Aggressive Posterior Retinopathy Research Articles

Comparative Analysis of Demographic and Clinical Profiles of Conventional Retinopathy of Prematurity with Aggressive Posterior Retinopathy of Prematurity

Aim: To compare the demographic and clinical profile of conventional retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity. Material and methods: A prospective, unmasked, and observational study involving 150 ROP patients was conducted over a period of one year. The risk factors including maternal and neonatal risk factors were recorded. The data was entered into the Excel sheet and analyzed to compare the risk factors between the conventional ROP and APROP. Results: A total of 17 (11.3%) babies were found to have AP-ROP and 133 (88.7%) babies were found to have conventional ROP. There was no significant difference in average gestational age between infants diagnosed with AP-ROP (29.6 ± 2.9 weeks) and those with Conventional ROP (30.1 ± 2.2 weeks) (p = 0.428). However, infants with AP-ROP had a significantly lower average birth weight (1022.7 ± 123.5 g) compared to infants with Conventional ROP (1208.2 ± 261.0 g) (p = 0.004). Multivariate logistic regression analysis revealed that birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis were independently associated with the development of AP-ROP. Conclusion: The development of APROP is multifactorial and complex. Although we have identified factors such as birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis in the causation of APROP, further long-term multicentric studies are required for validation.

Pre-term Familial Exudative Vitreoretinopathy: A Novel Nonsense LRP5 Mutation.

This case report details the diagnosis and management of a pre-term infant with aggressive bilateral retinal pathology. A 4-week-old preterm baby girl, born at 28 weeks and 6 days to consanguineous parents, was referred for suspected aggressive posterior retinopathy of prematurity (ROP). She had a family history of bilateral retinal detachments and intellectual disability in an older sister. Clinical assessment included retinal examination, fluorescein angiography, optical coherence tomography, dual-energy X-ray absorptiometry (DEXA), and genetic testing. The genetic testing involved sequence analysis and copy number variation analysis of 25 genes related to vitreoretinopathy. Retinal examination and fluorescein angiography revealed extensive non-perfusion and telangiectatic vessels in both eyes, and a macula-involving tractional retinal detachment in the left eye. Despite treatment with intravitreal bevacizumab and laser photocoagulation, they progressed to total retinal detachment and no light perception in both eyes. Genetic testing revealed a pathogenic homozygous nonsense mutation in the LRP5 gene (c.3259C>T, p.(Gln1087*)), a mutation not previously reported in association with familial exudative vitreoretinopathy (FEVR). At 10 months of age, DEXA demonstrated normal bone density, diverging from the typical presentation of osteoporosis pseudoglioma syndrome associated with LRP5 mutations. This case describes a novel mutation in a complex retinal disease and underscores the necessity of considering pre-term FEVR in the differential diagnosis of atypical or aggressive ROP in preterm infants. The overlap in clinical features between ROP and FEVR highlights the complexity of diagnosis and management and the importance of genetic testing in preterm infants with retinal vascular abnormalities.

Efficacy of an Indian Bevacizumab BIOSimilar (BEVATAS) for Type 1 and Aggressive Posterior Retinopathy of Prematurity (BIOS-ROP Study).

To evaluate the role of an Indian bevacizumab biosimilar (Bevatas®), for the management of type 1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP) over 24-weeks. A retrospective, single-center, interventional study of 144 eyes of type 1 (100 eyes) and APROP (44 eyes). All eyes received a single dose of 0.625mg Bevatas injection, and were advised additional laser therapy for suboptimal response. The study population had a mean gestational age of 28.94 (±2.32) weeks, an average birth weight of 1.2 (±0.34) kg, and modest male predominance (52.05%). Complete regression of ROP was seen in 65.97% of 144 eyes after 24 weeks of bevacizumab monotherapy, and in 97.22% of eyes (140 eyes) after adding laser photocoagulation. The remaining four eyes (all had APROP) developed Stage 4 ROP and needed vitreous surgery. After monotherapy with bevacizumab biosimilar, type 1 ROP eyes had significantly higher rate of complete ROP regression than APROP eyes (87% vs 18.18%; P<0.00001). All eyes with type 1 ROP, and 90.91% of eyes with APROP, regressed after receiving additional laser therapy. The study population experienced no ocular or systemic adverse effects. The BIOS-ROP study demonstrates that intravitreal bevacizumab biosimilar monotherapy offers significant benefit for type 1 ROP, but not APROP. Low-cost biosimilars can help sustain healthcare systems in lower-middle income countries (LMICs) with escalating healthcare expenditures. They can also improve healthcare equity by making vision-saving therapies like bevacizumab more affordable and accessible.

Efficacy of four anti-vascular endothelial growth factor agents and laser treatment for retinopathy of prematurity: A network meta-analysis.

This study undertakes a comprehensive comparison of five different interventions for the treatment of type-1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP), offering insights into their relative efficacies and contributing to better clinical decision making. The aim of this study was to compare the efficacy of intravitreal aflibercept (IVA), intravitreal bevacizumab (IVB), intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), and laser therapy in treating these conditions. We conducted a search for relevant randomized controlled trials (RCTs) in databases, namely, PubMed, Embase, Cochrane Library, Web of Science, and Ovid, focusing on these five treatment modalities for ROP. The quality of the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool, and data analysis was performed using STATA software. The results from our network meta-analysis (NMA) indicated that IVA significantly prolonged the interval between initial treatment and relapse in patients, with a surface under the cumulative ranking curve (SUCRA) value of 99.1%. Additionally, patients in the IVB group had a significantly higher spherical equivalent refraction (SER) after surgery, with a SUCRA value of 84.4%. Furthermore, IVR was the most effective in reducing the duration of peripheral retinal vascularization, with a SUCRA value of 95.6%. However, no statistically significant differences were found in relapse rates among the five treatment options. Our analysis concludes that intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drug monotherapy generally offer better outcomes than laser treatment for ROP. Nonetheless, additional RCTs are necessary to further evaluate the safety of anti-VEGF agents.

Treatment of Retinopathy of Prematurity by Intravitreal Injection of Bevacizumab

Introduction: Retinopathy of prematurity is a vasoproliferative disease of the developing retina that is a significant cause of paediatric morbidity and blindness worldwide. Although management by early treatment ROP (ETROP) criteria has led the way to improving the outcomes of treatment-requiring posterior (zone 1) ROP, the failure rate continues to be significant for aggressive disease. Managing a premature infant with ROP is a significant challenge to ophthalmologists and associated physicians. However, increasingly younger and lower birth-weight infants can survive with advances in neonatal care. Objectives: To assess the effectiveness of intravitreal injection of Bevacizumab on regression of retinal neovascularization in stage III, Zone 1, 2 retinopathy of prematurity and aggressive posterior retinopathy of prematurity. Methods: Intravitreal Injection of Bevacizumab (0.625mg/0.025mL) was performed on 34 eyes of 17 newborns with stage III, Zone 1, 2 retinopathy of prematurity and aggressive posterior retinopathy of prematurity. The changes in retinal neovascularization were assessed by frequent fundoscopy. Results: Retinopathy of prematurity regressed in all the eyes treated. The retinal vascularization proceeded beyond the demarcation line. Four eyes of 2 patients needed repeat injections. One eye needed an additional laser. There was no injection-related complication observed. Conclusion: Intravitreal injection of Bevacizumab can be considered an effective modality in treating Retinopathy of Prematurity. It is recommended to perform more studies to assess its long-term effect on the body's vascular system. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 24-27

Comparison of Bevacizumab and Aflibercept for Suppression of Angiogenesis in Human Retinal Microvascular Endothelial Cells.

Bevacizumab (Avastin) is a vascular endothelial growth factor (VEGF) inhibitor that is widely used for aggressive posterior retinopathy of prematurity (APROP). Its use is associated with multiple adverse effects. Aflibercept (Eylea) is a VEGFR-1 analogue that is approved for ocular use, but its efficacy for APROP is less studied. We tested the hypothesis that Eylea is as effective as Avastin for suppression of intermittent hypoxia (IH)-induced angiogenesis. Human retinal microvascular endothelial cells (HRECs) were treated with Avastin and low- or high-dose Eylea and exposed to normoxia, hyperoxia (50% O2), or neonatal IH for 24, 48, or 72 h. Cells were assessed for migration and tube formation capacities, as well as biomarkers of angiogenesis and oxidative stress. Both doses of Eylea suppressed migration and tube formation in all oxygen environments, although the effect was not as robust as Avastin. Furthermore, the lower dose of Eylea appeared to be more effective than the higher dose. Eylea induced soluble VEGFR-1 (sVEGFR-1) coincident with high IGF-I levels and decreased Notch/Jagged-1, demonstrating a functional association. Given the role of VEGFR-1 and Notch as guidance cues for vascular sprouting, these data suggest that Eylea may promote normal vascular patterning in a dose-dependent manner.

Эффективность анти-VEGF лечения задней агрессивной ретинопатии недоношенных

Purpose. To evaluate the anti-VEGF therapy efficacy for treatment aggressive posterior retinopathy of prematurity (AP-ROP). Material and methods. 14 children (28 eyes) with APROP, mean gestational age of 27.4 weeks. Birth weight were from 480 to 1360 grams, on average – 972.8 grams. AP-ROP were developed children post-conceptual age (PCA) from 31 to 34 weeks, with an average of 32.2 weeks. Intravitreal injection of ranibizumab was performed no later than one day after the detection of AP-ROP. Results. In 22 (78.5 %) of 28 eyes, only one injection of ranibizumab was required, of which, in 6 eyes, additional laser photocoagulation of the retina was performed after the injection in a period of 14 to 21 days. In the remaining 6 eyes (21.5 %), 2 injections of ranibizumab were required 4 to 8 weeks after the first injection. All 34 injections were completed without complications and were not accompanied by any adverse events in the treated children. Retinal detachment developed in 2 children in 3 eyes (10.7 %): in one child – in both eyes (stage 4A ROP – in one of the eyes, 4B – in the paired one); the second child has stage 4B ROP in one of the eyes. All children after anti-VEGF therapy had not complete fundus vascularization to 65 weeks of PCA. As a rule, the 3rd zone of the fundus remained avascular, but no signs of angiogenesis were observed, which we regarded as regression of disease without complete retinal vascularization. Conclusion. The efficacy of treatment of AP-ROP with anti-VEGF therapy was high and amounted to 89.3 %. In 78.5% of cases, one injection of ranibizumab is sufficient for regression of disease. Given the absence of complete retinal vascularization at 65 weeks of PCA, children undergoing anti-VEGF therapy require longer follow-up due to the possibility of reactivation of ROP later in PCA. Keywords: aggressive posterior retinopathy of prematurity, anti-VEGF therapy

Adversarial learning-based multi-level dense-transmission knowledge distillation for AP-ROP detection.

The Aggressive Posterior Retinopathy of Prematurity (AP-ROP) is the major cause of blindness for premature infants. The automatic diagnosis method has become an important tool for detecting AP-ROP. However, most existing automatic diagnosis methods were with heavy complexity, which hinders the development of the detecting devices. Hence, a small network (student network) with a high imitation ability is exactly needed, which can mimic a large network (teacher network) with promising diagnostic performance. Also, if the student network is too small due to the increasing gap between teacher and student networks, the diagnostic performance will drop. To tackle the above issues, we propose a novel adversarial learning-based multi-level dense knowledge distillation method for detecting AP-ROP. Specifically, the pre-trained teacher network is utilized to train multiple intermediate-size networks (i.e., teacher-assistant networks) and one student network by dense transmission mode, where the knowledge from all upper-level networks is transmitted to the current lower-level network. To ensure that two adjacent networks can distill the abundant knowledge, the adversarial learning module is leveraged to enforce the lower-level network to generate the features that are similar to those of the upper-level network. Extensive experiments demonstrate that our proposed method can realize the effective knowledge distillation from the teacher to student networks. We achieve a promising knowledge distillation performance for our private dataset and a public dataset, which can provide a new insight for devising lightweight detecting systems of fundus diseases for practical use.

Reactivation of retinopathy of prematurity after intravitreal bevacizumab monotherapy in aggressive posterior retinopathy of prematurity

Aims: The aim of the study was to identify the risk factors and timing for the reactivation of retinopathy of prematurity (ROP) after intravitreal bevacizumab (IVB) in aggressive posterior retinopathy of prematurity (APROP). Materials and Methods: A retrospective study to analyze the outcome of 24 eyes of 12 infants treated with IVB monotherapy (0.625 mg) was done. Data were analyzed regarding the initial response to IVB, the incidence of ROP reactivation, timing, location, and stage of reactivation. Gestational age, postmenstrual age, and other neonatal comorbid risk factors were compared between the reactivation and those without reactivation after IVB. Results: The mean follow-up time was 50.2 ± 1.4 weeks after IVB. Reactivation was identified in 8 (33.3%) eyes. Reactivation in zone I was seen in only two eyes and zone II reactivation was present in six eyes. The mean postmenstrual age at the time of recurrence was 44.0 ± 1.15 weeks (range: 43–45). The mean time between initial treatment and treatment-requiring recurrence was 11.8 ± 0.9 weeks. Multiple pregnancy, low birth weight, sepsis, and necrotizing enterocolitis were significantly associated with ROP reactivation. None of our patients progressed to retinal detachment after laser treatment for reactivation. Conclusions: Although IVB treatment is effective in inducing the regression of APROP, the effect may be transient. The recurrence of ROP should be carefully watched in a long-term follow-up after IVB monotherapy, particularly in the first 12 weeks after IVB.

Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population.

To investigate the ratio of spontaneous regression of retinopathy of prematurity (ROP) and to explore the possible relevant predictive factors. A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected. Stage, zone, and duration of ROP were recorded. Statistical analysis was performed on 51 possible predictive factors. Totally 356 infants showed spontaneous regression. The incidence was 100%, 95.3%, and 22.7% in stage 1, 2, and 3, respectively. The 13.4% of the ROP with plus disease eventually resolved spontaneously. All affected eyes of aggressive posterior retinopathy of prematurity (AP-ROP) failed to spontaneously regress. The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP. Days of mechanical ventilation (OR=0.981, 95%CI, 0.965-0.997, P=0.021), retinal hemorrhage (OR=0.173, 95%CI, 0.064-0.470, P=0.001), delivery pattern (OR=2.750, 95%CI, 1.132-6.681, P=0.025), maternal anemia in pregnancy (OR=0.142, 95%CI, 0.036-0.563, P=0.005), the stages (at initial diagnosis OR=0.183, 95%CI, 0.041-0.816, P=0.026; at final diagnosis OR=0.031, 95%CI, 0.006-0.167, P<0.001), and with plus disease or not (OR=0.005, 95%CI, 0.001-0.031, P<0.001) were independent predictive factors of the spontaneous regression of ROP. Most mild ROP can spontaneously resolve. Active treatment is still recommended for stage 3 ROP, zone I ROP, AP-ROP, and ROP with plus disease. Prolonged mechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution. The pattern of delivery and the mother's anemia during pregnancy can also affect the prognosis of ROP.

Retinopathy of prematurity: Risk factors and associated co-morbidities

To estimate the prevalence of ROP and identify risk factors and co-morbidities associated with it. This cross-sectional study was performed, enrolling all premature babies admitted to the NICU of Jawaharlal Nehru Medical College and Hospital, A.M.U., Aligarh, Uttar Pradesh over 18 months. Various risk factors and co-morbidities for ROP were assessed using univariate and multivariate analysis. Out of the studied 164 infants, 29 infants (17.68%) developed ROP in one or both eyes; 51.72% (15/29) had stage 1, 31.03% (9/29) had stage 2, 10.35 % (3/29) had stage 3, and 6.90% (2/29) babies had aggressive posterior retinopathy of prematurity (APROP). On univariate analysis, we observed a significant association between ROP and gestational age, low birth weight, multiple gestations, mechanical ventilation, history and duration of oxygen supplementation, history of blood transfusion, respiratory distress syndrome, apnea and sepsis. However, after multivariate analysis, only low birth weight, oxygen therapy, respiratory distress syndrome and apnea were found to have a significant association with ROP. A prevalence of 17.68% emphasises the importance of neonatal screening in this region. Low birth weight, oxygen therapy, apnea, respiratory distress syndrome pose significant risk factors for ROP. Supplemental oxygen should be weaned off as early as possible,

Classification of retinopathy of prematurity based on mixed attention

Children with aggressive posterior retinopathy of prematurity (AP-ROP) are prone to lose the best treatment time if they are not diagnosed in time, leading to complete retinal detachment and eventual blindness. In order to diagnose this special type of AP-ROP from ROP cases more accurately, we propose a semi-supervised learning method based on mixed attention network. We obtain two different data representations of unlabeled training data through a weak enhancer and a strong enhancer, respectively. The enhanced data obtained by the weak enhancer is used to generate pseudo labels of the unlabeled data, which will be further used as the supervised training labels of enhanced data obtained by the strong enhancer. In the devised model, we consider the self-attention, spatial attention and channel attention together to enhance the capabilities of feature extraction. Experimental results show that the proposed method can achieve performance comparable to fully-supervised learning with few labeled data, thereby realizing automatic detection of retinopathy of prematurity, and assisting doctors in the early screening of ROP and AP-ROP.

Сравнительная характеристика эффективности лазеркоагуляции и введения ингибитора VEGF как методов лечения задней агрессивной ретинопатии недоношенных

Aggressive posterior retinopathy of prematurity (APRP) is the most severe form of this disease and is difficult to treat. Purpose. Comparison of the effectiveness of the treatment of aggressive posterior retinopathy of prematurity with laser photocoagulation and the introduction of anti-VEGF. Material and methods. A comparative analysis of the case histories of 92 people (184 eyes) with aggressive posterior retinopathy of prematurity was carried out. Group I (58 people – 116 eyes) – laser coagulation of the retina was performed; Group II (34 people – 68 eyes) – intravitreal injection of a vascular endothelial growth factor (anti-VEGF) – Ranibizumab was used. The evaluation of the results was carried out according to three main indicators: stabilization of the disease, normalization of the periphery of the retina after treatment, as well as the time spent on providing anesthesia. Conclusion. The effectiveness of the treatment of aggressive posterior ROP was significantly higher with the introduction of the anti-VEGF – 97 % than with laser photocoagulation – 82.7 %, at p &lt; 0.05. Complete regression of posterior aggressive ROP is observed significantly earlier after laser photocoagulation – 50.2 ± 2.17 weeks than after the introduction of the anti-VEGF – 63.5 ± 3.47 minutes, at p &lt; 0.05. Normalization of the retina occurs significantly more often after the introduction of the anti-VEGF – 27.3 % than with laser photocoagulation, at p &lt; 0.001. The time of anesthetic relief is significantly less with the introduction of the anti-VEGF – 7.5 ± 1.19 min. than with laser photocoagulation – 66.3 ± 13.7 min., at p &lt; 0.001. Preferential intravitreal administration of the anti-VEGF is indicated for impaired visualization of the retina and its edema. Conclusion. In the treatment of posterior aggressive retinopathy of prematurity, intravitreal administration of the anti-VEGF is preferable. Given the novelty of this technique, the functional and structural outcomes of this manipulation are for further study. Keywords: anti-VEGF, laser photocoagulation, aggressive posterior retinopathy of prematurity, ranibizumab.

Role of visual illusions in the assessment of digital color images of aggressive posterior retinopathy of premature

AIM: To estimate the role of visual illusions in the diagnosis of aggressive posterior retinopathy of prematurity (APROP) using a pediatric retinal camera.&#x0D; MATERIAL AND METHODS: A retrospective analysis of images of the fundus structures obtained using a pediatric retinal camera was carried out in 31 children diagnosed with APROP. The children were treated at St. Petersburgs Childrens Hospital N17 of St. Nicholas from January 2011 to December 2018. Based on the analysis of digital colored images of the fundus, the diagnosis of ARN was confirmed in 18 children (58%), and in the remaining 42% of cases (13 children), the diagnosis was revised from APROP to classic ROP (stage 3, with signs of plus disease, zones I or II). Preterm infants with classic ROP were excluded from the study group.&#x0D; RESULTS: A total of 14 out of 18 (78%) children with APROP were initially diagnosed with manifestations of classical ROP. Analysis of colored images obtained with a retinal camera showed that all of them manifested Machs bands, which created the effect of a demarcation line or a demarcation ridge at the border of light and dark areas. Although they were manifestations of APROP, these illusions were the reason for the diagnosis of classical ROP along with the designation of stages. The effect of Mach band illusion was neutralized by the study of colored photographs on the monitor screen under high magnification.&#x0D; CONCLUSION: Visual illusions create difficulties in the timely diagnosis of APROP during the investigation with a retinal camera. They may influence the treatment of patients and lead to poor outcomes of this most severe form of ROP, including the development of retinal detachment and visual impairment in children.

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.

Скрининг, наблюдение и лечение недоношенных детей

Purpose. Тo analyze of the effectiveness of the screening, monitoring and treatment of premature babies. Material and methods. From 2012 to 2021 we observed 2298 preterm infants. Retinopathy of prematurity (ROP) was revealed in 796 cases (34.64 %), 34 of them with aggressive posterior ROP (AP-ROP) (4.27 %). 217 patients (27.26 %) had indications for laser coagulation of the retina (LCR); repeated interventions were performed in 26 cases (11.98 %). In 190 case (87.55 %), an induced regression of the disease occurred. An unfavorable outcome of ROP was diagnosed in 27 cases (12.45 %). 265 children with a cicatricial phase of ROP were dynamic observed. Results and conclusions. The effectiveness of LCR at the threshold stage has reached at 95.12 %. Regression in type-I occurred in 88.33 %. In cases of AP-ROP, the efficiency of LCR was 55.88 %. The total number of children with terminal stages was 109 people (13.69 %). In the cicatricial period of 265 people, 141 revealed ametropia, secondary glaucoma in 7 patients, complicated cataract in 6 and strabismus in 38. Timely screening and monitoring reveals early signs of ROP, if necessary, perform surgical treatment. These activities minimize risk of disability from blindness and low vision. An insignificant number of LCR performed, a small number of patients with terminal stages of ROP indicates the high efficiency of modern conditions for nursing premature babies. Functional results in long-term periods depend on the degree of residual changes, refractive pathology and strabismus. Correction of ametropia, functional treatment, strabismus surgery in the preschool period, allow to develop and maintain visual function in the most of patients with ROP. Keywords: retinopathy of prematurity, laser coagulation of the retina, aggressive posterior retinopathy of prematurity.

Спектральная оптическая когерентная томография с функцией ангиографии в оценке структурных и микроциркуляторных нарушений сетчатки при задней агрессивной ретинопатии недоношенных

Purpose. To identify the structural and microvascular changes in the retina in children with aggressive posterior retinopathy of prematurity (ROP) with early and pronounced clinical features using spectral optical coherence tomography (SOCT) with angiography function. Material and methods. SOCT was performed in 40 premature infants (40 eyes) with aggressive posterior ROP, born at 25–28 weeks gestation, with a birth weight of 680–1350 g. 15 infants had early clinical features, optical coherence tomography with angiography function (OCT-A) was performed in 4. 25 infants had pronounced clinical features, OCT-A was performed in 3. The comparison group included 10 premature infants (10 eyes) without signs of ROP, as well as 23 children (23 eyes) with an unfavorable type of stage 3 of classical active ROP. Results. Early clinical features of aggressive posterior ROP were characterized by the absence of an avascular zone in fovea, vasodilation of the superficial and deep retinal plexus, the presence of intraretinal neovascularization in the perifovea, and multiple arteriolo-venular shunts. The severity of the pathological process in children with pronounced clinical features of aggressive posterior ROP reflected the development of massive neovascularization affecting all structures of the vitreoretinal interface, as well as the presence of areas of retinoschisis, indicating a high risk of the retinal detachment. Conclusion. The studies revealed gross structural and microvascular retinal pathology in children with aggressive posterior ROP at an early stage already, which indicates the indisputable importance of the earliest diagnosis, and, consequently, earlier treatment, which plays a key role in creating favorable conditions for the visual functions development. Key words: spectral optical coherence tomography-angiography, aggressive posterior retinopathy of prematurity

Evaluation of Infants with Retinopathy of Prematurity Treated with Intravitreal Bevacizumab

Objective: To evaluate the systemic and local effects and side effects of intravitreal bevacizumab injection in preterm infants with aggressive posterior retinopathy of prematurity. Material and Methods: A total of 16 patients were included in this single-center observational cohort study between June 2020 and March 2021. The clinical, laboratory, and radiological findings before and after intravitreal injection of 0.3 mg bevacizumab were recorded for a total of 32 eyes. Results: The patients’ mean gestational age at birth was 25±0.38 weeks and their mean birth weight was 695±119.2 g. None of the patients developed complications such as local vitreous hemorrhage or endophthalmitis secondary to intravitreal injection administered at a postmenstrual age of 34 weeks, and none required repeated injections. There was no increase in the rate of intraventricular hemorrhage after injection. There was no statistically significant difference in the patients’ laboratory parameters, blood pressure values, or systemic findings before and after treatment. Conclusion: Although no systemic or local side effects were observed in patients treated with intravitreal bevacizumab injection in this study, patients should be monitored closely for systemic hypertension, intraventricular hemorrhage, and hypotension. More detailed studies are needed to evaluate later neurodevelopmental outcomes compared to other treatment options.

Aggressive Posterior Retinopathy of Prematurity: Long-Term Outcomes Following Intravitreal Bevacizumab.

PurposeThe purpose of this study is to review the neonatal and early childhood course of children who were treated with intravitreal bevacizumab for APROP and identify any long term limitations these children face years after treatment.MethodsThis retrospective consecutive case series reviewed both ophthalmologic and pediatric medical records to determine ocular and neurologic function following treatment with a single injection of intravitreal bevacizumab (IVB) for APROP. Patient records were reviewed to identify the gestational age, average birth weight, gender, post-menstrual age (PMA) at the time of injection, regression status, rescue therapy events, final visual acuity, final refraction, ophthalmologic diagnoses and complications, neurologic diagnoses, and duration of follow up.ResultsThe study included 43 eyes from 13 male and 9 female children. The average gestational age was 24 weeks and average birth weight was 625.2 grams. The average follow-up was 4.08 years (range: 1.85–7.36 years). The average PMA at time of bevacizumab injection was 35.59 weeks. Thirty-five eyes eventually received laser photocoagulation at an average PMA of 53.17 weeks. All eyes in this study demonstrated regression without progression to retinal detachment. At last follow up, 67% (29/43) of eyes were able to discern letters or shapes, with an average visual acuity of 20/37. 16 (72%) children were diagnosed with perinatal neurological disorders. 59% (n = 13) developed chronic neurological impairment, 77% (n = 10) of whom developed neurodevelopmental delay. Several infants were diagnosed with endocrine disease or genetic syndromes.ConclusionsExtreme prematurity is associated with significant morbidity. Nearly all infants (92%) who developed chronic neurologic disease were diagnosed with neurologic disease during the perinatal period. Intravitreal bevacizumab, often with adjuvant photocoagulation, led to regression without detachment in 100% of eyes, with most verbal children retaining functional vision.

Study of the Biological Developmental Characteristics of the Eye in Children After Laser Surgery for the Treatment of Retinopathy of Prematurity.

Study of the Biological Developmental Characteristics of the Eye in Children After Laser Surgery for the Treatment of Retinopathy of Prematurity.