Blindness in infants presenting with advanced and untreated ROP: a single-centre study in Pakistan

To describe the ocular features and characteristics of young children presenting with advanced, untreated retinopathy of prematurity and to determine appropriate screening guidelines for retinopathy of prematurity (ROP) in Pakistan.

Material and methods

A retrospective case series of young children with stage5A or 5B or cicatricial changes (4B or 4A ROP) was undertaken in the Department of Ophthalmology, Lahore General Hospital, Lahore, Pakistan, from August 2017 to July 2019. Information was obtained from interviewing parents and from neonatal care discharge summaries, if available. An assessment of visual function and a dilated fundus examination were performed.

Results

51 children presented at mean age of 9.7 (1.5–36) months. Their mean gestational age (GA) was 28.84 (26–38) weeks, and mean birth weight (BW) was 1229 (800–2100) g. Four children (7.8%) had a GA of >31 weeks plus a BW of >1501 g. 40 (76.4%) children were blind and 11 (23.6%) had impaired vision. Sixty-five eyes (63.7%) had stage 5B; 13 (12.7%) eyes had stage 5A; 18 (17.6%) had falciform macular folds (4B ROP) and 6 eyes (5.9%) had macular dragging (4A ROP). 39 (76.5%) children had bilateral stage 5A/5B. Half (47%) of the children lived outside the capital city of Lahore, and 15 came from small cities (population <1 million).

Conclusion

The third epidemic of blindness due to ROP has arrived in Pakistan, and premature babies are going blind even in smaller cities. Initial screening guidelines of a GA of ≤35 weeks and BW of ≤2000 g seem reasonable. There is an urgent need to improve the quality of neonatal care and to increase the coverage of ROP screening and treatment services across the country.

Intra Arterial Chemotherapy (IAC)- Advantages and pitfalls

Retinoblastoma is a blinding malignancy of the childhood, it is curable when diagnosed early and treated properly, but retinoblastoma is dismal when the basic elements in diagnosis and treatment are lacking. Survival and ocular prognosis mirrors economic development of the countries. Eighty percent of retinoblastoma affects children in the developing countries. The complexity of the required multi-disciplinory approach makes treatment difficult in the developing countries. We have set up an example of a retinoblastoma treatment center that caters for early diagnosis, systemic chemotherapy, intra arterial chemotherapy, intra vitreal chemotherapy, focal laser ablasion and long term follow up assisted with retinal camera. A brief account is given in this editorial

Outcome of interventional treatment modalities for retinoblastoma: Experience at a tertiary care centre in Pakistan

Retinoblastoma is the most common intra-ocular malignancy found in children in their infancy. Originating from the retinal cells, the disease has a significant association with mortality and morbidity. A case series study was conducted at the Lahore General Hospital eye department, from November 2016 to January 2018. Nineteen children having retinoblastoma in 19 eyes were included in the study. The retinoblastoma-affected eyes were classified according to the International Classification of Retinoblastoma (ICRB). Treatments assigned were based on the severity of the disease, monetary allowance and intervention availability. The treatment modalities employed were chemo-reduction, Ophthalmic artery chemosurgery (OAC), Intravitreal Melphalan, Cryotherapy and laser photocoagulation. To measure the outcome, the follow up period was between 6 to 12 months. The primary outcome measures among the majority of the patients were regres sion or obliteration of the tumour. Failure of treatments were also recorded which included progression of the malignancy requiring enucleation. This study concludes that the newer modalities such as OAC and Intravitreal Melphalan have shown promising results for tumour regression, leading to vision salvation, even at higher grades of ICRB.