Ultra-widefield (UWF) imaging is one of the new technologies available to ophthalmologists. Current UWF imaging modalities can provide several options for posterior segment documentation and evaluation, including color and red-free photography, fluorescein angiography, and fundus autofluorescence. 1 The use of UWF fundus fluorescein angiography (FFA), in particular, has contributed significantly to the detection of peripheral fundus disease in both adult and pediatric patients with retinal conditions. 2 Similar to standard field retinal angiography, FFA involves intravenous injection of fluorescein, after which fundus images are obtained. An alternative to intravenous injection of fluorescein is oral fluorescein angiography. It is used in cases in which intravenous injection is difficult to perform or is refused by patients who have a fear of needles. Oral FFA has been successfully used with standard and widefield camera systems. 3 Herein, we report our experience with UWF retinal angiography using oral fluorescein in pediatric patients.

Objective The purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis. Design This case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed. Results The results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced. Conclusion The use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.

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