Reducing Blindness from Retinopathy of Prematurity (ROP) in Argentina Through Collaboration, Advocacy and Policy Implementation.

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

Ocular Neuromyotonia noted after Recent Botulinum Toxin Injection for Sixth Nerve Palsy following Resection of a Posterior Fossa Skull Based Meningioma

Ocular neuromyotonia (ONM) is a rare paroxysmal neuromuscular disorder characterized by involuntary contraction of one or more ocular muscles resulting in episodic diplopia and strabismus. Reported etiologies include radiation, chronic nerve palsy, Graves disease, compressive lesions, stroke or idiopathic. The disorder is thought to be secondary to axonal instability; therefore membrane-stabilizing agents such as carbamazepine and gabapentin have been utilized. Sparse literature exists describing the role of radiation, the onset of prior nerve palsies in causing ONM, or the association with botulinum toxin. We present a case of ONM following bolutinum toxin for a recent postoperative 6th nerve palsy with a prior history of radiation

An Alternative Surgical Treatment of Torsional Diplopia Secondary to Bilateral Superior Oblique Palsy

Torsional diplopia causes significant visual disturbance for patients with bilateral superior oblique palsies and often poses a surgical challenge. The Harada-Ito procedure may address the excyclotorsion by inducing an intorsion effect from transposition of the anterior superior oblique tendon fibers, however this procedure may be technically challenging, may induce a Brown syndrome and may not address the associated V-pattern esotropia. We present a case of a patient with severe torsional diplopia secondary to a bilateral superior oblique palsy that resolved with a bilateral inferior rectus recession with nasal transposition

Ocular Neuromyotonia Noted after Recent Botulinum Toxin Injection for Sixth Nerve Palsy Following Resection of a Posterior Fossa Skull Base Meningioma

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