Background: Preterm infants with respiratory distress syndrome (RDS) requiring surfactant therapy have been traditionally receiving surfactant by intubation surfactant and extubation technique (InSurE), which comprises of tracheal intubation, surfactant administration, and extubation. However, more recently noninvasive methods like least invasive surfactant therapy or minimally invasive surfactant therapy have been reported to be successful. These methods, avoid intubation thus minimize airway trauma and avoid barotrauma. The primary aim of this randomized trial was to compare the need for mechanical ventilation (MV) between the administration of surfactant via a thin catheter during spontaneous breathing and the InSurE technique. Methods: Preterm infant's ≤34 weeks with RDS requiring continuous positive airway pressure (CPAP) within 6 hours of life were prospectively randomized to receive early surfactant either by SurE (surfactant without endotracheal tube intubation) or InSurE technique. The need for MV within the first 72 hours and other related outcomes were analyzed between the two groups. Results: One hundred seventy‐five infants in each group were analyzed. The need for MV in the first 72 hours of life was significantly lower in the SurE group compared to the InSurE group (19% vs 40%, P < .01). Similarly, duration of oxygen therapy and hospital stay were significantly shorter in the SurE group. Furthermore, bronchopulmonary dysplasia (BPD) rate was significantly lower among the infants administered surfactant by the SurE technique. Conclusion: In preterm neonates with RDS who are stabilized on CPAP, the SurE technique for surfactant delivery results in the reduced need for MV and also may decrease the rate of BPD in some vulnerable subpopulations.

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AimTo compare the surgical experience and preferred imaging platform, between digitally assisted vitreoretinal surgery systems (DAVS) and analogue microscope (AM), for performing various surgical manoeuvres.Material and methodsA questionnaire was used to evaluate the experience of surgeons who used DAVS for at least 6 months in the last 1 year.ResultsTwenty-three surgeons, including 12 fellows, answered the questionnaire. Eighty-two per cent of surgeons got accustomed to DAVS in <10 surgeries. The higher magnification provided by DAVS was perceived as helpful by 87.0% surgeons. Seventy-eight per cent surgeons felt that DAVS provided a bigger field of view. Colours displayed on DAVS appeared unnatural to 39.1%. Difficulty using three-dimensional glasses over spectacles, asthenopia and dry eye symptoms while using DAVS were faced by 17.4%, 17.4% and 21.7% surgeons, respectively. Difficulty in frequent switching between DAVS and AM was faced by 30.4% surgeons. Difficulty in depth perception, hand–eye coordination and performance anxiety while using DAVS was faced by 43.5%, 21.7 % and 30.4 % surgeons, respectively. Majority consultants did not have any imaging platform preference for most posterior segment procedures, while majority fellows preferred DAVS. Majority surgeons preferred AM for anterior segment procedures and complicated situations like small pupil, corneal oedema and surgical surprise(s). Once the surgeons became accustomed to DAVS, none of them had to shift back to AM during any case.ConclusionIt was easy to adapt to DAVS. DAVS was preferred for performing most posterior segment surgeries. Drawbacks like unnatural colours of the projected image and difficulty in performing anterior segment manoeuvres need to be addressed.

A family of three siblings affected with gyrate atrophy of the choroid and retina is presented. Ultrawide field fundus imaging was used to monitor the progression of the disease objectively over 5 years.

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