Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

In this prospective, interventional case-control study, 58 patients with unilateral acute central serous chorioretinopathy (CSCR) were recruited. Patients ≥ 18 years age, presenting with first episodes of acute CSCR, were included. Acute CSCR was defined by the presence of subretinal fluid (SRF) and symptoms for <12 weeks duration with no clinical or imaging features of chronicity. Patients were alternately divided into treatment (Table Eplerenone 50 mg/day for minimum 1 month) and observation groups. Vision, SRF height and subfoveal choroidal thickness (SFCT) were checked at 1-, 2- and 3-months in both eyes of each group. Each group had 29 eyes. Mean age was 40.4 ± 7.1 and 43.3 ± 8.34 years in treatment and observation group, respectively. Mean symptom duration was 6.46 ± 1.45 and 5.87 ± 2.09 weeks, respectively. Vision improvement to 6/6 was seen in 92%, 100% and 100% cases in treatment group and 74%, 86% and 100% in control group at each visit, respectively. Complete SRF resolution in the treatment group was noted in 45%, 55% and 62% cases at each respective monthly visit. In the observation group, complete SRF resolution was noted in 10%, 21% and 31% at 1-, 2- and 3-month visits, respectively. SRF (p < 0.001) and SFCT (p < 0.001) reduction was noted in the affected eye of both groups. SFCT was reduced in the fellow eye after treatment (p = 0.005) compared to the observation group (p = 0.276). In conclusion, oral eplerenone achieves faster SRF resolution and vision improvement in acute CSCR. Additionally, it shows beneficial effects on the fellow eye.

AIMTo report our initial experience with lens-sparing vitrectomy for stage 4 retinopathy of prematurity using the 27-gauge (G) system.METHODSThis retrospective case series involved nine eyes of five babies with active stage 4 ROP, who underwent 27-G lens-sparing vitrectomy. Surgery was done using 27-G valved cannulas and sclerotomies were made 1.5 mm from the limbus. Bilateral sequential vitrectomy was done in eight eyes.RESULTSAt one-year follow-up, anatomical outcome was favourable in all nine (100%) eyes. High-speed cutting and smaller sclerotomies were helpful in reducing the intra and post-operative complications.CONCLUSION27-G vitrectomy is well suited for stage 4 ROP surgeries.

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Background: Multicolour imaging (MI) is a novel, non-invasive retinal imaging technology. Its sensitivity for detecting the clinical features in central serous chorioretinopathy (CSCR) has not been previously described. The aim of this study is to evaluate the accuracy of MI compared to fluorescein angiography and colour fundus photography in CSCR, and to describe the imaging features of MI. Methods: In this retrospective study at a tertiary referral centre, 63 consecutive eyes with CSCR (both acute and chronic) were included after obtaining permission from the institutional review board. Multimodal imaging with colour fundus photography, optical coherence tomography, MI and fluorescein angiography/indocyanine green angiography and nearinfrared and blue wavelength autofluorescence was analysed to identify the clinical findings in CSCR. Sensitivity and specificity values were computed for the different clinical features for each imaging modality. Results: On comparison with fluorescein angiography, MI was found to be more effective in identifying the extent of subretinal fluid (78 per cent versus 13 per cent). MI was equally capable in identifying pigment epithelium detachment (100 per cent versus 100 per cent) and retinal pigment epithelial changes (100 per cent versus 100 per cent). Focal leaks were identified in 84 per cent and 97 per cent of eyes using MI and fluorescein angiography imaging, respectively. The sensitivity of MI in identifying focal retinal pigment epithelial leaks was higher compared to near-infrared autofluorescence (84 per cent versus 34 per cent) and blue wavelength autofluorescence (84 per cent versus 18 per cent) imaging. Conclusion: MI is a useful, non-invasive imaging modality for detecting clinical features in CSCR. In the future, MI has the potential to substitute for fluorescein angiography and colour fundus photography as the imaging modality of choice.

BackgroundTo describe the multicolour (MC) imaging characteristics associated with choroidal osteomas (CO) and their secondary complications.MethodsRetrospective descriptive case series of eleven eyes of ten patients with CO. Findings of multicolour imaging were correlated with visual acuity, clinical features, lesion characteristics and findings from other imaging modalities.ResultsInfrared reflectance (IR) images showed calcified CO lesions as hyporeflectance (dark) areas while decalcified lesions were seen as iso reflectance (normal) areas. Overlying RPE atrophy on IR were seen as white areas. MC images showed color variations depending upon the reflectivity of the tumour material tumour and retinal pigment epithelial (RPE) atrophy. Green color was noted in calcified CO tumour while decalcified CO tumour showed no color change. RPE atrophy were seen as bright orange areas. Green and blue reflectance images were not able to pick the choroidal osteoma lesion. Other changes secondary to CO like presence of choroidal neovascular membrane, hemorrhage and/or fluid in the retinal layers were identified on green and blue reflectance images.ConclusionMC imaging is a useful tool in our arsenal of existing imaging modalities in the assessment of CO and its secondary changes. Change in reflectance of the IR and MC images can be used as an indicator to assess the extent of tumour decalcification and its secondary changes and therefore, can aid in prognostication in the same. It has the potential to replace color fundus photography in documentation and follow up of patients with CO.

Purpose: To describe the multimodal imaging features including indocyanine green angiography (ICGA) in cases diagnosed clinically as central retinal artery occlusion (CRAO) at its different disease stages. Methods: In this retrospective observational study, patients diagnosed clinically as CRAO or hemi-CRAO were included. All patients underwent multimodal imaging with optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were studied. Analysis of ICGA images in different stages of artery occlusions and its correlation with accompanying FFA and OCT images was done. Results: Eight such studies in five patients were available for analysis. The most important observation noted on ICGA was the presence of hypercyanescent spots seen during the acute stages of the disease in four of the five cases. The spots were accompanied by retinal vessel staining on FFA in the corresponding region. As the disease showed signs of resolution, the hypercyanescent spots on ICGA and retinal vessel staining on FFA disappeared. The hypercyanescent spots seen on the ICGA were noted due to the red blood cell aggregation or ‘rouleaux’ formation. In addition, choroidal perfusion abnormalities were noted on ICGA in all five cases in the acute stage. Conclusion: Choroidal perfusion changes can be identified in acute phase of retinal artery occlusion. Rouleaux formation in the retinal circulation occurs due to the slowing of the blood flow following artery occlusion. These are seen as hypercyanescent spots in the late phase on ICGA.

Objectives: To describe medication use patterns and adherence rates for schizophrenia patients after initiating antipsychotic treatment in Tianjin, China. MethOds: Data were extracted from the Tianjin Urban Employee Basic Medical Insurance database (2008)(2009)(2010). Adult patients with a schizophrenia diagnosis, newly initiating or restarting antipsychotics (no antipsychotics during previous 90 days) with 12-month continuous enrollment after their first observed antipsychotic prescription were included. Patients' medication prescribing patterns and antipsychotic adherence are described. Results: A total of 1216 patients were identified, with a mean (SD) age of 51.43 (12.48) years, 54.11% female. 83.14% of patients initiated with one antipsychotic and 16.86% with ≥ 2 antipsychotics. 37.99% of patients were initiated on typical antipsychotics, 52.06% on atypicals, and 9.95% on both. A higher portion of typical initiators were co-prescribed antianxiety and anticholinergic medications than atypical starters (both p< 0.001). During the following 12 months, the majority of patients remained on medications from their initial antipsychotic class (80.74% of typical initiators vs. 86.41% of atypical initiators) or the same medication (66.45% of typical initiators vs. 70.93% of atypical initiators). More typical initiators switched to, or augmented with, atypical antipsychotics than atypical initiators to/with typical antipsychotics (19.26% vs. 13.59%, P= 0.011). During the following 3, 6 and 12 months, antipsychotic continuation rates (≤ 30 days gap) were 50.33%, 23.60%, and 8.88%, respectively. Medication Possession Ratios were low, with means (SD) of 0.58 (0.32), 0.44 (0.30), and 0.34 (0.27) for the 3, 6 and 12 months, respectively. cOnclusiOns: More individuals with schizophrenia were treated with atypicals rather than typical antipsychotics. The majority of patients tended to stay with one antipsychotic drug class or the same medication. Patients' adherence to prescribed antipsychotics was low. This study highlights the importance of selecting an effective medication when starting antipsychotic therapy in China. However much could be done to improve treatment adherence. MUscUlar-skeletal disorders -clinical outcomes studiesPMs1 tHe iMPact of coMorbidities on Utility cHanges in lower-liMb osteoartHritis : kHoala stUdy