Aggressive Retinopathy Of Prematurity Research Articles

Bilateral Anti VEGF on Same Day-Investigation on Safety in Retinopathy of Prematurity (BASISROP)- A Multicenter retrospective study

PurposeTo report incidence of procedure related complications in preterm infants with ROP treated with intravitreal anti vascular endothelial growth factors (anti VEGF) injection in both eyes on same day DesignRetrospective, multicenter case series SubjectsPreterm infants with ROP treated with anti VEGF bilaterally on same day MethodsIntervention: All included infants underwent intravitreal anti VEGF injection in both eyes under aseptic precautions in ophthalmic operation theatre (OT) or neonatal intensive care unit (NICU). Postoperative examination was performed to look for procedure related complications Main Outcome MeasuresIncidence of procedure related complication (Presumed endophthalmitis, intraocular inflammation, lens injury, vitreous hemorrhage, retinal tear) in the study cohort. To study association of indication, type of anti VEGF, type of needle used, setting of procedure, site of injection (distance from limbus) and experience of the treating ophthalmologist with the complications. Results9984 eyes of 4992 infants were analysed. The procedure was most commonly performed in ophthalmic OT (8258, 82.7%) using 29G (4514, 45.2%) needle between 1-1.5 mm (9984, 100%) from limbus. Aggressive retinopathy of prematurity was the most common indication for anti VEGF use (4866, 48.7%) while Bevacizumab was the most commonly used anti VEGF agent (8642, 86.6%). Overall, 26 eyes (0.3%) had procedure related complications. Lens injury (15, 0.15%) and presumed endophthalmitis (7, 0.07%) were most common complications. One eye had culture proven endophthalmitis with Pseudomonas aeruginosa. No case of bilateral endophthalmitis was noted. Endophthalmitis was not associated with setting of procedure or type of anti VEGF used, while risk of lens injury was seven times higher when performed in NICU and 30 times higher when performed by an ophthalmologist with < 1year of experience in injecting anti VEGF in preterm infants. ConclusionsThe incidence of presumed endophthalmitis after bilateral same day anti VEGF in infants with ROP is 0.07%. These infants can be treated in both eyes on same day with the anti VEGFs and needles (29-32G) evaluated in this study, with emphasis on the direction of needle parallel to visual axis. Extra precaution is advocated if the procedure is planned in NICU or by an ophthalmologist with limited experience.

Comparison of reactivation between ranibizumab and bevacizumab in aggressive retinopathy of prematurity: A retrospective case series.

To compare the incidence, type, interval for reactivation, and structural outcomes in infants with aggressive retinopathy of prematurity (A-ROP) treated with ranibizumab or bevacizumab. It is a single-center, retrospective, consecutive, case series. We included infants with A-ROP which were initially treated with either intravitreal ranibizumab (IVR, 0.25 mg) or intravitreal bevacizumab (IVB, 0.625 mg) between January 2017 and December 2023. The infants were followed up for reactivation. The demographic and clinical data were collected. The time, zone, type of reactivation, its treatment, type of final structural outcome, and factors associated with reactivation were analyzed. One hundred eight among the 322 infants with A-ROP were included in the study. Fifty-five received IVR, while 53 received IVB. Infants treated with IVR had higher incidence of reactivation (92.7% vs 52.8%, P < 0.001) at an earlier interval than IVB (7.7 weeks vs 12.8 weeks, P < 0.001). Infants treated with IVR had approximately 3.3 times higher possibility of reactivation than those treated with IVB. Three infants (5.9%) in the IVR group and five (9.4%) in the IVB group attained complete vascularization of the retina (P = 0.72). More infants treated with IVB had regression with a persistent avascular retina (PAR) than IVR (52.8% vs 15.7%, P < 0.001). Infants in the IVB group had 10 times higher possibility of regression with PAR. Infants of A-ROP treated with IVR have a higher incidence and earlier reactivation, while those treated with IVB have less incidence and delayed reactivation, albeit with a higher possibility of regression with a PAR.

A retrospective study of the incidence, patterns, and risk factors of retinopathy of prematurity in infants with birth weight &gt;1500 g in a South Indian tertiary care hospital

Abstract: OBJECTIVE: The objective of the study was to determine the incidence, patterns, and risk factors for the development of retinopathy of prematurity (ROP) in infants weighing &gt;1500 g at birth. MATERIALS AND METHODS: A retrospective analysis was done of the ROP screening records between April 2019 and March 2022. All the infants with birth weight &gt;1500 g who underwent ROP screening were included. Data collected included demographic details, details of the risk factors (respiratory distress syndrome [RDS], hypoxia, anemia, septicemia, patent ductus arteriosus, congenital heart disease [CHD], i.e., atrial septal defects or ventricular septal defects, and multiple gestations), and ocular examination findings. Statistical analyses included calculation of mean, range, Chi-square test, and bivariate logistic regression for associations of risk factors with ROP. RESULTS: ROP was noted in 16.6% of the 336 eyes of 168 infants. The mean birth weight and mean gestational age (GA) of the infants were 1850 ± 33 g and 33.33 weeks ± 1.71 weeks, respectively. Eighteen eyes (32.1%) had Stage I, 17 eyes (30.35%) had Stage II, and 11 eyes (19.64%) had Stage III ROP in Zone II. Aggressive ROP was seen in 8 eyes (14.28%) and stage 5 ROP in two eyes (0.59%). Male gender, GA, CHD, and RDS showed a statistically significant association with the development of ROP in these infants. CONCLUSION: ROP was seen in 16.66% of our subjects. Treatment was required in 6.25% of infants. Risk factors for the development of ROP were low gestational age, male gender, the presence of RDS, and congenital heart disease.

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.

CHARACTERISTICS OF 'NOTCH' IN RETINOPATHY OF PREMATURITY FOLLOWING INTRAVITREAL RANIBIZUMAB MONOTHERAPY.

To explore the clinical features and significance of "notch" in reactivation of retinopathy of prematurity (ROP) post-intravitreal ranibizumab (IVR) monotherapy. Ninety-six infants (173 eyes) with type 1 or aggressive ROP (A-ROP) post-IVR monotherapy were retrospectively analyzed; 51 eyes were notch (+) and 122 eyes were notch (-). General demographics and clinical outcomes were compared by notch status for type 1 and A-ROP. The notch primarily appeared in stage 2 ROP (84.4 and 78.9%) at the junction of zones I and II (68.8 and 63.2%) on the temporal side in type 1 ROP and A-ROP. Notch was present in the type 1 ROP group before first IVR but post-treatment in the A-ROP group. A significantly higher reactivation rate, longer follow-up duration, and postmenstrual age at last follow-up were seen in the notch (+) versus the notch (-) group. In the notch (+) ROP group, the mean gestational age (28.34±0.93 vs. 29.94±1.48 weeks) was significantly lower in reactivated versus regressed eyes. Notches appeared at different times but similar locations in type 1 ROP and A-ROP. The reactivation rate after IVR was increased in ROP with notches. Notch may be a useful biomarker for reactivation after IVR in ROP.

SHORT-TERM REACTIVATION OF RETINOPATHY OF PREMATURITY AFTER PRIMARY RANIBIZUMAB TREATMENT.

Investigate risk factors for short-term reactivation of retinopathy of prematurity (ROP) after intravitreal ranibizumab (IVR) therapy and determine safety and efficacy of repeat injections. Retrospective chart review study of patients screened for ROP as inpatients between 2013 and 2023 who received IVR within the UCLA health care system. Primary outcomes were rates and timing of short-term ROP reactivation, defined as repeat worsening of ROP to stage 2 or 3 before 52 weeks postmenstrual age, as well as risk factors for reactivation. Other outcomes included adverse events and rates of reactivation after a second intravitreal injection. Eighty-two eyes of 43 patients received primary IVR 0.25 mg/0.025 cc for type 1 ROP. Thirteen patients (22 eyes) (30.2% of patients, 26.8% of eyes) developed short-term reactivation an average of 7.2 weeks ± 1.7 weeks after treatment. Increased reactivation risk was associated with zone I disease (odds ratio 6.23, 95% CI, 1.35-28.7, P = 0.019), lower postmenstrual age at first injection (odds ratio 1.64, 95% CI, 1.19-2.26; P = 0.003), and lower gestational age at birth (odds ratio 1.80, 95% CI, 1.04-3.13, P = 0.037). Of the 13 patients that received repeat injections, five required laser treatment for a second reactivation (11.6% of patients receiving IVR). No eyes developed retinal vascular occlusion, endophthalmitis, or cataract. Repeat injections may be required after primary IVR for aggressive ROP. Repeat IVR treatment for ROP is effective and poses few ophthalmic adverse events, although additional reactivation remains a risk.

Comparison of intravitreal bevacizumab monotherapy and combined laser photocoagulation and intravitreal bevacizumab therapy in the same session in the treatment of aggressive retinopathy of prematurity.

To compare the results of intravitreal bevacizumab (IVB) monotherapy and combined intravitreal bevacizumab and laser photocoagulation (LPC) therapies applied in the same session to patients with aggressive retinopathy of prematurity (A-ROP) in our clinic. The study included 67 eyes of 37 patients diagnosed with A-ROP and treated. Forty-nine eyes treated with anti-vascular endothelial growth factor agent injection monotherapy for A-ROP treatment were included in the first group. The second group consisted of 18 eyes that received injection therapy and LPC treatment. The clinical findings of the two groups were investigated, and their treatment results were compared. Recurrence was observed in 19 of the 49 (38%) eyes in the first group, but there was no recurrence in any of the cases in the second group. While only IVB was applied to eight cases with recurrence, the combination of LPC and IVB treatment was applied to 11 cases. A second recurrence was detected in two of the eight cases that had received IVB monotherapy as a treatment for recurrence and in three of the 11 cases that had received LPC and IVB. The treatment outcomes of the two groups did not statistically significantly differ (P = 0.181). We consider that the combined simultaneous LPC and IVB treatment we applied in A-ROP cases is an effective approach, particularly for cases where there are concerns about the patient's ability to attend follow-up appointments.

Comparison of Intravitreal Ranibizumab and Laser Photocoagulation in the Treatment of Type I Retinopathy of Prematurity in Malaysia: A One-Year Follow-Up Study.

This study aimed to evaluate the treatment efficacy, anatomical outcomes, and refractive outcomes of laser photocoagulation (LPC) and intravitreal ranibizumab (IVR) in the treatment of type I retinopathy of prematurity (ROP) at one-year follow-up. This is a retrospective study on the treatment of type I ROP and aggressive ROP (A-ROP) using LPC or IVR in three Malaysian hospitals providing pediatric ophthalmology services from January 2019 to December 2021. Information on gestational age, birth weight, ROP zone and stage, and underlying comorbidities was collected. Parameters for evaluating treatment efficacy include the time taken to achieve complete regression, the regression rate, and the reactivation rate. The anatomical and refractive outcomes were evaluated at one year of adjusted age. This study included 92 eyes from 46 infants. Of these, 42 eyes received LPC as the initial treatment, while 50 eyes underwent IVR. A higher percentage of infants with cardiovascular disease were treated with IVR (66.7%) compared to LPC (40%) (p<0.05). However, there were no significant differences in gestational age, birth weight, respiratory distress syndrome, sepsis, or intraventricular hemorrhage between the two treatment groups (p>0.05). Infants treated with LPC had a higher regression rate than those treated with IVR, but they were also significantly more myopic and had worse best-corrected visual acuity (BCVA). Conversely, infants treated with IVR experienced a significantly higher reactivation rate compared to those treated with LPC. Logistic regression analysis showed no significant associations between gestational age, birth weight, plus disease, zone 1 ROP, and the choice of initial treatment with the reactivation of ROP. Both LPC and IVR effectively treat type I ROP in infants, with IVR yielding superior anatomical and refractive outcomes and LPC offering a lower reactivation rate. Understanding individual patient characteristics is crucial for treatment selection.

Evaluating the causes of retinopathy of prematurity relapse following intravitreal bevacizumab injection

BackgroundRetinopathy of prematurity (ROP) is a proliferative disorder of the developing retina. Intravitreal bevacizumab injection (IVB) is an emerging treatment for severe forms of ROP, which does not restrict the visual field in comparison to laser therapy. The present study aimed to determine and evaluate the risk factors for ROP recurrence following IVB injection.Materials and methodsIn this retrospective study, 98 eyes of 49 infants with ROP who had received IVB injections as the primary treatment for type 1 ROP are included.ResultsFifty-four eyes (55.1%) had aggressive retinopathy of prematurity (A-ROP), and forty-four (44.9%) had Stage III Plus ROP in Zone II. ROP recurred in 13 eyes (13.26%) of 8 infants. The mean period between IVB and the ROP recurrence was 8.08 (95% CI:5.32–10.83) weeks. The infants who had ROP recurrence had lower birth weight (P value = 0.002), lower postmenstrual age at IVB injection (P value = 0.001), lower IVB injection gap period from birth (P value = 0.044), higher oxygen therapy requirement rate after IVB injection (P value < 0.001, OR:19.0) and higher oxygen therapy duration (P value = 0.006). The ROP severity, gestational age at birth, and diet were not statistically different between the recurrence and complete regression groups. Out of 13 eyes treated with laser photocoagulation because of ROP relapse, macula dragging occurred in one eye, and all the cases met the complete regression.ConclusionLow birth weight and oxygen therapy are the most important risk factors for ROP relapse, which requires meticulous oxygen treatment guidelines for premature infants.

Profile and risk factors of sight-threatening retinopathy of prematurity: Experience from SNCU in North India.

This research aimed to identify the clinical profile and risk factors of retinopathy of prematurity (ROP) among "at-risk" newborns treated at a sick newborn care unit (SNCU) located at high altitude in North India, with the intention of contributing to formulate regional and national ROP screening guidelines. In a prospective observational study from 2021 to 2022, outborn and inborn babies eligible for ROP screening were screened. Total 39/122 screened neonates had laser for Type 1 ROP, and 22/39 (56.4%) had aggressive ROP (AROP). The average birth weight (BW) was 1803.87 g, and the average gestational age was 34 weeks. Respiratory distress, bronchopulmonary dysplasia, sepsis, and apnea were present in 57.3%, 13%, 52.5%, and 25.4%, respectively. Sight-threatening ROP was present in 50% below 28+6 weeks, 27% between 29 and 30+6 weeks, 52% between 31 and 33+6 weeks, and 15% with gestation >34 weeks. Two babies with Type 1 ROP weighed >2 kg and one had AROP. Upon regression analysis, BW <1500 g, gestation <32 weeks, oxygen >48 h, clinical sepsis, total SNCU stay >14 days, continuous positive airway pressure support with oxygen >50%, and >10 days to achieve full feeds were associated with severe ROP. Caffeine to treat apnea and kangaroo mother care reduced ROP. None had short-term unfavorable outcome. With similar infrastructure and work force shortage in most SNCUs, these findings can be generalized. The burden of Type 1 and AROP is increasing, as seen in higher gestation and BWs. This needs revision of ROP screening criteria at local and national level. It is crucial to emphasize on the importance of pediatrician and ophthalmologist collaboration, early ROP screening, diagnosis, and treatment to stop disease progression to severe ROP.

A pilot optical coherence tomography angiography classification of retinal neovascularization in retinopathy of prematurity

Extraretinal neovascularization is a hallmark of treatment-requiring retinopathy of prematurity (ROP). Optical coherence tomography angiography (OCTA) offers vascular flow and depth information not available from indirect ophthalmoscopy and structural OCT, but OCTA is only commercially available as a tabletop device. In this study, we used an investigational handheld OCTA device to study the vascular flow in and around retinal neovascularization in seven preterm infants with treatment-requiring ROP and contrasted them to images of vascular flow in six infants of similar age without neovascular ROP. We showed stages of retinal neovascularization visible in preterm infants from 32 to 47 weeks postmenstrual age: Intraretinal neovascularization did not break through the internal limiting membrane; Subclinical neovascular buds arose from retinal vasculature with active flow through the internal limiting membrane; Flat neovascularization in aggressive ROP assumed a low-lying configuration compared to elevated extraretinal neovascular plaques; Regressed neovascularization following treatment exhibited decreased vascular flow within the preretinal tissue, but flow persisted in segments of retinal vessels elevated from their original intraretinal location. These findings enable a pilot classification of retinal neovascularization in eyes with ROP using OCTA, and may be helpful in detailed monitoring of disease progression, treatment response and predicting reactivation.

Anatomical outcome of laser treatment alone in aggressive retinopathy of prematurity.

The purpose is to study the anatomical outcome of eyes in aggressive retinopathy of prematurity (AROP), treated with laser photocoagulation alone and to evaluate factors affecting outcomes. Records of consecutive babies diagnosed with AROP, undergoing laser photocoagulation treatment in rural tertiary care centers from October 2016 to January 2021 were reviewed retrospectively. Anatomical outcome at 6 months follow-up was grouped as good in eyes with complete regression and poor in those who developed retinal detachment (stage IV a, IV b, and V). Both groups were compared with respect to the period of gestation, birth weight (BW), age at screening, age at treatment, zone of disease, presence of retinal fibrovascular proliferation (FVP), tunica vasculosa lentis, preretinal bleed, need for supplement laser, and associated systemic risk factors. Of the total of 2468 babies screened, 124 (5.02%) were diagnosed with severe retinopathy of prematurity (ROP), of which 54 (43.5%) lasered AROP babies were analyzed. Mean BW and gestation period of the AROP cohort were 1.43 kg and 31.1 weeks, respectively. Eighty-six eyes (79.6%) had good outcomes with laser photocoagulation alone. Posterior location of disease, presence of FVP, neonatal sepsis, shock, and late screening for ROP were found to be factors associated with poor outcomes. Adequate and timely treatment with laser photocoagulation in AROP can achieve good treatment outcomes in a significant proportion of babies. Although a combined approach using laser, anti-vascular endothelial growth factor and early vitrectomy is better, laser remains a viable treatment option in AROP, especially with limited resources and high risk of loss to follow-up.

Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity.

To observe the vascular development results of tertiary anti-vascular endothelial growth factor (anti-VEGF) therapy following spontaneous second reactivation of retinopathy of prematurity (ROP). This retrospective study included 22 infants (42 eyes) with Type 1 or aggressive ROP (A-ROP) who received three anti-VEGF drug treatments for ROP from January 2018 to December 2022. The vascular growth, possible associated risk factors, and the retinal vascularization (DB/DF ratio) were assessed. The mean follow-up was 17.6 months. After the 3rd intravitreal injection, seven eyes showed complete vascularization (Group 1), while the remaining 35 eyes demonstrated persistent avascular retina (PAR) (Group 2). In Group 2, 17 eyes maintained a stable state and were classified in the regression subgroup. The other 18 eyes developed a 3rd reactivation (reactivation subgroup) and were treated with laser photocoagulation (LPC).Birth weight (BW) was significantly lower in Group 2 than in Group 1 (p < 0.001). The decision tree analysis shows that only infants weighing more than 1,250 g (17.50%) had a chance to achieve complete retinal vascularization. The possibility of PAR was higher in patients with BW <1,250 g than ≥1,250 g (70.00% vs. 12.50%). In addition, most infants with BW ≥ 1,290 g and initial ROP disease in Zone I or posterior Zone II developed PAR. Tertiary IVR can successfully treat a second ROP reactivation and improve peripheral retinal vascularization. BW is the most significant factor related to complete retinal vascularization. Our decision tree model may be helpful in predicting the prognosis of anti-VEGF drugs in the event of a second ROP reactivation.

FLUORESCEIN ANGIOGRAPHY EVALUATION OF CHILDREN PREVIOUSLY TREATED WITH ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY FOR RETINOPATHY OF PREMATURITY.

To determine the level of vascularization and peripheral vascular findings by fluorescence angiography in patients with aggressive retinopathy of prematurity or Type 1 retinopathy of prematurity treated with a single dose of anti-vascular endothelial growth factor. Data of patients referred to the authors' clinic for fluorescence angiography examination between June 2016 and September 2021 were retrospectively analyzed. Patients who had their first fluorescence angiography examination at the age of 1 year or older were included in the study. A total of 486 eyes of 250 patients were included. Of these, 83 eyes (17.1%) had vascular termination in Zone II and 403 eyes (82.9%) in Zone III. In 62.7% of eyes, the distance from the vascular terminals to the temporal ora serrata was less than two disk diameters, and in 20.2%, it was more than two disk diameters. Abnormal vascular findings were noted, including circumferential vessels (41.2%), finger-like projection anomaly (36.2%), hyperfluorescence (16.9%), fine branching and blunt termination (15%), and arteriovenous shunt (9.9%). Fluorescence angiography performed late in the course of treatment can clearly define the vascular termini and detect abnormalities that cannot be detected by indirect ophthalmoscopy. Follow-up with fluorescence angiography can help prevent complications that can lead to vision loss.

Evaluation of optical coherence tomography biomarkers to differentiate favourable and unfavourable responders to intravitreal anti-vascular endothelial growth factor treatment in retinopathy of prematurity.

Evaluation of optical coherence tomography biomarkers in predicting treatment response to intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) Bevacizumab, in aggressive retinopathy of prematurity (A-ROP). Non-contact ultra-widefield (NC-UWF) fundus imaging with integrated UWF guided swept source Optical coherence tomography (SS-OCT) was performed prospectively in preterm babies before and after intravitreal anti-VEGF (Bevacizumab) monotherapy. OCT biomarkers were analysed in eyes that reached complete vascularization versus others. Eyes with retinal vessels reaching near ora serrata were labelled as regressed ROP and vascularised retina (Group1). Eyes with reactivation of ROP needing laser or vitreoretinal surgery or eyes with peripheral avascular retina (PAR) at 16th week post-injection were considered as Group 2. Pre-injection baseline OCT showed a hyperreflectivity of inner retinal layers in 12 out of 46 eyes in Group 1 versus 30 out of 34 eyes in Group 2 (p value 0.002). None of the eyes in Group 1 showed choroidal thinning at posterior pole as compared to 14 out of 34 eyes in Group 2 (p value 0.001). Intraretinal hypo reflective Cystic changes at fovea were seen in 16 out of 46 eyes in Group 1 and 2 out of 34 eyes in Group 2 (p value 0.012). Pre-injection swept source OCT biomarkers could predict the treatment outcomes of anti-VEGF (Bevacizumab) monotherapy in A-ROP eyes. Hyperreflectivity of inner retinal layers and choroidal thinning had poorer and unpredictable response to anti-VEGF injection whereas, cystic changes at fovea predicted favourable response.

Surgical outcomes in aggressive retinopathy of prematurity (AROP)-related retinal detachments.

Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the disc toward the posterior lens surface progressing to Stage 5 disease without traversing the classical course that includes Stages 1 to 3. Since AROP behaves differently from type 1 ROP, this study was undertaken to evaluate the surgical outcome of AROP-related detachments. Retrospective analysis of data from electronic medical records of babies diagnosed with AROP-related detachments who underwent micro-incision vitrectomy surgery (MIVS) was included. The demographic data, details of primary intervention (laser and/or intravitreal bevacizumab), and surgery were noted. In a subset of patients, surgical intervention was planned early at the onset of fibrovascular tissue. 43 eyes of 26 babies with median birth weight 1175 g and median gestational age of 29 weeks were analyzed. 42/43 eyes underwent primary intervention in form of laser and/or anti-VEGF injection before surgery. 41.8%, 25.5%, and 32.5% eyes progressed to stages 4A, 4B, and 5, respectively, requiring surgical intervention. 66% eyes underwent lensectomy and vitrectomy (LV), and 44% eyes underwent lens sparring vitrectomy (LSV). 58% eyes had attached macula. 44% eyes that had a relatively less vascular diseases had better anatomical outcome (P = 0.019). At final follow-up, 53.4% eyes followed or at least had light fixation, and 77.7% eyes undergoing LSV fixated and/or followed light compared to 33% for LV (P = 0.04). Challenges in AROP include rapid progression to advanced stages of ROP requiring close monitoring and multiple interventions. Surgeries for AROP have a favorable anatomical and functional outcome in 58% and 53%, respectively. Eyes undergoing lens sparing vitrectomy had better visual outcomes.

Analysis of trends in retinopathy of prematurity over 5 years in a tertiary neonatal intensive care unit.

The aim of the study was to look at the incidence and trend of retinopathy of prematurity (ROP) between 2017 and 2021 in a tertiary neonatal intensive care unit (NICU) in Australia and to compare potential modifiable risk factors of ROP between preterm infants who required treatment for ROP and who did not need treatment. This retrospective study used the data of newborn infants who were <31 weeks gestational age (GA) or birth weight (BW) of <1250 g born between 2017 and 2021 at a tertiary NICU in Australia (n = 261). Univariate analysis using t test for continuous data, Fischer exact test for categorical data and multiple logistic regression analysis were undertaken to identify any significant differences between two groups. A total number of 261 infants were studied. 55.9% of infants developed any type of ROP (146 infants out of 261 infants), type 1 ROP was 5.4% (14 out of 261) and aggressive ROP (AROP) was 3% (8 out of 261). Out of 146 infants who were diagnosed with ROP, 22 (15%) of them required treatment. Mean GA for those who underwent ROP treatment was 25.6 (±1.47) weeks and for those who did not require treatment was 27.6 (±1.95) weeks. The mean BWs for those who needed treatment was 764 (±189.32) g and for those who did not need treatment was 1039 (±306.06) g. The mean duration of invasive ventilation for infants with ROP requiring treatment and those who did not require treatment were 23.95 (±22.41) days and 9.89 (±17.2) days. The total duration of oxygen requirement was 235.54 (±160.5) days and 121.11 (±117.34) days for those who needed treatment and those who did not need treatment respectively. Among infants who required treatment for ROP, 68.18% required blood transfusion whereas among those who did not need treatment, 24.19% required blood transfusion. Lower GA, lower BW, longer duration of invasive ventilation, longer total duration of oxygen requirement and blood transfusion in first 2 weeks of life were significant in preterm infants who required treatment for ROP compared with those who did not.

Correlation between tear levels of vascular endothelial growth factor and vitamin D at retinopathy of prematurity stages in preterm infants

Deregulation of vascular endothelial growth factor (VEGF) levels leads to retinopathy of prematurity (ROP). Vitamin D (VIT-D) is known to regulate VEGF in an oxygen dependent manner. The purpose of this study was to correlate tear levels of VEGF and VIT-D with different ROP stages in preterm infants. In this prospective cross-sectional study, we enrolled 104 pre-term infants. They were grouped into: Group-1 (Classical ROP) and Group-2 (Aggressive ROP), which were further subdivided into Group-1A (progressing), Group-1B (regressing), Group-2A (pre-treatment), and Group-2B (post-treatment). Tear VEGF and VIT-D levels and their association with different ROP stages were assessed. Stage 1 and stage 2 had higher whereas stage 3 had lower VEGF levels in Group-1B compared to Group-1A. Stage 1 and stage 3 showed higher levels of VIT-D with no difference in stage 2 in Group-1B compared to Group-1A., Group-2B showed higher VEGF and lower VIT-D levels compared to Group-2A. Presence of a positive correlation at an early stage (stage 1) of ROP and a negative correlation at a more advanced stage (stage 3) of ROP with VIT-D and VEGF implies stage-specific distinct signaling crosstalk. These findings suggest that VIT-D supplementation may have the potential to modify the course and outcome of ROP.

Comparison of Intravitreal Bevacizumab and Ranibizumab Injections in Aggressive and Type 1 Retinopathy of Prematurity

Purpose: To investigate the differences in treatment effects between primary intravitreal bevacizumab injections and ranibizumab injections in type 1 retinopathy of prematurity (ROP) and aggressive ROP.Methods: We retrospectively analyzed the medical records of 61 eyes from 32 premature infants who underwent primary intravitreal anti-vascular endothelial growth factor (VEGF) injections for ROP. Patients with type 1 or aggressive ROP were divided into two groups: the intravitreal bevacizumab injection group and the ranibizumab injection group. We analyzed the period until plus disease disappeared after the first injection, reactivation, additional treatment, and the primary treatment success rate (cases in which retinal vessels formed to the periphery without additional treatment after the first injection).Results: In the type 1 ROP group, the primary treatment success rates for 16 patients (30 eyes) in the bevacizumab injection group and 6 patients (12 eyes) in the ranibizumab injection group were 100.0% and 91.7%, respectively. In the aggressive ROP group, the primary treatment success rates for 5 patients (9 eyes) in the bevacizumab injection group and 5 patients (10 eyes) in the ranibizumab injection group were 55.6% and 60.0%, respectively. In both type 1 and aggressive ROP, there were no significant differences in the period until plus disease disappeared after the first injection, reactivation rate, or additional treatment rate depending on the type of anti-VEGF.Conclusions: Bevacizumab and ranibizumab demonstrated similar efficacy in type 1 ROP and aggressive ROP. However, because aggressive ROP required additional treatment more frequently regardless of the type of anti-VEGF used, close follow-up after the primary injection is essential.

Neurodevelopment of patients who received intravitreal bevacizumab or aflibercept for type 1 and aggressive retinopathy of prematurity.

We aimed to compare the neurodevelopment of patients who received intravitreal bevacizumab (IVB) and intravitreal aflibercept (IVA) for type 1 retinopathy of prematurity (ROP) and aggressive ROP (A-ROP) using the Ages and Stages Questionnaire (ASQ-3) test. Patients who underwent IVB (group 1), IVA (group 2), and patients who did not receive treatment (group 3) were included in the prospective-controlled study. The patients were grouped as low-intermediate-high risk according to the high-risk infant follow-up guide. With the ASQ-3 test, fine and gross motor movements, communication, problem solving, and personal-social developments of the patients were compared. The gender distribution, birth weight (BW), and neonatal risk category of the groups were similar. Gestational age (GA) of group 1 was found to be lower compared to group 3. There was no difference between the groups in the development of gross and fine motor movements, communication and problem solving. The personal and social development of group 1 and group 2 was found to be retarded compared to the control group. As a result, the detection of retardation in the personal and social areas in the treated patients, and the detection of retardation in other areas, although not significant, reveals the necessity of following the development of these patient groups and providing the necessary support in the areas where retardation is detected.