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Rate of refractive growth in pseudophakic eyes in the Infant Aphakia Treatment Study
Volume 20 Number 4 / August 2016 patients and that BiS may be a useful measure of binocularity in this population. 023 Visual outcomes following perinatal ischemic stroke. Erin C. Kiskis, Lori Billinghurst, Rebecca Ichord, Laura Jastrzab, Gil Binenbaum Introduction: There are limited data describing visual outcomes following perinatal stroke. We sought to describe the prevalence and type of visual deficits observed in children after perinatal arterial ischemic stroke (PAIS) and to evaluate clinical factors associated with abnormal visual outcome. Methods: Single-center prospective consecutive cohort study of PAIS subjects enrolled 2006-2014 and followed by pediatric neurology and/or ophthalmology. Abnormal visual outcome was defined as any of poor central vision, suspected or confirmed visual field cut, or manifest strabismus. Clinical factors evaluated were early head turn (\1 year of age), infarct location, and infarct volume estimated by a validated scale (modASPECTS). Results: Median follow-up of 98 children was 4.5 years (IQR 2.1-6.6). Infarct was unilateral in 85 (87%) and within anterior, posterior, or both circulations in 85 (86%), 4 (4%), and 9 (9%), respectively. Early head turn was detected in 33(33%), which later resolved in 31/33 (94%). At latest follow-up, central vision was good in 96 (98%), but 29 (29%) had abnormal visual outcome (strabismus 18, field cut 15, poor central vision 2), which was associated with early head turn (P 5 0.01), basal ganglia involvement (P 5 0.01), and large stroke volume (P \ 0.0001). Discussion: Central vision is usually preserved following PAIS. Field cut and strabismus occur in a minority of children. Risk factors for abnormal visual outcome include early head turn and larger stroke volume. Conclusions: Parents can be counseled that visual outcomes following perinatal stroke are generally good and early head turn typically resolves. However, children remain at risk for visual deficits and should be screened by treating physicians.
024 Rate of refractive growth in pseudophakic eyes in the Infant Aphakia Treatment Study. Scott R. Lambert, M. Edward Wilson, David A. Plager, Edward G. Buckley Introduction: To report the rate of refractive growth for pseudophakic eyes in the Infant Aphakia Treatment Study (IATS). Methods: 55 infants (age, 1-6 months) in the IATS randomized to IOL implantation (targeted undercorrection: +8 D, surgery age 4-6 weeks; +6 D, surgery .6 weeks) had their rate of refractive growth calculated using the RRG3 formula. The change in refraction (1 month postop to age 5 years) was used to calculate the RRG3 except for 3 patients who underwent IOL exchange (RRG3 calculated using refraction prior to IOL exchange). Results: Cataract surgery was performed at a mean age of 0.21 0.13 years. The mean IOL power implanted was 29.45 5.90 D and the mean refraction 1 month postop was +6.05 2.48 D. The mean age at last refraction was 4.81 0.83 years. The mean RRG3 was 20.7 13.1 D (range, 4.7 to 93.9 D). The mean RRG3 for the 3 eyes that underwent IOL exchanges was 52.2 D. Their mean postop refraction was +2.0 D and their mean refraction at the time of IOL exchange was 12.5 D. Two of these eyes developed glaucoma. Discussion: Rates of refractive growth vary widely in infants undergoing IOL implantation. Glaucoma is a risk factor for a high RRG3. A low initial undercorrection coupled with a high rate of refractive growth increases the likelihood of early IOL exchange.
Journal of AAPOS
e7 Conclusions: Further research is needed to identify factors associated with differing rates of refractive growth after infantile IOL implantation 025 Longitudinal refractive development in pre-term children following treatment of retinopathy of prematurity (ROP) with intravitreal bevacizumab (IVB). Joel N. Leffler, Jingyun Wang, Sarah E. Morale, Angie De La Cruz, Kathryn M. Haider, Rand Spencer, Eileen E. Birch Introduction: The prevalence of high myopia in children with ROP has been reported to be significantly lower with IVB treatment than with laser treatment. Data on moderate myopia post-treatment is conflicting and there are no longitudinal cycloplegic retinoscopy data. Here we report longitudinal refractive error during the first 3 years for a prospective cohort treated with IVB. Methods: Preterm infants (BW \ 1000 g, GSA 24-26 weeks) treated for type 1 ROP with IVB were eligible (IVB group: N 5 30). Preterm infants who met the same eligibility criteria treated with laser provided an historical comparison group (laser group: N 5 28). Cycloplegic retinoscopy was conducted at 0.5 years adjusted age and every 0.5-1.0 years thereafter. Results: Children in the IVB Group had less myopia at 0.5 years ( 0.13 0.46 D), 1.5 years ( 1.86 0.91 D), and 2.5 years ( 2.02 1.38 D) than in the Laser Group ( 4.02 0.64D, 6.42 0.91 D, and 7.78 1.16 D, resp.; P \ 0.001, P 5 0.0009, and P 5 0.02, resp.). Regardless of treatment modality, the most rapid increase in myopia occurred during the first 1.5 years. The incidence of high myopia ($ 6.00D) was 8X lower in the IVB group (7%) than in the laser group (57%; P \ 0.0001). There was no significant difference in the prevalence of moderate myopia (\ 6.00 D; 37% vs 32%). Discussion: Compared with laser treatment, treatment of severe ROP with IVB is associated with less severe myopia, and a striking 8 lower incidence of high myopia. Conclusions: We propose that the reduced incidence of high myopia is due to differences in the effects of bevacizumab versus laser treatment on anterior segment development. Confirmation awaits assessment of biometric components. 026 Validation of the CHOP model for detecting high-grade retinopathy of prematurity in a cohort of Colorado infants. Emily A. McCourt, Anne Lynch, Brandie Wagner, Ashlee Cerda, Jennifer Jung, Jasleen Singh, Robert Enzenauer, Rebecca Braverman Introduction: To validate the CHOP postnatal weight gain, birth weight, and gestational age retinopathy of prematurity risk model (CHOP-ROP) in a Colorado cohort of infants. Methods:The CHOP-ROP model was applied to 1,225 preterm infants. Sensitivities and specificities for detection of high grade ROP, low grade, and overall ROP with corresponding 95% confidence intervals were calculated using exact Clopper Pearson type test. Results: Of the 1,225 infants, 75 (6.2%) developed type 1 ROP, 50 (4.1%) developed Type 2 ROP, and 294 (24.0%) developed low grade ROP. Application of the CHOP-ROP model to our infants would have triggered screening for 633 infants and reduced the number of infants screened compared to 2013 national criteria by 48.3%. In our cohort, application of the CHOP-ROP model had a sensitivity of 99.2% (95%CI 95.6%-99.9%) for detecting high-grade ROP and 85.9% (82.2%-89.1%) for detecting any ROP. The specificity of CHOP-ROP for detecting ROP when applied to our cohort was 66.1%. The CHOP-ROP model missed 1/125 infants with high grade ROP (1 baby with type 2 ROP). Discussion: The CHOP-ROP model has the potential to improve ROP screening efficiency and would eliminate almost half of the babies
024 Rate of refractive growth in pseudophakic eyes in the Infant Aphakia Treatment Study. Scott R. Lambert, M. Edward Wilson, David A. Plager, Edward G. Buckley Introduction: To report the rate of refractive growth for pseudophakic eyes in the Infant Aphakia Treatment Study (IATS). Methods: 55 infants (age, 1-6 months) in the IATS randomized to IOL implantation (targeted undercorrection: +8 D, surgery age 4-6 weeks; +6 D, surgery .6 weeks) had their rate of refractive growth calculated using the RRG3 formula. The change in refraction (1 month postop to age 5 years) was used to calculate the RRG3 except for 3 patients who underwent IOL exchange (RRG3 calculated using refraction prior to IOL exchange). Results: Cataract surgery was performed at a mean age of 0.21 0.13 years. The mean IOL power implanted was 29.45 5.90 D and the mean refraction 1 month postop was +6.05 2.48 D. The mean age at last refraction was 4.81 0.83 years. The mean RRG3 was 20.7 13.1 D (range, 4.7 to 93.9 D). The mean RRG3 for the 3 eyes that underwent IOL exchanges was 52.2 D. Their mean postop refraction was +2.0 D and their mean refraction at the time of IOL exchange was 12.5 D. Two of these eyes developed glaucoma. Discussion: Rates of refractive growth vary widely in infants undergoing IOL implantation. Glaucoma is a risk factor for a high RRG3. A low initial undercorrection coupled with a high rate of refractive growth increases the likelihood of early IOL exchange.
Journal of AAPOS
e7 Conclusions: Further research is needed to identify factors associated with differing rates of refractive growth after infantile IOL implantation 025 Longitudinal refractive development in pre-term children following treatment of retinopathy of prematurity (ROP) with intravitreal bevacizumab (IVB). Joel N. Leffler, Jingyun Wang, Sarah E. Morale, Angie De La Cruz, Kathryn M. Haider, Rand Spencer, Eileen E. Birch Introduction: The prevalence of high myopia in children with ROP has been reported to be significantly lower with IVB treatment than with laser treatment. Data on moderate myopia post-treatment is conflicting and there are no longitudinal cycloplegic retinoscopy data. Here we report longitudinal refractive error during the first 3 years for a prospective cohort treated with IVB. Methods: Preterm infants (BW \ 1000 g, GSA 24-26 weeks) treated for type 1 ROP with IVB were eligible (IVB group: N 5 30). Preterm infants who met the same eligibility criteria treated with laser provided an historical comparison group (laser group: N 5 28). Cycloplegic retinoscopy was conducted at 0.5 years adjusted age and every 0.5-1.0 years thereafter. Results: Children in the IVB Group had less myopia at 0.5 years ( 0.13 0.46 D), 1.5 years ( 1.86 0.91 D), and 2.5 years ( 2.02 1.38 D) than in the Laser Group ( 4.02 0.64D, 6.42 0.91 D, and 7.78 1.16 D, resp.; P \ 0.001, P 5 0.0009, and P 5 0.02, resp.). Regardless of treatment modality, the most rapid increase in myopia occurred during the first 1.5 years. The incidence of high myopia ($ 6.00D) was 8X lower in the IVB group (7%) than in the laser group (57%; P \ 0.0001). There was no significant difference in the prevalence of moderate myopia (\ 6.00 D; 37% vs 32%). Discussion: Compared with laser treatment, treatment of severe ROP with IVB is associated with less severe myopia, and a striking 8 lower incidence of high myopia. Conclusions: We propose that the reduced incidence of high myopia is due to differences in the effects of bevacizumab versus laser treatment on anterior segment development. Confirmation awaits assessment of biometric components. 026 Validation of the CHOP model for detecting high-grade retinopathy of prematurity in a cohort of Colorado infants. Emily A. McCourt, Anne Lynch, Brandie Wagner, Ashlee Cerda, Jennifer Jung, Jasleen Singh, Robert Enzenauer, Rebecca Braverman Introduction: To validate the CHOP postnatal weight gain, birth weight, and gestational age retinopathy of prematurity risk model (CHOP-ROP) in a Colorado cohort of infants. Methods:The CHOP-ROP model was applied to 1,225 preterm infants. Sensitivities and specificities for detection of high grade ROP, low grade, and overall ROP with corresponding 95% confidence intervals were calculated using exact Clopper Pearson type test. Results: Of the 1,225 infants, 75 (6.2%) developed type 1 ROP, 50 (4.1%) developed Type 2 ROP, and 294 (24.0%) developed low grade ROP. Application of the CHOP-ROP model to our infants would have triggered screening for 633 infants and reduced the number of infants screened compared to 2013 national criteria by 48.3%. In our cohort, application of the CHOP-ROP model had a sensitivity of 99.2% (95%CI 95.6%-99.9%) for detecting high-grade ROP and 85.9% (82.2%-89.1%) for detecting any ROP. The specificity of CHOP-ROP for detecting ROP when applied to our cohort was 66.1%. The CHOP-ROP model missed 1/125 infants with high grade ROP (1 baby with type 2 ROP). Discussion: The CHOP-ROP model has the potential to improve ROP screening efficiency and would eliminate almost half of the babies