Mahmoud Mamdouh Nassar

Morning glory disc anomaly is associated with serous retinal detachments, high refractive errors, amblyopia, and strabismus. There have been limited reports of an association between morning glory disc and peripheral retinal non-perfusion. The authors report a case of unilateral morning glory disc anomaly associated with markedly asymmetric retinopathy of prematurity. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e55–e57.]

Purpose: To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis. Patients and methods: This interventional case series study included 9 patients referred to the Ophthalmology Department, Minia University Hospital with unilateral combined endophthalmitis and orbital cellulitis between April 2020 and March 2021. In addition to the COVID-19 work-up, all patients were subjected to full ophthalmological evaluation and managed according to their ophthalmic and systemic disease. Results: The patients were 5 females and 4 males. They had clinical, laboratory and imaging findings that confirmed COVID-19 infection. All patients had unilateral endophthalmitis with orbital cellulitis and profound visual loss in the affected eye. Three patients died due to respiratory failure, while 6 patients recovered systemically. The survived patients developed atrophia bulbi in 4 patients and in 2 patients, the globe retained normal size but with complete visual loss. Conclusion: Combined endophthalmitis and orbital cellulitis can be one of the early presentations of patients with COVID-19 infection with poor visual prognosis. Trial registration: Clinical registration: clinicaltrials.gov identifier: NCT04456556.

Following the publication of our recent article in British and Irish Orthoptic Journal https://www.bioj-online.com/articles/10.22599/bioj.109/ we wish to bring the following corrigendum to your attention.

Objective The aim of this study was to identify the prevalence of prescribing topical beta-blockers (TBB) despite documented contraindications in general practice and whether patients were involved in decisions about treatment. Design This was a primary-care-based cross-sectional descriptive study. Introduction Glaucoma is one of the commonest causes of irreversible blindness in the United Kingdom, causing ∼5.9% of blind registration. TBB are currently considered the best adjunctive treatment and are well known for their systemic effects. The effect of concurrent prescription of TBB with systemic contraindications was found to significantly increase the rate of hospitalization and emergency room visits. Patients and methods Electronic medical records of four primary care providers in the North East of England were searched for primary open-angle glaucoma, use of TBB, and known systemic contraindications. Included records were further searched for correspondence from ophthalmology departments to primary care. We contacted those patients whose records showed no documentation of communicating potential risks with patients and rationale of using TBB. Results Of the 49 816 patients registered with the four primary health care providers, 798 (1.6%) had primary open-angle glaucoma. Of these, 279 (35%) were prescribed TBB; 260 (93.2%) of whom had no systemic contraindications. Conclusion Nineteen (6.8%) patients with systemic contraindications were prescribed TBB despite alerts from electronic medical records. Furthermore, these patients were not made aware of the potential risk.

Many authors have investigated the methodology and outcomes of amblyopia treatment. However, the evidence on termination of treatment, specifically referring to the stability of visual outcome and timing of reviewing patients after treatment ends, has received less interest with no agreement on risk factors of visual regression. To study the final part of amblyopia service with particular emphasis to stability of visual outcome; efficacy and timing of follow up after treatment ends. A retrospective review of patients discharged following treatment for strabismic and anisometropic amblyopia. Exclusion criteria were ocular pathology, poor attendance or poor compliance. Collected data included: age at the start of treatment, type and duration of treatment, number of visits, visual acuity (at start and end). Additionally, we analysed the duration and number of visits after stopping treatment, final visual acuity at discharge and duration of treatment with minimal change in vision. Thirty-nine patients were identified with a mean age 4.2 ± 1.7SD years. Patients had an average of 116.6 ± 13.9SD visits over 30.5 ± 21.5SD months. Of these, 71.8% had occlusion only and 28.2% in combination with atropine. All but three patients had improved vision, with mean letters gained 13.2 ± 8.7SD LogMAR. The improvement in vision was statistically significant p < 0.005 and patients were further followed without treatment for 10 ± 13.5SD months over 5.2 ± 6.6SD visits. The mean final vision at discharge was not significantly different from vision at termination (p = 0.68) and we found no significant recurrence. Amblyopia treatment is effective; however, there is inconsistency in many aspects of ending treatment. Further improvement is needed to standardise care from termination of treatment up to discharge from service.

To detect the incidence of retinopathy of prematurity (ROP) in a tertiary referral neonatal intensive care unit in upper Egypt and to describe the obstacles faced during implementing the screening protocol for the first time. Consecutive infants were enrolled at birth and screened for ROP. We used the UK ROP guideline (May 2008) for infant selection, follow up and treatment. Repeat examinations were performed until retinal vascularisation was complete. Fifty-two infants were enrolled: 24 males and 28 females. Mean gestational age was 31.3wk (±2.8 SD) and mean birth weight was 1234.6 g (±221.1 SD). Incidence of ROP was 36.5% (stages 1, 2, 3 and 4a were 9.6%, 9.6%, 15.4% and 1.9% respectively), no stages 4b or 5 were found in this series. Six infants (11.5%) died during screening without ROP, 25 infants (48.1%) were discharged from screening with retinal vascularisation reaching zone III, 5 infants (9.6%) were treated with indirect diode with or without additional cryotherapy and 16 infants (30.8%) were lost to follow up. In this series gestational age rather than birth weight was found significantly correlated and predictive (P<0.05) with ROP stages. ROP in a single site in Upper Egypt appears to have comparable incidence to other areas worldwide. The main screening obstacle was missing cases due to the absence of a national ROP screening protocol.

Introduction Low-cost intraocular lenses (IOLs) have been used in developing countries for many years. In a recent randomized trial, they were found comparable to high-end IOLs in terms of safety, visual outcomes, and posterior capsule opacification (PCO) formation. Our team observed occasional significant refractive changes following Nd:YAG capsulotomy for patients implanted with these IOLs. We aimed to assess the changes in refraction and the anterior chamber (AC) depth induced by Nd:YAG capsulotomy for PCO following implantation of a low-cost IOL. Patients and methods This prospective study was conducted on a cohort of sequential patients with PCO following uncomplicated phacoemulsification and implant of in-the-bag low-cost IOL. Changes in refraction (spherical equivalence, cylinder power, and cylinder axis) were assessed by means of subjective verification of autorefraction. Changes in AC depth were assessed by means of ultrasound biomicroscopy. Changes in cylinder power and axis were included to assess IOL tilt. Results A total of 50 consecutive eyes were enrolled. However, five eyes of three patients were lost to follow-up. A total of 45 eyes of 36 patients completed the pre-YAG and post-YAG assessments. An overall 66.7% of patients were female. An overall 25% had bilateral capsulotomy. The mean age at capsulotomy was 62.4±7.46 years. The mean duration since cataract extraction was 13.3±17.15 months. The mean IOL power was 20.4±2.43 D. No significant changes were found in spherical equivalence, axis of cylinder, and AC depth. However, a significant change in the cylinder power (mean change: 0.36±0.93 D, P=0.039) was observed. Conclusion Our study adds further confirmation on low-cost IOLs being a suitable alternative to high-end IOLs in developing countries and in outreach settings.

Introduction: The evidence base for the treatment of strabismus (squint) is poor. Our main aim is to improve this evidence base for the treatment of a common type of childhood squint {intermittent exotropia, [X(T)]}. We conducted an external pilot study in order to inform the design and conduct of a future full randomised controlled trial (RCT).Methods: Children of between 6 months and 16 years with a recent diagnosis of X(T) were eligible for recruitment. Participants were recruited from secondary care at the ophthalmology departments at four UK NHS foundation trusts. Participants were randomised to either active monitoring or surgery. This report describes the findings of the Pilot Rehearsal Trial and Qualitative Study, and assesses the success against the objectives proposed.Recruitment and retention: The experience gained during the Pilot Rehearsal Trial demonstrates the ability to recruit and retain sites that are willing to randomise children to both trial arms, and for parents to agree to randomisation of their children to such a study. One child declined the group allocation. A total of 231 children were screened (expected 240), of whom 138 (60%) were eligible (expected 228: 95%) and 49 (35% of eligible) children were recruited (expected 144: 63% of eligible). Strategies that improved recruitment over the course of the trial are discussed, together with the reasons why fewer children were eligible for recruitment than initially anticipated. Attrition was low. Outcome data were obtained for 47 of 49 randomised children.Trial processes and data collection: The Trial Management processes proved effective. There were high levels of completion on all of the data collection forms. However, the feedback from the treatment orthoptists revealed that some modifications should be made to the length and frequency of the health service assessment and travel assessment questionnaires, thus reducing the burden on participants in the main trial. Modifications to the wording of the questions also need to be made.Monitoring of bias: Children who recruited to the trial were older and had more severe strabismus than those children eligible but declining participation. Strategies to account for this in a full trial are proposed.Reasons for participation or declining study: These were identified using qualitative interviews. The principal reasons for declining entry into the study were strong preferences for and against surgical treatment.Harms: There were no serious unexpected adverse events. Two children had overcorrection of their X(T) with reduction in binocular vision following surgery, which is in line with previous studies. No children in the active monitoring arm developed a constant strabismus although two showed some reduction in control.Conclusions: The SamExo study has demonstrated that it is possible to recruit and retain participants to a randomised trial of surgery compared with active monitoring for X(T). For longer-term full RCTs, in order to maximise the generalisability of future studies, consideration needs to be given to planning more time and clinic appointments to assess eligibility and to allow consideration of participation; the greater use of research nurses for recruitment; and accommodating the strong preferences of some parents both for and against surgical intervention.Trial registration: Current Controlled Trials ISRCTN44114892.Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 39. See the NIHR Journals Library website for further project information.