13.0 Introduction
13.1 Cornea
13.2 Cataract
13.3 Medical Retina – Age-Related Macular Degeneration (AMD)
13.4 Medical Retina - Diabetes
13.5 Medical Retina – Retinal Vein Occlusion (RVO)
13.6 Vitreoretinal Surgery
13.7 Glaucoma
13.8 Oculoplastics
13.9 Paediatrics
13.10 Neuro-Ophthalmology
13.11 Ocular Oncology
A Consensus Statement
A CLASSIFICATION SYSTEM for the clinical features of ROP:
Defines Zone, Stage, Plus disease, Pre-plus disease and AP-ROP features
Prematurity*, C.o.R.o. 2005. The International Classification of Retinopathy of Prematurity Revisited. Archives of Ophthalmology 123(7) 991-999.
Defined threshold disease
Cryotherapy for threshold ROP in BW ≤ 1250g, halves risk of poor structural outcome and reduces poor VA outcome by 1/3, at 1 - 15 years
Threshold = 5 continuous, or total 8 clock hrs, of stage 3 disease in Zone 1, or 2 with plus
Palmer, E.A. 1990. Results of U.S. randomized clinical trial of cryotherapy for ROP (CRYO-ROP). Doc Ophthalmol 74(3) 245-251.
Defined pre-threshold disease Treat high risk (type 1) pre-threshold ROP with laser:
Observe low risk (type 2) pre-threshold ROP:
Palmer, E.A. 1990. Results of U.S. randomized clinical trial of cryotherapy for ROP (CRYO-ROP). Doc Ophthalmol 74(3) 245-251.
Supplemental O2 doesn’t affect progression from pre-threshold to threshold
Light exposure doesn’t alter incidence of ROP
Reynolds, J.D., Hardy, R.J., Kennedy, K.A. et al. 1998. Lack of efficacy of light reduction in preventing retinopathy of prematurity. Light Reduction in Retinopathy of Prematurity (LIGHT-ROP) Cooperative Group. N Engl J Med 338(22) 1572-1576.
IVB vs. laser for Zone 1 or posterior Zone 2, Stage 3 ROP with plus
IVB resulted in less chance of re-treatment compared with conventional laser treatment for Zone 1, but not posterior Zone 2 disease. Peripheral retinal vascularisation continued after treatment. Study not powered for safety. Significantly better refractive outcomes in eyes treated with IVB after 2.5 years
Geloneck, M.M., Chuang, A.Z., Clark, W.L. et al. 2014. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmol 132(11) 1327-1333.
Mintz-Hittner, H.A., Kennedy, K.A. and Chuang, A.Z. 2011. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 364(7) 603-615.
Monitored Occlusion Treatment of Amblyopia Study
Greatest effect of patching in first few weeks (> 80% effect in first 6 weeks)
Need about 250 hours total, but doesn’t matter how or when (i.e. can “get it over with”)
Refractive correction alone in anisometropic amblyopia (75% improve 2 lines or more, 25% of which resolve fully)
Final VA significantly better in children < 4 years of age (i.e. earlier treatment)
Stewart, C.E., Moseley, M.J., Stephens, D.A. et al. 2004. Treatment dose-response in amblyopia therapy: the Monitored Occlusion Treatment of Amblyopia Study (MOTAS). Invest Ophthalmol Vis Sci 45(9) 3048-3054.
Unilateral cataract, aphakic 4 weeks to 7 months old
No difference in vision at 4 ½ years between IOL and aphakic group
More complications and more surgeries in IOL group (P < 0.001)
Glaucoma in at least 1/3 of both groups
Leave children < 15 months old aphakic and correct with CL
Infant Aphakia Treatment Study, G., Lambert, S.R., Lynn, M.J. et al. 2014. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmology 132(6) 676-682.
Strabismic and anisometropic or ametropic amblyopia. All given appropriate glasses and time to improve from glasses alone
Moderate Amblyopia (6/12 to 6/24): 3-7 Years Old
Severe Amblyopia (6/24-6/120): 3 - 7 Years Old
Older Children Amblyopia Treatment (Moderate/Severe Only): (7 - 18 Years Old)
Recommendations
Prognosis
Pediatric Eye Disease Investigator Group. 2020. Pediatric Eye Disease Investigator Group Publications [online]. Available at: https://public.jaeb.org/pedig/pubs/ [Accessed 8th June 2020].
Early vs Late Infantile Strabismus Surgery Study
Early (6-24 months) vs, late (32-60 months) surgery appears to increase gross stereopsis at 6 years of age, but high drop out and study design make definitive recommendations difficult
High drop out > 20%. At age 6years, 13.5% (early) vs. 3.9% (late) recognised Titmus housefly. 3% (early) vs. 3.9% (late) had higher stereopsis
Simonsz, H.J., Kolling, G.H. and Unnebrink, K. 2005. Final Report of the Early vs. Late Infantile Strabismus Surgery Study (ELISSS), a Controlled, Prospective, Multicenter Study. Strabismus 13(4) 169-199.
Atropine for the Treatment of Myopia (ATOM) 1
Children with myopia (-1 to -6, aged 6 - 12 years, < 1.5D astigmatism) received either Atropine 1% or placebo eye drops nightly for 2 years. Myopia progression and axial length increase were significantly less in the treatment group (- 0.28D and - 0.02mm) compared with the control group (- 1.2D and +0.38mm)
Chua, W.H., Balakrishnan, V., Chan, Y.H. et al. 2006. Atropine for the treatment of childhood myopia. Ophthalmology 113(12) 2285-2291
Atropine for the Treatment of Myopia (ATOM) 2
Progression with the low dose atropine (0.01%) was half (-0.49D) compared to placebo (- 1.2D)
Progressing myopia > 0.5D over 12-months and myopia > 2D. RCT atropine 0.5% vs 0.1% vs. 0.01% vs placebo
Chia, A., Lu, Q.S. and Tan, D. 2016. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology 123(2) 391-399.
Ranibizumab versus laser therapy for the treatment of very low birth weight infants for the treatment of ROP
Infants randomized to receive intravitreal ranibizumab (RBZ) 0.2mg, RBZ 0.1mg or conventional laser treatment. Treatment success (defined as no other treatment modality required before 24 weeks; no ROP recurrence by 24 weeks; and no unfavourable structural outcomes by 24 weeks) achieved in 80% RBZ 0.2; 75% RBZ 0.1 and 66% laser
No evidence of systemic suppression of VEGF after RBZ
Stahl, A., Lepore, D., Fielder, A. et al. 2019. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial. Lancet 394(10208) 1551-1559.
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13.8 Oculoplastics
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.