Vascular endothelial growth factor (VEGF) and inflammation. VEGF-A circulates normally in the body and is essential in endothelial cell growth. In the pathological state in the eye, hypoxia increases VEGF-A, promotes growth of neovascularization and accelerates the breakdown of blood-retinal barrier and build-up of fluid in or under the neurosensory retina and retinal pigment epithelium (RPE). It has 6 isoforms; the predominant isoform (most common of which) is VEGF 165 and is most linked to neovascularization in the eye. VEGF-A provided the rationale for targeted drug development. Anti-VEGF drugs are anti-angiogenic, anti-inflammatory, antifibrotic, and anti-permeable. The rationale for the use of steroids to treat macular edema is related to their ability to reduce capillary permeability, to inhibit the expression of VEGF gene, and to inhibit the metabolic pathway of VEGF.
Vascular Endothelial Growth Factor A ; Retinal Pigment Epithelium

Objective: To identify maternal and infantile risk factors for retinopathy of prematurity (ROP) among preterm infants screened in St. Luke’s Medical Center, Quezon City (SLMC-QC) from 2014-2017. Methods: This was a retrospective study that included the ROP databank of the Eye Institute and the Research and Biotechnology Group of St. Luke’s Medical Center, Quezon City from 2014 to 2017. This study included medical records of all premature infants screened for ROP and excluded those who had incomplete data or other ocular pathologies other than ROP. Risk factors were analyzed using univariate analysis. Odds ratio (OR) and 95% confidence interval (CI) were also calculated with significant P value set at <0.05. Results: Among the 455 infants screened for ROP, 118 (25.9%) had any stage of ROP while 23 (5.0%) had treatment-warranted ROP (TW-ROP). Univariate regression analysis showed that the top 5 infantile risk factors associated with any stage of ROP and TW-ROP were low birth weight (97.5% and 100%, respectively), prematurity (87.3% and 100%, respectively), history of blood transfusion (21.2% and 13%, respectively), sepsis (21.2% and 17.4%, respectively), and oxygen supplementation (16.1% and 8.7%, respectively). After multivariate analyses, the most important adjusted risk factors associated with any stage of ROP include low birth weight (OR 52, CI 16.20166.96, P =0.001), prematurity (OR 25.73, CI 14.10-46.95, P =0.001), and history of blood transfusion (OR 8.79, CI 4.08-18.96, P =0.0001). Conclusion The most significant infantile risk factors associated with any ROP include low birth weight, prematurity, and history of blood transfusion. There were no significant probable maternal risk factors. Timely ROP screening is recommended especially among infants with any of these risk factors in their profile.
Retinopathy of Prematurity ; Risk Factors ; Blood Transfusion ; Infant, Low Birth Weight

OBJECTIVE: To describe a case of choroidal osteoma.

METHODS: This is a case report.

RESULTS: A 49-year old female had unilateral, gradual, progressive, painless, blurring of vision. She was previously started on anti-TB treatment because of positive PPD skin test. T-spot test was negative and vision of hand movement persisted in the left eye. Both eyes had yellow, slightly elevated, peripapillary subretinal patches with scalloped margins. Fluorescein angiography revealed bilateral subretinal patchy hyperfluorescence and perifoveal petalloid hyperfluorescence in the left. Macular OCT showed hyporeflective ill-defined sub-retinal pigment epithelial (RPE) lesion in the right eye and a hyporelective well-defined sub-RPE thickening with large cystoid macular edema in the left. B-scan ultrasonography revealed bilateral densely hyperechoic subretinal concave band with posterior shadowing that persisted on decreased gain. These were consistent with bilateral choroidal osteoma with secondary cystoid macular edema in the left eye.

CONCLUSION: Choroidal osteoma is a rare benign choroidal tumor of healthy young women wherein the choroid is replaced with mature bone. It is a clinical diagnosis with characteristic ultrasonographic findings.

 

Human ; Female ; Middle Aged ; Fluorescein Angiography ; Macular Edema ; Tuberculin ; Choroidal Osteoma, Bilateral ; Osteoma ; Choroid Neoplasms ; Choroid ; Choristoma ; Retinal Pigments ; Skin Tests

Objective: To describe a case of adult-onset foveomacular vitelliform dystrophy (AOFVD). Method: This is a case report. Results: A 22-year-old female presented with painless blurring of vision and metamorphopsia 3 days prior to consultation. There were 2 similar episodes in the past that spontaneously resolved after 2 to 4 weeks. Visual acuity (VA) was 20/50 in the right eye (OD) and 20/40 in the left (OS), both best corrected to 20/25. Dilated-fundus examination revealed a discrete area of mixed hypoand hyperpigmentation 1 disc diameter over the fovea in OD and a solitary round hypopigmented lesion with a hyperpigmented border 3 to 4 disc diameters on the fovea in OS. Fluorescein angiography (FA) revealed an area of hyperfluorescence surrounded by a rim of hypoflourescence in OD and an area of blocked fluorescence with subtle hyperfluorescence superior to the lesion in OS, both of which did not increase in size and intensity toward the late phases. Optical coherence tomography (OCT) revealed neurosensory detachment in both eyes. Electrooculogram (EOG) was normal with Arden ratio of 0.91. VA returned to 20/25 in both eyes, and repeat fundus photography showed no change in the characteristics of the lesions. Conclusion Differential diagnosis of a hypopigmented macular lesion in the young with self-limited blurring of vision should include AOFVD. FA, OCT, and EOG can help distinguish AOFVD from Best’s disease or other similar macular conditions.
Vitelliform Macular Dystrophy ; Bestrophins ; Peripherins

OBJECTIVE: To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR).

METHODS: This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed.

RESULTS: There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000).

CONCLUSION: SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Visual Field Tests ; Visual Fields ; Retina ; Fundus Oculi ; Retinal Diseases

Objective: (1) To determine the inter and intra-observer reliability in diagnosing ROP in terms of the stage, zone, and presence of plus disease among local ROP screeners involved in the ROP Working Group; and (2) to determine the inter-observer reliability between 2 groups of subspecialties – retina specialists and pediatric ophthalmologists. Methods: This is a prospective observational study that analyzed the inter- and intra-observer reliability in describing ROP in 3 key observations: stage, zone, and presence of plus disease. This study utilized a test with 32 sets of fundus images from 27 cases, five of which were repeated. Images from previously photographed infants with and without ROP were collated into a downloadable powerpoint test and tested against retina specialists and pediatric ophthalmologists of the ROP Working Group. Outcome measures included presence of variability in ROP diagnosis in terms of the stage, zone, and presence of plus disease among screeners, and reliability coefficient (intra-class coefficient or ICC) in 2 levels: (1) individual and 2-group inter-observer reliability, and (2) intra-observer reliability. Results: There were 11 respondents: 5 retina specialists and 6 pediatric ophthalmologists. Seven (46%) reported prior experience with RetCam image review. There was high inter-observer reliability (ICC 1.0) in the staging of ROP, but poor reliability in the identification of zone (ICC 0.3) and plus disease (ICC 0.5). The group of retina specialists and pediatric ophthalmologists scored high reliability for diagnosis of stage (ICC 1.0 vs 0.9) and plus disease (ICC 0.9 vs 0.9), while both showed poor reliability in the identification of zone (ICC 0.5 vs 0.4). Majority had high intra-observer reliability with regard to the stage (55%) and zone (73%) of ROP and most (73%) had acceptable intra-observer reliability in identifying plus disease. None of the respondents had poor intra-observer reliability. Conclusion The diagnosis of the stage of ROP was consistently reliable for both inter- and intra-observer parameters. However, identification of zone of ROP and plus disease were sources of significant discrepancies.
Retinopathy of Prematurity ; Mass Screening

Objective: To describe a case of serpiginous choroidopathy. Methods: This is a case report. Results: A 61-year-old female with a 22-year history of gradual blurring of vision in the left eye sought consultation. Ten months prior, her left vision worsened, described as central scotoma that progressed inferiorly. Best-corrected vision was 20/20 (right) and counting fingers at 1 foot (left). Inferior hemifield scotoma was documented on Amsler grid testing of the left eye. Anteriorsegment findings were unremarkable. Retinal examination through a clear media revealed multiple contiguous hypopigmented patches radiating from the peripapillary area extending to the periphery in both eyes with extension to the superior fovea on the left. Fluorescein angiogram showed progressive faint hypofluorescence of the hypopigmented patches in both eyes with involvement of the superior fovea on the left. No active vessel leakage was noted. No treatment was given and regular Amsler monitoring was advised. Follow-up 3 and 6 months after revealed stable visual acuity and fluorescein angiogram (FA) findings. Conclusions This is a case of serpiginous choroidopathy with inactive pattern. There was unilateral decrease in central vision, scotoma, and retinal pigment epithelial atrophy in a serpentine pattern originating from the disc with macular involvement in one eye. FA aids in the diagnosis and monitoring of inflammatory activity as the presence of active leakage on the borders. Goals of management include monitoring, prevention of recurrences and progression, and rapid control of sequela with potential use of immunosuppressive therapy.
White Dot Syndromes ; White Dot Syndromes ; Uveitis

Objective: (1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP. Methods: This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria. Results Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.
Retinopathy of Prematurity ; Mass Screening