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Optics/Refraction/Contact Lens Free Papers OPTICS/ REFRACTION/ CONTACT LENS Chairman: Dr. Shreekant Kelkar B; Co-Chairman: Dr. Deepak Mehta C Convenor: Dr. Amit Tarafder; Moderator: Dr. R R Battu Dr. ROHAN RAMCHANDRA CHAUHAN: MBBS (2005), B J Medical College, Ahmedabad; DO (2007), Smt. N H L Municipal Medical College, Ahmedabad; Long Term Fellowship in Vitreo Retinal Diseases, Surgery & Intra Ocular Imflammation (2007-09). Presently, Associate Vitreo-Retinal Surgeon, Banker’s Retina Clinic & Laser Centre, Ahmedabad. E-mail: rohan_28782@yahoo.co.in; Contact: 9825203022 Refractive Status of Eyes Treated for Retinopathy of Prematurity (ROP) with Avastin and/or Laser Dr. Rohan Chauhan, Dr. Alay S Banker, Dr. Usman Memon, Dr. Chatura Hutheesing, Dr. Kinnari Thakkar Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Treatment for ROP has evolved from the past from more destructive (cryo therapy) to lesser destructive (laser therapy) peripheral retinal ablation. Although these ablative treatments reduce the incidence of blindness by 25% in infants with severe disease, visual acuity post-treatment remained considerably impaired. 1 The role of vascular endothelial growth factor (VEGF) in the pathogenesis of ROP has been identified. It is believed that exposure to high levels of oxygen during the neonatal period leads to obliteration of vessels. Vaso-obliteration leads to ischemia which further leads to the release of vascular growth factors and neovascularization. 2 VEGF increases permeability of vessels 3 and promotes endothelial cell proliferation. 4 Transcription of VEGF mRNA increases with hypoxia and has been identified to play a vital role in retinal angiogenesis. 5 Recent studies have identified that insulin-like growth factor 1 (IGF-1) plays a permissive role—in its absence VEGF is unlikely to fully stimulate vessel growth. 1 If evidence-based data supports early findings, the use of Avastin may be recommended without the need for ablative laser therapy and before retinal detachment develops. To evaluate refractive status of eyes with ROP treated with laser and/or avastin. MATERIALS AND METHODS Prospective, Nonrandomized, Non comparative case series. The procedure and the side effects of atropine were explained in details to the patient’s parents. Informed consent was obtained from the parents prior to the study with clear guidelines on the procedures and tests involved. 403
69th AIOC Proceedings, Ahmedabad 2011 Atropine was advised three times a day for 3 days prior to retinoscopy. Thereafter retinoscopy of the patient was performed on the fourth day. Out of 29 patients, only 1 patient had to be examined under general anaesthesia due to the hyperactivity and lack of co-operation of the patient. Based on cycloplegic retinoscopy, the patient was prescribed glasses depending on degree of refractive error. The refraction values of the patient’s parents were also noted. All patients were examined and evaluated by single optometrist. 57 eyes of 29 patients were being evaluated in the study. 26 eyes were treated with laser, 26 eyes with only avastin and 5 eyes, with both laser and avastin. All patients underwent atropinized refractive evaluation under sedation. Based on cycloplegic retinoscopy with streak retinoscope, the patients were prescribed glasses depending on his/her age and degree of refractive error. RESULTS 26 Avastin treated eyes at the mean age of 1 year showed a mean spherical equivalent (MSE) of -3.087 DS and -0.920 DC. 6/26 eyes were high myopic (-10.50 DS). 26 eyes in laser group at the mean age of 2 years showed a MSE of -2.058 DS and -1.00 DC. 3/26 eyes were high myopic (-13.16 DS). 5 eyes treated with laser and avastin at the mean age of 2 years showed MSE -2.30 DS and -1.00 DC. Amongst the avastin treated patients, 18/26 eyes were myopic and 7 were hyperopic with a mean spherical refractive error to be -3.087DS. 22/26 eyes were astigmatic with a mean astigmatic error of -0.920D. Amongst the laser treated patients in study, 12/26 eyes were myopic and 12 were hyperopic with a mean spherical refractive error as -2.058DS. 23/26 eyes were astigmatic with a mean astigmatic error as -1.00D. Amongst the patients treated with laser as well as avastin in study, 3/5 eyes were myopic and 2 were hyperopic with a mean spherical refractive error of -2.30 DS. 4/5 eyes were astigmatic with a mean astigmatic error of -1.00 D. Therefore myopia was seen to be the most predominant refractive error amongst all the 3 sub-groups of patients – avastin treated, laser treated as well as both, laser and avastin treated. It was found that 6/26 eyes in the avastin treated group of patients were highly myopic (that is, greater than -8.00 DS). If we exclude those highly myopic eyes from the study, the mean spherical refractive error was found to be -0.8625 DS. Similarly, in the laser treated group of patients, 3/26 eyes were found to be highly myopic. On excluding those highly myopic eyes, the mean spherical refractive error of the patients treated with laser was found to be -0.609 DS. In this study, the mean age on retinoscopy of the patients treated with avastin is 1 year. Whereas the mean age on retinoscopy of the patients treated with laser photocoagulation is 2 years. As these two groups are incomparable due to the vast difference in the mean age group of the patients, for better 404
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