Nonischemic Central Retinal Vein Occlusion in an Adolescent Patient with Ulcerative Colitis

Inflammatory bowel disease (IBD) can present with extraintestinal manifestations occasionally involving the eye. Retinal vein occlusions are rarely seen and have never been reported in the pediatric population though vascular thrombosis can be associated with IBD. Here, we present a case of what we believe is the youngest reported patient with nonischemic central retinal vein occlusion (CRVO)

Development of an evidence-based regimen of prednisolone to treat giant cell arteritis - the Norwich regimen

We have reviewed the literature to form a bespoke regimen for daily oral prednisolone (DP) in GCA. Initial DP in clinical trials is 40-60 mg daily, but relapse rates are 67-92%. Cumulative prednisolone (CP) of 3.2 and 3.9 g (at 6 months) resulted in a relapse rate of 83 and 67%, respectively; and 3 and 3.9 g (at 12 months) resulted in 92 and 82% relapse, respectively. CP was 6.2-7.1 g in the first year. Mean DP was 18.8 mg at 3 months and 6.6-7.4 mg at 12 months. The duration of treatment with prednisolone for GCA was 22-26 months. The CP to achieve discontinuation was 6.5-12.1 g. Using these data, the Norwich regimen starts DP at 1 mg/kg/day of lean body mass, discontinuing over 100 weeks. For the average UK woman, initial DP is 45 mg daily, reaching 21 mg daily by 12 weeks and 6 mg daily by 52 weeks. The CP for the average UK woman would be 6.5 g at 52 weeks and 7.4 g to discontinuation

Is diabetic retinopathy screening worthwhile among people first diagnosed with diabetes at older ages? A cohort study of Norfolk diabetic retinopathy screening programme

Aims: England's Diabetic Eye Disease Screening Programme offers screening to every resident over age 12 with diabetes, starting as soon as possible after diagnosis and repeated annually. People first diagnosed with diabetes at older ages have shorter life expectancy and therefore may be less likely to benefit from screening and treatment. To inform decisions about whether diabetic eye screening policy should be stratified by age, we investigated the probability of receiving treatment according to age at first screening episode. Methods: This was a cohort study of participants in the Norfolk Diabetic Retinopathy Screening Programme from 2006 to 2017, with individuals' programme data linked to hospital treatment and death data recorded up to 2021. We estimated and compared the probability, annual incidence and screening costs of receiving retinal laser photocoagulation or intravitreal injection and of death, in age groups defined by age at first screening episode. Results: The probability of death increased with increasing age at diagnosis, while the probability of receiving either treatment decreased with increasing age. The estimated cost of screening per person who received either or both treatments was £18,608 among all participants, increasing with age up to £21,721 in those aged 70–79 and £26,214 in those aged 80–89. Conclusions: Diabetic retinopathy screening is less effective and less cost-effective with increasing age at diagnosis of diabetes, because of the increasing probability of death before participants develop sight-threatening diabetic retinopathy and can benefit from treatment. Upper age limits on entry into screening programmes or risk stratification in older age groups may, therefore, be justifiable

Registration of visual impairment due to diabetic retinopathy in a subpopulation of Cambridgeshire

Patel Gordon-Bennett1, Aseema Misra2, Wendy Newsom1, Declan Flanagan21Eye Department, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK; 2Eye Department, Addenbrookes Hospital, Hills Road, Cambridge, Cambridgeshire, UKBackground/Aims: The UK National Screening Committee (NSC) has set 18 standards for diabetic retinopathy (DR) screening services in England and Wales, the first of which is to reduce new visual impairment (VI) due to DR by 10% within 5 years. This study examined the incidence of VI due to DR in Cambridgeshire (City, South, and Huntingdonshire) in order to establish a baseline rate of VI registration.Methods: A retrospective review of all certificates of visual impairment (CVI) for 2004 and 2005 was conducted. Hospital records of patients registered due to DR were reviewed to ascertain conformity to NSC Standards. The incidence of VI registration due to DR was calculated.Results: The number of registrations predominantly due to DR was 18; 13 visually impaired and 5 with severe VI. The rates of VI and severe VI predominantly due to DR were 17.1 and 6.5 per million per year, respectively. The VI and severe VI registration rates in the diabetic population were 600 and 230 per million per year, respectively.Conclusion: The severe VI registration rate due to DR lies within the national standard. The VI registration rate exceeds 1990–1991 national standards but lies within 1999–2000 national figures.Keywords: diabetic retinopathy, visual impairment, severe visual impairment, registration, certification of visual impairmen

Validating a diagnostic GCA ultrasonography service against temporal artery biopsy and long-term clinical outcomes

Currently, there is no mechanism for service validation of diagnostic ultrasonography (US) for giant cell arteritis (GCA). Temporal artery biopsy (TAB) and classification criteria are poor benchmarks. We validated our service against physician-verified diagnosis at 100 weeks (100wD). Twenty-five patients underwent US within 7 days, and TAB within 28 days, of commencing prednisolone. US, TAB and baseline diagnosis (bD) were all compared with 100wD using Cohen's kappa. Fourteen US and 8 TABs were positive. Twenty at baseline and 14 at 100 weeks had diagnosis of GCA. The kappa (95% CI) were 0.4 (0.1, 0.7) for US vs. TAB; 0.5 (0.2, 0.8) for US vs. bD and 0.2 (0.0, 0.4) for TAB vs. bD. Versus 100wD, the kappa (95% CI) were 0.8 (0.6, 1.0) for US; 0.4 (0.1, 0.7) for TAB and 0.6 (0.3, 0.9) for bD. Seven cases were US+/TAB-. Four had alternate confirmation: 18FDG-PET (n = 1), CT Aorta (n = 1) and US at relapse (n = 2). At 100 weeks, 4 cases (all US-/TAB-) with bD of GCA had alternative diagnoses including cancer (n = 2). This is the first study validating US service provision for GCA. Twenty-five US with a robust kappa on comparison with long-term diagnosis validates our service. A diagnosis of GCA should be made with extreme caution for US-/TAB- cases. Key Points • This is the first study offering a way to validate a new diagnostic US service by validation against TAB and long-term physician-verified diagnosis. • US has substantial to near-perfect agreement with long-term physician-verified diagnosis and is more reliable than TAB in our hands. • Alternative diagnoses should be sought in patients with dual negativity for US and TAB