 11.56% of all the screened population) needed further interference or observation. Among them, 258 patients (0.41% of all the screened population) needed immediate or timely intervention, including congenital cataract, retinal detachment, retinoblastoma and other ocular abnormalities. One thousand and ninety-eight patients (1.75% of all the screened neonates) should be followed up closely and needed further diagnosis or intervention if necessary, such as ROP or ROP-like retinopathy, familial exudative vitreoretinopathy and persistent hyperplasia of primary vitreous. Five thousand nine hundred and six patients (9.4%) with minor clinical significance needed short-term follow-up. CONCLUSIONS This prospective multicentre study of newborn ocular examination showed a relatively high prevalence of ocular abnormalities. There are a relatively high percentage of congenital eye pathology that required further referral and treatment in those neonates who were not screened routinely. According to the benefits and risks associated with neonatal eye examinations, neonatal ocular screening programme can detect ocular abnormalities at the very early stage and may play a positive role in promoting paediatric eye health.
Collapse
Affiliation(s)
- Ping Fei
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Zijiang Liu
- Department of Ophthalmology Urumqi Maternal and Child Health Hospital Xinjiang China
| | - Liying He
- Department of Ophthalmology Chongqing Health Center for Women and Children Chongqing China
| | - Na Li
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Lihua Xu
- Department of Ophthalmology Dezhou Women's and Children's Hospital Shandong China
| | - Meiju Zhang
- Department of Ophthalmology Women and Children’s Health Care Hospital of Linyi Shandong China
| | - Yu Zhou
- Department of Ophthalmology Maternity and Child Health Care of Guangxi Zhuang Autonomous Region Giangxi China
| | - Fuxin Li
- Department of Ophthalmology Jilin Women and Children Health Hospital Jilin China
| | - Hong Wang
- Department of Ophthalmology Maanshan Wemen and children's Hospital Anhui China
| | - Qi Zhang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Qiujing Huang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Yi'an Li
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Shuangshuang Chen
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Wei Guo
- Department of Ophthalmology Jilin Women and Children Health Hospital Jilin China
| | - Yun Li
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Ya Liu
- Department of Ophthalmology Chongqing Health Center for Women and Children Chongqing China
| | - Jun Lu
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Ying Wang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
- Department of Ophthalmology Dezhou Women's and Children's Hospital Shandong China
| | - Xiuyu Zhu
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Lei Wang
- Department of Ophthalmology Urumqi Maternal and Child Health Hospital Xinjiang China
| | - Yanhong Wang
- Department of Ophthalmology Women and Children’s Health Care Hospital of Linyi Shandong China
| | - Jianying Xian
- Department of Ophthalmology Maternity and Child Health Care of Guangxi Zhuang Autonomous Region Giangxi China
| | - Yu Xu
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Xunda Ji
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Tingyi Liang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jianing Ren
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Xi Zhang
- Clinical Research Unit Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jing Li
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Peiquan Zhao
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| |
Collapse
|
20
|
Gjerde H, Mantagos IS. Charting the Globe: How Technologies Have Affected Our Understanding of Retinal Findings in Abusive Head Trauma/Shaken Baby Syndrome. Semin Ophthalmol 2021; 36:205-209. [PMID: 33793387 DOI: 10.1080/08820538.2021.1890150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: Ocular findings such as retinal hemorrhages are common in abusive head trauma (AHT). Binocular indirect ophthalmoscopy has been the standard for assessing the eyes of children who are victims of AHT. However, technological advances have changed our understanding of retinal findings in AHT.Methods: Literature review on AHT - retinal findings, imaging technologies, models of representation, and telemedicine applications.Results: Many studies suggest vitreoretinal traction from repetitive acceleration-deceleration shearing forces during shaking plays an important role in the development of retinal findings in AHT. This is further supported by different imaging modalities [optical coherence tomography (OCT); magnetic resonance imaging (MRI); fluorescein angiography (FA)] and models of representation (animal and mechanical models; finite element analysis).Conclusion: Emerging technologies have augmented our diagnostic abilities, enhanced our understanding regarding the pathophysiology of retinal findings, and strengthened the link between vitreoretinal traction and ocular pathology in AHT. Telemedicine is also starting to play an important role in AHT.
Collapse
Affiliation(s)
- Harald Gjerde
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Teow Kheng Leong K, Abu Kassim SNA, Sidhu JK, Zohari Z, Sivalingam T, Ramasamy S, Mohd Khialdin S, Mohd Nordin N, Rahmat J. Neonatal eye screening for 203 healthy term new-borns using a wide-field digital retinal imaging system. BMC Ophthalmol 2021; 21:128. [PMID: 33750348 PMCID: PMC7941744 DOI: 10.1186/s12886-021-01882-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background The current practice for new-born eye examination by an Ophthalmologist in Malaysian hospitals is limited to only preterm new-borns, syndromic or ill infants. Healthy term new-borns are usually discharged without a thorough eye examination. This study is aimed at determining the proportion and types of ocular abnormalities detected in purportedly healthy term new-borns. Method This cross-sectional study is comprised of 203 participants, all purportedly healthy term new-born infants from the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a 6 months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared and correlated with similar studies published in the literature previously. Results Total ocular abnormalities were detected in 34% of the infants. The most common finding was retinal haemorrhage in 29.6% of the infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of new-borns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1-min increment in the duration of 2nd stage of labour. Conclusion Universal eye screening for all new-borns using a wide-field digital imaging system is realistically possible, safe, and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage.
Collapse
Affiliation(s)
- Kenneth Teow Kheng Leong
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia. .,Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia.
| | | | - Jasvinjeet Kaur Sidhu
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Zayani Zohari
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Thivakar Sivalingam
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Sunder Ramasamy
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Safinaz Mohd Khialdin
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics & Gynaecology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Jamalia Rahmat
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| |
Collapse
|
22
|
Ali SMA, Ossuetta I, Dahlmann-Noor A, Jayaram H, Kozak I. Comprehensive Ocular Examination of Healthy Newborns in the Middle East. Ophthalmic Epidemiol 2020; 28:306-311. [PMID: 33213247 DOI: 10.1080/09286586.2020.1849740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To report the prevalence of the perinatal ocular disease in healthy infants referred to a referral eye centre in the Middle East region for comprehensive ocular examinations.Methods: All healthy full-term babies born at a tertiary care women's and children hospital were referred to Moorfields Eye Hospital Centre in Abu Dhabi (MEHCAD), the United Arab Emirates for comprehensive ocular examination between January 2018 and April 2019. The examination included red-reflex testing, external, anterior and dilated posterior segment examination, and refraction.Results: Out of 6836 newborns, 4719 (69%) were not referred due to lack of national insurance (n = 3089), out of network referral (n = 1405), required ROP screening (n = 220) and identification of systemic diagnosis (n = 5). Of 2117 eligible referrals 897 (42%) babies were not examined because they either did not attend (890) or had a double booking for ROP screening (7); hence, 1220 babies (56%) were examined. Their mean age was 39 ± 16 days, and 48.8% were male, 51.2% were female. One hundred and sixty-four (13.4%) babies had an ocular abnormality in 249 (10.2%) eyes. The commonest abnormalities were nasolacrimal duct obstruction (36%) and refractive errors in 53 patients (32.3%). Congenital cataract and ptosis were present in four (0.3%) and three (0.2%) babies, respectively. The commonest retinal findings were intra-retinal haemorrhages (1.4%). Other posterior pole abnormalities included optic disc pit (0.08%) and myelinated nerve fibers (0.08%). One eye (0.08%) had a congenital macular hole.Conclusion: Comprehensive ocular examinations of healthy infants identifies a number of ocular abnormalities that would not be detected using red-reflex testing by a paediatrician or nurse.
Collapse
Affiliation(s)
- Syed M A Ali
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iviano Ossuetta
- Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates
| | | | | | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
23
|
Kozner P, Stepankova J, Dotrelova D. Long-term evaluation of pars plana vitrectomy in children with Abusive head trauma. Eur J Ophthalmol 2020; 32:553-558. [PMID: 33118379 DOI: 10.1177/1120672120968760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the efficacy of pars plana vitrectomy (PPV) in children with intraocular hemorrhage (IOH) secondary to Abusive head trauma (AHT). METHODS A long-term retrospective analysis evaluating epidemiology, management, safety, anatomical and functional results of PPV for IOH in children with AHT at tertiary referral center for children in the Czech Republic from 2004 to 2017. RESULTS 18 children were identified with IOH due to AHT during observation period of 14 years. Overall incidence of IOH related to AHT was 29.6/100 000, in children under 1 year 22.2/100 000, in children 1 to 5 years 7.4/100 000. Mean age at the time of diagnosis was 13.7 (SD±20.53) months, median 5 months. IOH resolved in 56% of children, 64% eyes, spontaneously. 44% children, 36% eyes, underwent PPV. PPV was performed 30.5 (SD±16.98) days after established diagnosis on average. Postoperatively, 80% of eyes had anatomical improvement, 20% eyes had preexisting irreversible changes in the posterior pole. Vision of 50% eyes improved after surgery, vision of 20% eyes remained poor, 30% of eyes was not possible to test due to severe neurological impairment. Mean observational period was 33.4 (SD±38.21) months. Mortality rate of AHT in our group was 17%, all victims were younger 4 months. CONCLUSIONS PPV is a safe and effective procedure to clear IOH in children with AHT. Ophthalmology outcomes are strongly associated with degree of neurological impairment. Best outcomes were achieved with PPV performed between 2 and 5 weeks after trauma. Opportunity to plan surgery within this time frame indicates a good neurological prospect and prevents deprivation amblyopia.
Collapse
Affiliation(s)
- Pavel Kozner
- Department of Ophthalmology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jana Stepankova
- Department of Ophthalmology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Dagmar Dotrelova
- Department of Ophthalmology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
24
|
|
25
|
Viquez MV, Wu L. Sensitivity and specificity of the red reflex in Costa Rican newborns. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:4-8. [PMID: 31826811 DOI: 10.1016/j.oftal.2019.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/06/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the results of indirect ophthalmoscopy versus determination of the red reflex in newborns admitted to the intermediate neonatal intensive care unit. METHODS All the patients (71) admitted to the intermediate neonatal intensive care unit from July to September of 2017 were screened with the red reflex. Immediately afterwards, they were pharmacologically dilated and indirect ophthalmoscopy was performed. All of the red-reflex screening and the funduscopic examination were performed by the same evaluator. RESULTS A total of 14.1% (20/142) of the eyes had an altered red reflex. Indirect ophthalmoscopy revealed that 21.8% (31/142) of the eyes had intraocular abnormalities. Two of these eyes had optic nerve colobomas, two eyes had cataracts, and the rest had intra-retinal haemorrhages. Indirect ophthalmoscopy revealed that only 35% (7/20) of the eyes with an altered red reflex had intraocular disease. Indirect ophthalmoscopy also revealed that intraocular disease was present in 77.4% (24/31) of the eyes despite a normal red reflex. The false positive rate of the red reflex was calculated to be 9.2%, and the false negative rate was 16.9%. The sensitivity of the red reflex was only 56.4%, and the specificity was 89.5%. The positive predictive value was 70.4%, and the negative predictive value was 82.2%. CONCLUSIONS Neonatal screening with the red reflex is not sufficient to detect intraocular disease. A normal neonatal red reflex does no exclude intraocular disease. It has a specificity of nearly 90%, but its sensitivity is only 56%. Most retinal haemorrhages are undiagnosed as they cannot be detected with a red reflex.
Collapse
Affiliation(s)
- M V Viquez
- Caja Costarricense del Seguro Social, San José, Costa Rica
| | - L Wu
- Asociados de Mácula, Vítreo y Retina de Costa Rica, San José, Costa Rica.
| |
Collapse
|
26
|
Silva AHD, Gander L, Wijesinghe H, Rodrigues D. Spontaneous neonatal subdural haemorrhage: always non-accidental injury? Br J Neurosurg 2019; 34:24-27. [PMID: 31771378 DOI: 10.1080/02688697.2019.1694134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In any neonate or infant presenting with an acute onset of encephalopathy, and/or retinal haemorrhages with no history of major trauma and imaging showing subdural haemorrhage (SDH), the diagnostic priority is to exclude a non-accidental injury (NAI), given the association of these clinical features with the shaken baby syndrome. However, other causes of SDH may present in a similar manner in neonates and infants, in particular vascular lesions such as aneurysms. A four week old neonate presenting with seizures and retinal haemorrhages, was diagnosed with an acute subdural haemorrhage (ASDH) on imaging with significant midline shift needing surgical evacuation. As there was some blood extending into the left sylvian fissure, further imaging was considered before surgical intervention. This showed a distally located middle cerebral artery aneurysm, which was successfully treated and the neonate made a remarkable recovery. We present a case of a neonate presenting with spontaneous acute subdural haematoma in the absence of classical diffuse subarachnoid haemorrhage, intracerebral haemorrhage or intraventricular haemorrhage, secondary to a ruptured middle cerebral artery aneurysm. The distribution of aneurysms in the neonatal age group is different to adults, with middle cerebral artery aneurysms and more distally located peripheral aneurysms being more common. Vigilance should be borne to exclude the aforementioned as causes for this presentation especially prior to undertaking surgical intervention.
Collapse
Affiliation(s)
| | - Lara Gander
- School of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Haren Wijesinghe
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Desiderio Rodrigues
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| |
Collapse
|
27
|
Eris E, Eris D, Seymen Z, Karasu B, Dıracoglu A, Perente I, Cömert S. Retinal haemorrhage rates and resolution time of retinal haemorrhage in newborns after hypothermic treatment for hypoxic-ischemic encephalopathy. Arch Pediatr 2019; 27:29-32. [PMID: 31767499 DOI: 10.1016/j.arcped.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to evaluate retinal hemorrhages (RHs) in newborns after therapeutic hypothermia performed for hypoxic-ischemic encephalopathy (HIE). METHODS From 2014 January to October 2016, full-term newborns who were referred to us from the neonatal intensive care unit at our hospital for ophthalmological examination were evaluated retrospectively. Neonates diagnosed with HIE were examined with a RetCam Digital Retinal Camera (Massie Research Laboratories Inc., Pleasanton, CA) using a 130-degree or binocular indirect ophthalmoscope (Heine, Herrsching, Germany) imaging tool and were classified into three groups. Group 1 included patients without HIE, group 2 included patients with stage I HIE, and group 3 included patients with stage II or III HIE. The RH rates in cases of HIE were retrospectively reviewed. RESULTS A total of 148 eyes of 74 patients were included in the study. RH was detected in 36 eyes (24.3%); there were two eyes (3.7%), 14 eyes (20.6%), and 20 eyes (76.9%), in groups 1, 2, and 3, respectively. In group 3, RH was mostly seen in a widespread form. RHs involving the macula were resorbed later than haemorrhages in other locations. CONCLUSION RHs are frequent in neonates with HIE. RHs were seen significantly more frequently in stage II-III HIE. These haemorrhages may require treatment, especially when the macula is involved.
Collapse
Affiliation(s)
- E Eris
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - D Eris
- Suleymaniye Education and Research Hospital Intensive Care Unit, Istanbul, Turkey
| | - Z Seymen
- Suleymaniye Education and Research Hospital Ophthalmology clinic, Istanbul, Turkey
| | - B Karasu
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - A Dıracoglu
- Haseki Education and Research Hospital Ophthalmology clinic, Istanbul, Turkey
| | - I Perente
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - S Cömert
- Suleymaniye Education and Research Hospital Intensive Care Unit, Istanbul, Turkey
| |
Collapse
|
28
|
Mao J, Luo Y, Chen K, Lao J, Chen L, Shao Y, Zhang C, Sun M, Shen L. New grading criterion for retinal haemorrhages in term newborns based on deep convolutional neural networks. Clin Exp Ophthalmol 2019; 48:220-229. [PMID: 31648403 DOI: 10.1111/ceo.13670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND To define a new quantitative grading criterion for retinal haemorrhages in term newborns based on the segmentation results of a deep convolutional neural network. METHODS We constructed a dataset of 1543 retina images acquired from 847 term newborns, and developed a deep convolutional neural network to segment retinal haemorrhages, blood vessels and optic discs and locate the macular region. Based on the ratio of areas of retinal haemorrhage to optic disc, and the location of retinal haemorrhages relative to the macular region, we defined a new criterion to grade the degree of retinal haemorrhages in term newborns. RESULTS The F1 scores of the proposed network for segmenting retinal haemorrhages, blood vessels and optic discs were 0.84, 0.73 and 0.94, respectively. Compared with two commonly used retinal haemorrhage grading criteria, this new method is more accurate, objective and quantitative, with the relative location of the retinal haemorrhages to the macula as an important factor. CONCLUSIONS Based on a deep convolutional neural network, we can segment retinal haemorrhages, blood vessels and optic disc with high accuracy. The proposed grading criterion considers not only the area of the haemorrhages but also the locations relative to the macular region. It provides a more objective and comprehensive evaluation criterion. The developed deep convolutional neural network offers an end-to-end solution that can assist doctors to grade retinal haemorrhages in term newborns.
Collapse
Affiliation(s)
- Jianbo Mao
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Yuhao Luo
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China
| | - Kun Chen
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China
| | - Jimeng Lao
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Ling'an Chen
- Department of Automation, University of Science and Technology of China, Hefei, China
| | - Yirun Shao
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Caiyun Zhang
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Mingzhai Sun
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China.,Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, University of Science and Technology of China, Hefei, China
| | - Lijun Shen
- Eye Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
29
|
Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort. Eye (Lond) 2019; 33:1819. [PMID: 31285570 DOI: 10.1038/s41433-019-0523-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/08/2022] Open
|
30
|
Ami O, Maran JC, Gabor P, Whitacre EB, Musset D, Dubray C, Mage G, Boyer L. Three-dimensional magnetic resonance imaging of fetal head molding and brain shape changes during the second stage of labor. PLoS One 2019; 14:e0215721. [PMID: 31091263 PMCID: PMC6519794 DOI: 10.1371/journal.pone.0215721] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
To demonstrate and describe fetal head molding and brain shape changes during delivery, we used three-dimensional (3D) magnetic resonance imaging (MRI) and 3D finite element mesh reconstructions to compare the fetal head between prelabor and the second stage of labor. A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1 Tesla open field MRI. Seven of these patients subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head molding and brain shape changes. Varying degrees of fetal head molding were present in the infants of all seven patients studied during the second phase of labor compared with the images acquired before birth. The cranial deformation, however, was no longer observed after birth in five out of the seven newborns, whose post-natal cranial parameters were identical to those measured before delivery. The changing shape of the fetal brain following the molding process and constraints on the brain tissue were observed in all the fetuses. Of the three fetuses presenting the greatest molding of the skull bones and brain shape deformation, two were delivered by cesarean-section (one after a forceps failure and one for engagement default), while the fetus presenting with the greatest skull molding and brain shape deformation was born physiologically. This study demonstrates the value of 3D MRI study with 3D finite element mesh reconstruction during the second stage of labor to reveal how the fetal brain is impacted by the molding of the cranial bones. Fetal head molding was systematically observed when the fetal head was engaged between the superior pelvic strait and the middle brim.
Collapse
Affiliation(s)
- Olivier Ami
- Ramsay Generale de Sante, La Muette Clinic, Paris, France
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
- GIE IMIDF, Clinique de l'Essonne, Evry, France
- * E-mail:
| | - Jean Christophe Maran
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Petra Gabor
- Department of Obstetrics and Gynecology, Hospital Center of Argenteuil, Argenteuil, Île-de-France, France
| | - Eric B. Whitacre
- Breast Center of Southern Arizona, Tucson, AZ, United States of America
| | - Dominique Musset
- Paris-Sud University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - Claude Dubray
- Center for Clinical Research, University of Auvergne, Clermont-Ferrand, France
| | - Gérard Mage
- Department of Obstetrics and Gynecology, University of Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of Radiology, CHU Clermont-Ferrand Gabriel Montpied, Clermont Ferrand, France
| |
Collapse
|
31
|
Simkin SK, Misra SL, Battin M, McGhee CNJ, Dai S. Prospective observational study of universal newborn eye screening in a hospital and community setting in New Zealand. BMJ Paediatr Open 2019; 3:bmjpo-2018-000376. [PMID: 30815584 PMCID: PMC6361368 DOI: 10.1136/bmjpo-2018-000376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Early detection of ocular abnormalities in newborn infants is essential for timely diagnosis and treatment. This study aimed to assess wide-field digital imaging for universal newborn eye screening (UNES) to determine the prevalence of ocular abnormalities, including retinal haemorrhages, in newborn infants in New Zealand. DESIGN Prospective ocular screening study of infants. SETTING A public hospital maternity ward and a community birth centre in Auckland, New Zealand. PATIENTS A total of 350 infants were enrolled in UNES, those with birth weight <1250 g or gestational age <30 weeks were excluded. METHODS Wide-field digital images of the external eye and retina were captured by RetCam (Natus Medical, San Carlos, California, USA) and reviewed by an ophthalmologist via an established telemedicine methodology. MAIN OUTCOME MEASURES Detection of ocular abnormalities, including retinal haemorrhages. Correlation between haemorrhages and maternal, obstetric and neonatal factors. RESULTS A total of 346 infants completed screening (median age 2 days). Retinal haemorrhages were present in 50 cases (14.5%), two cases exhibited persistent retinal haemorrhages at 6-week follow-up. A significant increase in the odds of retinal haemorrhages was present for vaginal delivery compared with caesarean section. Other ocular abnormalities, including congenital cataract and optic nerve hypoplasia, were present in 1.4% of infants. CONCLUSIONS Ocular abnormalities were detected by UNES including congenital cataract and optic nerve hypoplasia. However, retinal haemorrhages, significantly associated with delivery modality, were the most common abnormality detected. The majority of retinal haemorrhages resolved spontaneously.
Collapse
Affiliation(s)
- Samantha Kaye Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Shuan Dai
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
32
|
Application of a deep convolutional neural network in the diagnosis of neonatal ocular fundus hemorrhage. Biosci Rep 2018; 38:BSR20180497. [PMID: 30333258 PMCID: PMC6435455 DOI: 10.1042/bsr20180497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
There is a disparity between the increasing application of digital retinal imaging to neonatal ocular screening and slowly growing number of pediatric ophthalmologists. Assistant tools that can automatically detect ocular disorders may be needed. In present study, we develop a deep convolutional neural network (DCNN) for automated classification and grading of retinal hemorrhage. We used 48,996 digital fundus images from 3770 newborns with retinal hemorrhage of different severity (grade 1, 2 and 3) and normal controls from a large cross-sectional investigation in China. The DCNN was trained for automated grading of retinal hemorrhage (multiclass classification problem: hemorrhage-free and grades 1, 2 and 3) and then validated for its performance level. The DCNN yielded an accuracy of 97.85 to 99.96%, and the area under the receiver operating characteristic curve was 0.989–1.000 in the binary classification of neonatal retinal hemorrhage (i.e., one classification vs. the others). The overall accuracy with regard to the multiclass classification problem was 97.44%. This is the first study to show that a DCNN can detect and grade neonatal retinal hemorrhage at high performance levels. Artificial intelligence will play more positive roles in ocular healthcare of newborns and children.
Collapse
|
33
|
Ma Y, Deng G, Ma J, Liu J, Li S, Lu H. Universal ocular screening of 481 infants using wide-field digital imaging system. BMC Ophthalmol 2018; 18:283. [PMID: 30376816 PMCID: PMC6208088 DOI: 10.1186/s12886-018-0943-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/16/2018] [Indexed: 12/04/2022] Open
Abstract
Background Universal ocular screening of infants is not a standard procedure in children’s health care system in China. This pilot study investigated prevalence of ocular abnormalities of 6 weeks-age infants using wide-field digital imaging system. Methods Infants aged 6 weeks around were consecutively enrolled in a public hospital between April 2015 and August 2016. All the infants who were enrolled in the study underwent vision assessment, eye position examination, external eye check, pupillary light reflex, red reflex examination, anterior and posterior ocular segments were examined using flashlight, ophthalmoscope, and wide-field digital imaging system. Results A total of 481 infants at 45.1 ± 6.1 days after birth were enrolled in the study. 198 infants had abnormal findings (41.2%). Retinal white spots and retinal white areas were the most common findings (42.9% of abnormalities and 17.7% of all infants screened). The second major finding was retinal hemorrhage (16.2% of abnormalities and 6.7% of all infants screened). Other abnormal findings include retinal pigmentation, concomitant exotropia, neonatal dacryocystitis, retinopathy of prematurity, ‘albinism-like fundus’, congenital nasolacrimal duct obstruction, familial exudative vitreoretinopathy, immature retina, corneal dermoid tumor, large physiologic cupping of optic disc, congenital persistent pupillary membrane, entropion trichiasis, subconjunctival hemorrhage, congenital cataract, vitreous hemorrhage, ptosis and choroidal nevus. Intervention of any form was required in 22 infants, which accounted for 11.1% of abnormalities detected and 4.6% of all infants screened. Conclusion Universal ocular screening is not only necessary for preterm infants but also for full-term infants. Addition of red reflex examination with wide-field digital imaging system can enhance the sensitivity of screening for ocular fundus abnormities. Further study with a long-term follow-up is needed in the future.
Collapse
Affiliation(s)
- Yan Ma
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Guangda Deng
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jing Ma
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jinghua Liu
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Songfeng Li
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Hai Lu
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
34
|
Moshfeghi DM. Terson Syndrome in a Healthy Term Infant: Delivery-Associated Retinopathy and Intracranial Hemorrhage. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e154-e156. [PMID: 30395678 DOI: 10.3928/23258160-20181002-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/28/2018] [Indexed: 11/20/2022]
Abstract
A term healthy infant was noted to have cephalohematoma following normal spontaneous vaginal delivery (NSVD). At 9 days of age, the attending team performed wide-angle remote digital fundus imaging and the left eye was noted to have scattered multi-laminar hemorrhages. Magnetic resonance imaging was performed which revealed occipital infarct and subarachnoid hemorrhage. A diagnosis of neonatal Terson syndrome was made. The child remained asymptomatic and the fundus hemorrhages resolved without sequelae. This case represents the first documented instance of Terson syndrome following NSVD and may represent a possible etiology of the common newborn retinal hemorrhage. Alternative terminology - delivery-associated retinopathy and intracranial hemorrhages - is proposed to describe these findings. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e154-e156.].
Collapse
|
35
|
Cohen MC, Scheimberg I. Forensic Aspects of Perinatal Deaths. Acad Forensic Pathol 2018; 8:452-491. [PMID: 31240056 DOI: 10.1177/1925362118797725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022]
Abstract
From a forensic pathologist's perspective, there are several aspects of the perinatal postmortem that are particularly important. If a fetus is found abandoned, the pathologist needs to ascertain the fetal age, the appropriateness of growth, if the baby was born alive or dead, and the possible causes of death. In cases of litigation for perinatal deaths occurring in hospitals, access to the obstetric and neonatal notes (if the baby is born alive and dies a few hours or days later) is fundamental to reach a correct interpretation and conclusion. The most important points to consider in cases of intrapartum death are the roles of asphyxia and trauma in the causation of the baby's death. Timing of the fetal death in relation to delivery may also be an important point in these cases. Finally, intrapartum lesions should always be considered in the differential diagnosis of possible child abuse in babies aged two months or less.
Collapse
|
36
|
Chen F, Cheng D, Pan J, Huang C, Cai X, Tian Z, Lu F, Shen L. The efficacy and safety of Retcam in detecting neonatal retinal hemorrhages. BMC Ophthalmol 2018; 18:202. [PMID: 30126460 PMCID: PMC6102910 DOI: 10.1186/s12886-018-0887-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To investigate the ability of characterizing neonatal retinal hemorrhage (RH) using RetCam in healthy newborns and the systemic effects during the procedure. METHODS This prospective study enrolled 68 healthy newborns aged 2 to 4 days old. The RH was imaged and classified according to the location and numbers of hemorrhages. The heart rate (HR), respiration rate (RR), and oxygen saturation (OS) were recorded at 4 time points before (Phase 1, P1), during (P2 and P3) and after the examination (P4). RESULTS The median exam time was 151 s. RH was present in 15 infants and 23 eyes. All 23 eyes had hemorrhage in Zone II. Grade II and III hemorrhages were present in 5 and 18 eyes, respectively. The HR increased to 168 beats per minute (bpm) in P3 and recovered to 122.5 bpm in P4. The RR increased to 38 bpm in P3 and recovered to 25 bpm in P4. The OS was reduced to 83% in P2 and recovered to 96% in P4. CONCLUSIONS RH in healthy newborns, mostly present in Zone II with grade II and III, can be characterized in detail by RetCam. Systemic effects during the process are mild and can be revolved spontaneously.
Collapse
Affiliation(s)
- Feng Chen
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Dan Cheng
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Jiandong Pan
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Chongbin Huang
- Neonate Department, Yueqing Maternal and Child Health Hospital, Yueqing, China
| | - Xingxing Cai
- Neonate Department, Yueqing Maternal and Child Health Hospital, Yueqing, China
| | - Zhongxu Tian
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Fan Lu
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Lijun Shen
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China.
| |
Collapse
|
37
|
Christian CW, Levin AV, Flaherty EG, Sirotnak AP, Budzak AE, Gavril AR, Haney SB, Idzerda SM, Laskey A, Legano LA, Messner SA, Moles RL, Palusci VJ, Karr DJ, Bradford GE, Nischal K, Roarty JD, Rubin SE, Suh DW. The Eye Examination in the Evaluation of Child Abuse. Pediatrics 2018; 142:peds.2018-1411. [PMID: 30037976 DOI: 10.1542/peds.2018-1411] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Child abuse can cause injury to any part of the eye. The most common manifestations are retinal hemorrhages (RHs) in infants and young children with abusive head trauma (AHT). Although RHs are an important indicator of possible AHT, they are also found in other conditions. Distinguishing the number, type, location, and pattern of RHs is important in evaluating a differential diagnosis. Eye trauma can be seen in cases of physical abuse or AHT and may prompt referral for ophthalmologic assessment. Physicians have a responsibility to consider abuse in the differential diagnosis of pediatric eye trauma. Identification and documentation of inflicted ocular trauma requires a thorough examination by an ophthalmologist, including indirect ophthalmoscopy, most optimally through a dilated pupil, especially for the evaluation of possible RHs. An eye examination is helpful in detecting abnormalities that can help identify a medical or traumatic etiology for previously well young children who experience unexpected and unexplained mental status changes with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, and children with unexplained death.
Collapse
Affiliation(s)
- Cindy W. Christian
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Alex V. Levin
- Departments of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital and Departments of Ophthalmology and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Chee RI, Darwish D, Fernandez-Vega A, Patel S, Jonas K, Ostmo S, Campbell JP, Chiang MF, Chan RVP. Retinal Telemedicine. CURRENT OPHTHALMOLOGY REPORTS 2018; 6:36-45. [PMID: 30140593 PMCID: PMC6101043 DOI: 10.1007/s40135-018-0161-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW An update and overview of the literature on current telemedicine applications in retina. RECENT FINDINGS The application of telemedicine to the field of Ophthalmology and Retina has been growing with advancing technologies in ophthalmic imaging. Retinal telemedicine has been most commonly applied to diabetic retinopathy and retinopathy of prematurity in adult and pediatric patients respectively. Telemedicine has the potential to alleviate the growing demand for clinical evaluation of retinal diseases. Subsequently, automated image analysis and deep learning systems may facilitate efficient processing of large, increasing numbers of images generated in telemedicine systems. Telemedicine may additionally improve access to education and standardized training through tele-education systems. SUMMARY Telemedicine has the potential to be utilized as a useful adjunct but not a complete replacement for physical clinical examinations. Retinal telemedicine programs should be carefully and appropriately integrated into current clinical systems.
Collapse
Affiliation(s)
- Ru-ik Chee
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - Dana Darwish
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | | | - Samir Patel
- Department of Ophthalmology, Wills Eye Hospital, Oregon Health & Science University, Portland, OR, United States
| | - Karyn Jonas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, OR, United States
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, OR, United States
| | - Michael F. Chiang
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, OR, United States
| | - RV Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| |
Collapse
|
39
|
Ludwig CA, Callaway NF, Blumenkranz MS, Fredrick DR, Moshfeghi DM. Validity of the Red Reflex Exam in the Newborn Eye Screening Test Cohort. Ophthalmic Surg Lasers Imaging Retina 2018; 49:103-110. [DOI: 10.3928/23258160-20180129-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022]
|
40
|
Scheller J. Infantile retinal haemorrhages in the absence of brain and bodily injury. Acta Paediatr 2017; 106:1902-1904. [PMID: 28833451 DOI: 10.1111/apa.14043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/10/2017] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
|
41
|
Li LH, Wu WC, Li N, Lu J, Zhang GM, Zhao JY, Ma Y. Full-Term Neonatal Ophthalmic Screening in China: A Review of 4-Year Outcomes. Ophthalmic Surg Lasers Imaging Retina 2017; 48:983-992. [DOI: 10.3928/23258160-20171130-05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/02/2017] [Indexed: 11/20/2022]
|
42
|
The analysis of posterior segment findings in term and premature infants using RetCam images. Int Ophthalmol 2017; 38:1879-1886. [DOI: 10.1007/s10792-017-0670-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022]
|
43
|
Normalization of Congenital Venous Stasis Retinopathy Following Sclerotherapy of a Macrocystic Lymphatic Malformation. Ophthalmic Plast Reconstr Surg 2017; 34:e19-e21. [PMID: 28746255 DOI: 10.1097/iop.0000000000000975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe, for the first time to their knowledge, a case of a congenital macrocystic lymphatic malformation of the orbit with associated venous stasis retinopathy that acutely normalized after drainage and sclerotherapy of the lesion. Prenatal ultrasound revealed prominence of the left orbital soft tissue, and at birth, the patient was noted to have unilateral proptosis, tortuous retinal vessels, and intraretinal hemorrhages in all 4 quadrants in the left eye. MRI demonstrated a primarily intraconal, multiloculated, T2-hyperintense mass consistent with a lymphatic malformation. Ultrasound-guided cyst aspiration and sclerotherapy was performed, with subsequent improvement of the proptosis and resolution of the vessel tortuosity and intraretinal hemorrhages. Although venous stasis retinopathy is usually related to central retinal vein occlusion or carotid artery occlusive disease, any entity that increases orbital venous resistance can generate retinal venous dilation and intraretinal hemorrhages, including an orbital lymphatic malformation.
Collapse
|
44
|
Goyal P, Padhi TR, Das T, Pradhan L, Sutar S, Butola S, Behera UC, Jain L, Jalali S. Outcome of universal newborn eye screening with wide-field digital retinal image acquisition system: a pilot study. Eye (Lond) 2017; 32:67-73. [PMID: 28737759 DOI: 10.1038/eye.2017.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/27/2017] [Indexed: 12/25/2022] Open
Abstract
PurposeTo evaluate the outcome of universal newborn eye screening with wide-field digital retinal imaging (WFDRI) system.MethodsIn this pilot study, we examined 1152 apparently healthy newborn infants in the obstetrics and gynecology ward of a civil hospital in Eastern India over 1.5 years. The examination included external eye examination, red reflex test and fundus imaging by WFDRI (RetCam II, Clarity medical system, Pleasanton, CA, USA) by a trained optometrist. The pathologies detected, net monetary gain and skilled manpower saved were documented. The results were compared with three similar studies thus far published in the literature.ResultsOcular abnormality of any kind was seen in 172 (14.93%) babies. Retinal hemorrhage in 153 babies (88.9% of all abnormal findings) was the most common abnormality; it was bilateral in 118 (77.12%) babies and 4 babies had foveal hemorrhage. Other abnormalities included vitreous hemorrhage (n=1), congenital glaucoma (n=2), uveal coloboma (n=2), retinopathy mimicking retinopathy of prematurity (n=2), and cystic fovea (n=3). The retinal hemorrhages resolved spontaneously in all eyes. One baby with congenital glaucoma received surgery and the other was treated medically. The benefits included savings in skilled manpower, a net monetary gain of INR 4.195 million (US$ 62,612) and skilled manpower saving by 319.4 h.ConclusionsThe universal neonatal eye screening using WFDRI detected pathologies that needed immediate care or regular follow up; saved skilled manpower with a net monetary gain. But compared to a red reflex test the benefits were marginal in terms of detecting treatment warranting ocular pathologies.
Collapse
Affiliation(s)
- P Goyal
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - T R Padhi
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - T Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - L Pradhan
- Infosys Pediatric Center, Capital Hospital, Bhubaneswar, India
| | - S Sutar
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - S Butola
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - U C Behera
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - L Jain
- Retina and Vitreous services, Shri Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - S Jalali
- Smt. Kanuri Santhamma Center for Vitreoretinal Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
45
|
Chee RI, Chan RVP. Universal newborn eye screening: an effective strategy to improve ocular health? Eye (Lond) 2017; 32:50-52. [PMID: 28731056 DOI: 10.1038/eye.2017.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- R I Chee
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA.,Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - R V P Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.,Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
46
|
Razeghinejad MR, Nowroozzadeh MH. Optic disk hemorrhage in health and disease. Surv Ophthalmol 2017; 62:784-802. [PMID: 28400276 DOI: 10.1016/j.survophthal.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
Abstract
Optic disk hemorrhage occurs in all age groups from neonates to the elderly. Optic disk hemorrhage is best known for its association with visual field loss and progression in patients with glaucoma; however, it may occur in conjunction with other ocular or systemic conditions as well as in healthy individuals. It may also be the first sign of a sight-threatening condition. Variations in the shape, location, and size of the optic disk hemorrhage, as well as associated ocular and systemic signs or symptoms, may help determine the underlying pathology. We address the epidemiology, demographics, pathophysiology, clinical presentations and implications, differential diagnoses, and management of eyes with optic disk hemorrhage in diseased and healthy subjects.
Collapse
Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA; Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | |
Collapse
|
47
|
Pathipati AS, Moshfeghi DM. Telemedicine Applications in Pediatric Retinal Disease. J Clin Med 2017; 6:E36. [PMID: 28333078 PMCID: PMC5406768 DOI: 10.3390/jcm6040036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022] Open
Abstract
Teleophthalmology is a developing field that presents diverse opportunities. One of its most successful applications to date has been in pediatric retinal disease, particularly in screening for retinopathy of prematurity (ROP). Many studies have shown that using telemedicine for ROP screening allows a remote ophthalmologist to identify abnormal findings and implement early interventions. Here, we review the literature on uses of telemedicine in pediatric retinal disease and consider future applications.
Collapse
Affiliation(s)
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, CA 94303, USA.
| |
Collapse
|
48
|
Wood EH, Moshfeghi AA, Nudleman ED, Moshfeghi DM. Evaluation of Visunex Medical's PanoCam(TM) LT and PanoCam(TM) Pro wide-field imaging systems for the screening of ROP in newborn infants. Expert Rev Med Devices 2017; 13:705-12. [PMID: 27424884 DOI: 10.1080/17434440.2016.1208560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas. AREAS COVERED A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies' websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures. Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.
Collapse
Affiliation(s)
- Edward H Wood
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
| | - Andrew A Moshfeghi
- b USC Eye Institute, Department of Ophthalmology , University of Southern California Keck School of Medicine , Los Angeles , CA , USA
| | - Eric D Nudleman
- c Shiley Eye Institute, Department of Ophthalmology , University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Darius M Moshfeghi
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
| |
Collapse
|