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Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.

Purpose To report the surgical treatment of hypertropia coexisting with exotropia, with either vertical offset surgery or additional vertical muscle surgery simultaneous to correction of the exotropia. Methods A total of 35 patients with exotropia and hypertropia who underwent a horizontal muscle surgery for exotropia were included. To determine efficacy in resolving a vertical deviation in patients with exotropia, 28 patients were compared in 2 groups: those who underwent horizontal muscle surgery with vertical offset and those who underwent horizontal muscle surgery with additional vertical muscle surgery. An additional 7 patients who had exotropia and hypertropia but did not undergo vertically corrective surgery were included for comparison. Results Vertical offset of horizontal rectus muscles (4 mm) resulted in 8Δ correction of the distance hypertropia. Vertical rectus muscle recession used in the treatment of larger hypertropic deviations with exotropia had a 3Δ correction per 1 mm of recession. Success rates for hypertropia correction were similar between groups, 63% vertical offset and 71% vertical muscle groups; overcorrections occurred in 29% of the vertical muscle group. The vertical correction in both groups was stable in 88% over 6 months postoperatively. Conclusions Vertical offset of the horizontal muscles simultaneous with exotropia correction has a beneficial effect in small-angle hypertropia (<14Δ). Vertical rectus muscle surgery in patients with hypertropia greater than 10Δ had equivalent success; however, in intermittent exotropia the hypertropia was prone to overcorrection.

BackgroundChoroidal neovascularization (CNV) is a rare complication of intermediate uveitis. Risk factors are not well-characterized. Here, we describe a case of peripapillary CNV in a patient with intermediate uveitis and explore the pathophysiology and treatment of this condition. This study is a case report and review of the literature.ResultsA 15-year-old boy with intermediate uveitis - suppressed for the preceding year on immunosuppressive therapy and low-dose corticosteroids - and chronic disc swelling presented with unilateral metamorphopsia, peripapillary subretinal hemorrhage, and subretinal fluid. Fluorescein angiogram confirmed the presence of an active choroidal neovascular membrane. Treatment with intravitreal bevacizumab 1.25 mg every 4 weeks for 4 months resulted in resolution of subretinal fluid, subretinal hemorrhage, and regression of the CNV. The patient's intermediate uveitis remained inactive throughout this time.ConclusionReview of the existing literature and pathophysiologic consideration suggests that chronic disc edema may be a risk factor for this condition. Peripapillary CNV in the context of intermediate uveitis appears to respond well to VEGF-inhibitor therapy.

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A 56-year-old female complained of diplopia immediately after surgical excision of a recurrent left skull base tuberculum meningioma. She was found to have a left sixth nerve palsy, which was subsequently treated with botulinum toxin injection to the medial rectus muscle. Three months post injection, the patient had partial recovery of the sixth nerve palsy and new-onset ocular neuromyotonia.

Despite the successes of the VISION 2020 global initiative, large economic and societal consequences still exist across the life span from vision impairment and blindness, which have not yet been addressed by the global health community. n There remains a lack of reliable global data on vision health, especially in the case of childhood blindness and vision impairment. n Historically, vision has been poorly represented in global health budgeting and finance, which objectively reflects its lack of prioritization on the overall global health agenda. nWe need greater investment in cost-effective strategies to prevent and treat a rapidly increasing global burden of ocular disease because of an aging and changing population.