Classification Of Retinopathy Of Prematurity Research Articles

Automated detection of type 1 ROP, type 2 ROP and A-ROP based on deep learning

PurposeTo provide automatic detection of Type 1 retinopathy of prematurity (ROP), Type 2 ROP, and A-ROP by deep learning-based analysis of fundus images obtained by clinical examination using convolutional neural networks.Material and methodsA total of 634 fundus images of 317 premature infants born at 23–34 weeks of gestation were evaluated. After image pre-processing, we obtained a rectangular region (ROI). RegNetY002 was used for algorithm training, and stratified 10-fold cross-validation was applied during training to evaluate and standardize our model. The model’s performance was reported as accuracy and specificity and described by the receiver operating characteristic (ROC) curve and area under the curve (AUC).ResultsThe model achieved 0.98 accuracy and 0.98 specificity in detecting Type 2 ROP versus Type 1 ROP and A-ROP. On the other hand, as a result of the analysis of ROI regions, the model achieved 0.90 accuracy and 0.95 specificity in detecting Stage 2 ROP versus Stage 3 ROP and 0.91 accuracy and 0.92 specificity in detecting A-ROP versus Type 1 ROP. The AUC scores were 0.98 for Type 2 ROP versus Type 1 ROP and A-ROP, 0.85 for Stage 2 ROP versus Stage 3 ROP, and 0.91 for A-ROP versus Type 1 ROP.ConclusionOur study demonstrated that ROP classification by DL-based analysis of fundus images can be distinguished with high accuracy and specificity. Integrating DL-based artificial intelligence algorithms into clinical practice may reduce the workload of ophthalmologists in the future and provide support in decision-making in the management of ROP.

Assessing spectral effectiveness in color fundus photography for deep learning classification of retinopathy of prematurity.

Retinopathy of prematurity (ROP) poses a significant global threat to childhood vision, necessitating effective screening strategies. This study addresses the impact of color channels in fundus imaging on ROP diagnosis, emphasizing the efficacy and safety of utilizing longer wavelengths, such as red or green for enhanced depth information and improved diagnostic capabilities. This study aims to assess the spectral effectiveness in color fundus photography for the deep learning classification of ROP. A convolutional neural network end-to-end classifier was utilized for deep learning classification of normal, stage 1, stage 2, and stage 3 ROP fundus images. The classification performances with individual-color-channel inputs, i.e., red, green, and blue, and multi-color-channel fusion architectures, including early-fusion, intermediate-fusion, and late-fusion, were quantitatively compared. For individual-color-channel inputs, similar performance was observed for green channel (88.00% accuracy, 76.00% sensitivity, and 92.00% specificity) and red channel (87.25% accuracy, 74.50% sensitivity, and 91.50% specificity), which is substantially outperforming the blue channel (78.25% accuracy, 56.50% sensitivity, and 85.50% specificity). For multi-color-channel fusion options, the early-fusion and intermediate-fusion architecture showed almost the same performance when compared to the green/red channel input, and they outperformed the late-fusion architecture. This study reveals that the classification of ROP stages can be effectively achieved using either the green or red image alone. This finding enables the exclusion of blue images, acknowledged for their increased susceptibility to light toxicity.

EVALUATION OF CLINICAL COURSE AND OUTCOMES IN ZONE I RETINOPATHY OF PREMATURITY IN A TERTIARY CARE INSTITUTE

Objectives: The objectives are to study the clinical course and outcomes of Zone I retinopathy of prematurity and also to study the indication of management and the factors affecting the choice of treatment modality. Methods: The present study was a prospective observational study conducted at the Department of Ophthalmology. All the neonates having Zone I retinopathy of prematurity (ROP) at presentation according to the International Classification of ROP classification were included in the study after obtaining permission from the institutional ethics committee and consent from parents. Results: In the present study, 526 neonates were screened and ROP was detected in 131 neonates with an incidence of 24.90%. Out of those 131, Zone I ROP was detected in 50 neonates, giving an incidence of 9.50%. Conclusion: In our study, Type 1 ROP has a variable course with 47.61% who initially had mild-looking disease developed Type 1 ROP requiring treatment. Hence, a proper timely follow-up is also important in these patients, we cannot exclude the probability of ROP based on the first examination, because when they are present, they are very preterm so vascularization is only until Zone I.

P Score: A Reference Image-Based Clinical Grading Scale for Vascular Change in Retinopathy of Prematurity

The International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), acknowledged that plus-like retinopathy of prematurity (ROP) vascular changes occurs along a spectrum. Historically, clinician-experts demonstrate variable agreement for plus diagnosis. We developed a 9-photograph reference image set for grading plus-like changes and compared intergrader agreement of the set with standard grading with no plus, preplus, and plus disease. Retinal photographic grading and expert consensus opinion. The development set included 34 international ICROP3 committee members. The validation set included 30 ophthalmologists with ROP expertise (15 ICROP3 committee members and 15 non-ICROP3 members) METHODS: Nine ROP fundus images (P1 through P9) representing increasing degrees of zone I vascular tortuosity and dilation, based on the 34 ICROP3 committee members' gradings and consensus image reviews, were used to establish standard photographs for the plus (P) score. Study participants graded 150 fundus photographs 2 ways, separated by a 1-week washout period: (1) no plus, preplus, or plus disease and (2) choosing the closest P score image. Intergrader agreement measured by intraclass correlation coefficient. Intergrader agreement was higher using the P score (intraclass correlation coefficient, 0.75; 95% confidence interval, 0.71-0.79) than no plus, preplus, or plus disease (intraclass correlation coefficient, 0.67; 95% confidence interval, 0.62-0.72). Mean ± standard deviation P scores for images with mode gradings of no plus, preplus, and plus disease were 2.5 ± 0.7, 4.8 ± 0.8, and 7.4 ± 0.8, respectively. Intergrader agreement of plus-like vascular change in ROP using the P score is high. We now incorporate this 9-image reference set into ICROP3 for use in clinician daily practice alongside zone, stage, and plus assessment. P score is not yet meant to replace plus diagnosis for treatment decisions, but its use at our institutions has permitted better comparison between examinations for progression and regression, communication between examiners, and documentation of vascular change without fundus imaging. P score also could provide more detailed ROP classification for clinical trials, consistent with the spectrum of plus-like change that is now formally part of the International Classification of Retinopathy of Prematurity. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Retinopathy of prematurity, the prevalence and risk factors in Moldova

Background: Retinopathy of prematurity (ROP) is a serious disease that affects premature infants and still represents the leading cause of blindness worldwide that can be prevented if detected earlier in time. Material and methods: The ROP prospective observational study was performed enrolling all premature infants admitted to the Intensive Neonatal Care (INC) and Premature Care Unit from January 2020 to December 2021 with the gestational age (GA) of 32 weeks and less at birth and body weight (BW) of 2000 g and less. A total of 98 premature infants had retinal evaluation by indirect ophthalmoscopy starting with the five postpartum weeks followed every 7-10 days until 38 weeks and then every 2 weeks until 42-45 weeks. The severity of ROP was graded according to the International classification of ROP. The effects of GA and BW on the prevalence and severity on ROP were evaluated. Results: Out of studied 98 infants, 36 patients (36.7 %) developed ROP stage 1 and 2, in one or both eyes, 3 (3.07%) infants developed stage 3. Out of these 3 premature infants with stage 3, one underwent avastin intravitreal injection with successful regression, 2 patients underwent laser photocoagulation treatment successfully. Conclusions: The prevalence of ROP in this unit-based study was 36 patients (36.7 %). The most important risk factors: Low gestational age, and low body weight. Lower gestational age and body weight was a risk factor, as the greatest number (76%) 20 infants out of 26 with GA ≤ 29 weeks and BW ≤1000g developed ROP stage 1 and stage 2; 3.06% (3 infants) developed stage 3. Very important in preventing ROP vision loss, screening all infants at risk regardless of GA and BW as well as the duration of staying in INC represents the greatest priority.

Incidence and Risk Factors for Retinopathy of Prematurity at a Rural Tertiary Hospital in Thailand.

To estimate the incidence and identify the factors affecting retinopathy of prematurity (ROP) in a rural tertiary hospital in Thailand. This retrospective chart review included all infants screened for ROP. The study included all infants with gestational age (GA) 30 weeks or birth weight (BW) 1,500 gr or selected larger infants with an unstable clinical course. Retinal findings were classified according to the revised International Classification of ROP. Data were analyzed using univariate and multivariable logistic regression analyses. Of the 113 screened infants, the incidences of any ROP and ROP requiring intervention were 17.7% and 8.8%, respectively. In univariate analysis, lower GA, lighter BW, total days of supplemental oxygen, days of continuous positive airway pressure (CPAP), presence of apnea, and intraventricular hemorrhage (IVH) were associated with the development of any ROP. In the stepwise multivariable logistic regression analysis, lighter BW, male gender, and bronchopulmonary dysplasia (BPD) were significant risk factors for the development of any ROP. Lower GA and being either a twin or triplet were significant risk factors for ROP requiring intervention. However, no antenatal condition was identified as a risk factor for ROP. The incidence of ROP in rural tertiary hospitals was relatively high as compared with previously published data from urban tertiary hospitals. Lighter BW, male gender, and BPD were significantly associated with the development of ROP in a local context. Epidemiological studies are necessary to prevent ophthalmic morbidities.

Retinopathy of Prematurity in the 21st Century and the Complex Impact of Supplemental Oxygen

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Not only do the epidemiologic determinants and distributions of patients with ROP vary worldwide, but clinical differences have also been described. The Third Edition of the International Classification of ROP (ICROP3) acknowledges that aggressive ROP (AROP) can occur in larger preterm infants and involve areas of the more anterior retina, particularly in low-resource settings with unmonitored oxygen supplementation. As sub-specialty training programs are underway to address an epidemic of ROP in sub-Saharan Africa, recognizing characteristic retinal pathology in preterm infants exposed to unmonitored supplemental oxygen is important to proper diagnosis and treatment. This paper describes specific features associated with various ROP presentations: oxygen-induced retinopathy in animal models, traditional ROP seen in high-income countries with modern oxygen management, and ROP related to excessive oxygen supplementation in low- and middle-income countries: oxygen-associated ROP (OA-ROP).

Incidence, risk factors, progression, and involution in retinopathy of prematurity at a tertiary care center in South India.

Retinopathy of prematurity (ROP) is a vasculoproliferative disorder of immature retina, seen in preterm babies. Multiple risk factors attribute to this condition. Our aim was to correlate the role of any early neonatal surgeries with low gestational age (GA) and birth weight (BW) on preterm babies as a risk factor on the progression of ROP. A prospective, cohort study conducted in a hospital in South India over 3 years, including 600 babies with GA <35 weeks and BW <2500 g. Babies were divided into Group A (ROP) and Group B (no ROP). Group A included A1 (severe ROP) and A2 (nonsevere ROP) based on early treatment of ROP classification. We compared various risk factors of ROP, specifically the association of any early neonatal surgery undergone by these babies, on progression of ROP. The Chi-square test, unpaired t-test, and one-way analysis of variance tests were used for the comparisons and considered statistically significant if P < 0.05. 28.7% babies developed ROP, with 37.6% requiring treatment (Aggressive ROP in 2.1% of babies). Low GA and BW, longer duration on ventilator, respiratory distress syndrome, apnea of prematurity, Patent Ductus Arteriosus, sepsis, anemia, thrombocytopenia, history of blood transfusion, and history of early neonatal surgery under GA were associated with babies with ROP (P < 0.005), strongly with severe ROP. The most common surgeries undergone by the babies developing ROP were inguinal herniotomy under general anesthesia. The study predicts preterm babies undergoing early surgical interventions are at risk of progressing to severe ROP, hence warranting frequent follow-ups.

Role of the haematological phenotype as a predictive biomarker of retinopathy of prematurity development

AbstractPurpose: To evaluate haematological parameters as possible biomarkers of the development of retinopathy of prematurity (ROP).Methods: Multicenter, observational, and prospective study of preterm infants (PTI) from eight NICU, born in Portugal with gestational age (GA) &lt; 32 weeks or birth weight (BW) &lt;1500 g. ROP staging performed according to the International Classification of ROP (ICROP). Sociodemographic, clinical and laboratory data were collected from the first week of life. Complete blood count (CBC) was determined according to standardized methods. According to the maximum stage of ROP, PTI were divided into four groups: without ROP, ROP stage 1 (ROP‐1), ROP stage 2 (ROP‐2) and ROP stage 3 (ROP‐3). Statistical analysis was performed with the SPSS program with significant value for p &lt; 0.05.Results: 455 PTI were included, GA average of 29.5 ± 2.3 weeks, BW average of 1165.7 ± 313.9 grams and 50.5% were female. In this study 37.8% of the PTI developed ROP: 20% had ROP‐1, 9.4% ROP‐2 and 8.4% ROP‐3. 4.6% of PTI received treatment: laser was performed in 12 PTI (2.6%), anti‐VEGF in 7 PTI (1.5%), anti‐VEGF and laser in 1 PTI (0.2%), and anti‐VEGF, laser, and surgery in 1 PTI (0.2%). ROP‐3 was significantly associated with lower GA (p = &lt;0.001), BW (p &lt; 0.001), erythrocytes (p &lt; 0.001), haemoglobin (p &lt; 0.001), haematocrit (p &lt; 0.001), lymphocyte (p = 0.047) and lymphocyte to monocyte ratio (LMR) (p = 0.018) compared with the other groups. Neutrophils (p = 0.039) and neutrophil to lymphocyte ratio (NLR) (p &lt; 0.001) were higher in ROP‐3. For PTI who did not develop ROP were observed, in relation with the other groups: higher mean corpuscular haemoglobin concentration (MCHC) (p &lt; 0.001), platelets (p = 0.029) and plateletcrit (PCT) (p = 0.007) and lower red cell distribution width (RDW) (p = 0.015) and erythroblast (p &lt; 0.001).Conclusions: This study shows that the increase in neutrophils, NLR, and RDW and the decrease in lymphocytes, LMR, erythrocytes, and platelets may constitute early and low‐cost predictive biomarkers of ROP development.

Evaluation of an Artificial Intelligence System for Retinopathy of Prematurity Screening in Nepal and Mongolia.

To evaluate the performance of a deep learning (DL) algorithm for retinopathy of prematurity (ROP) screening in Nepal and Mongolia. Retrospective analysis of prospectively collected clinical data. Clinical information and fundus images were obtained from infants in 2 ROP screening programs in Nepal and Mongolia. Fundus images were obtained using the Forus 3nethra neo (Forus Health) in Nepal and the RetCam Portable (Natus Medical, Inc.) in Mongolia. The overall severity of ROP was determined from the medical record using the International Classification of ROP (ICROP). The presence of plus disease was determined independently in each image using a reference standard diagnosis. The Imaging and Informatics for ROP (i-ROP) DL algorithm was trained on images from the RetCam to classify plus disease and to assign a vascular severity score (VSS) from 1 through9. Area under the receiver operating characteristic curve and area under the precision-recall curve for the presence of plus disease or type 1 ROP and association between VSS and ICROP disease category. The prevalence of type 1 ROP was found to be higher in Mongolia (14.0%) than in Nepal (2.2%; P<0.001) in these data sets. In Mongolia (RetCam images), the area under the receiver operating characteristic curve for examination-level plus disease detection was 0.968, and the area under the precision-recall curve was 0.823. In Nepal (Forus images), these values were 0.999 and 0.993, respectively. The ROP VSS was associated with ICROP classification in both datasets (P < 0.001). At the population level, the median VSS was found to be higher in Mongolia (2.7; interquartile range [IQR], 1.3-5.4]) as compared with Nepal (1.9; IQR, 1.2-3.4; P < 0.001). These data provide preliminary evidence of the effectiveness of the i-ROP DL algorithm for ROP screening in neonatal populations in Nepal and Mongolia using multiple camera systems and are useful for consideration in future clinical implementation of artificial intelligence-based ROP screening in low- and middle-income countries.

Retinopathy of Prematurity: A Global Perspective and Recent Developments.

Retinopathy of prematurity (ROP) is a significant cause of potentially preventable blindness in preterm infants worldwide. It is a disease caused by abnormal retinal vascularization that, if not detected and treated in a timely manner, can lead to retinal detachment and severe long term vision impairment. Neonatologists and pediatricians have an important role in the prevention, detection, and management of ROP. Geographic differences in the epidemiology of ROP have been seen globally over the last several decades because of regional differences in neonatal care. Our understanding of the pathophysiology, risk factors, prevention, screening, diagnosis, and treatment of ROP have also evolved over the years. New technological advances are now allowing for the incorporation of telemedicine and artificial intelligence in the management of ROP. In this comprehensive update, we provide a comprehensive review of pathophysiology, classification, diagnosis, global screening, and treatment of ROP. Key historical milestones as well as touching upon the very recent updates to the ROP classification system and technological advances in the field of artificial intelligence and ROP will also be discussed.

Evaluation of clinical profile and screening guidelines of retinopathy of prematurity in an urban level III neonatal intensive care unit.

Purpose:To evaluate the clinical profile and screening guidelines of retinopathy of prematurity (ROP) in an urban level III neonatal intensive care unit (NICU).Methods:Infants with ≤2000-gm birth weight or <34 weeks gestational age were prospectively screened for ROP in an urban level III NICU between January 2018 and December 2020, based on national screening guidelines. Standard guidelines were used for ROP classification and treatment.Results:In total, 211 infants completed screening; 46 (21.8%) infants developed ROP and 13 (6.2%) had type 1 (laser treatable) ROP. Of the 46 infants with ROP, 44 (95.65%) had zone 2 and two (4.34%) had zone 1 disease. In the 102 infants with ≤1500-gm birth weight, the incidence of ROP and type 1 ROP were 41.18% and 11.76%, respectively. Out of the 109 infants with >1500-gm birth weight, four (3.67%) developed ROP and one (0.91%) infant (an outborn) required treatment.Conclusion: The majority of infants developing ROP in a level III urban NICU had ≤1500-gm birth weight. Zone 1 ROP was uncommon. Incidence of ROP in heavier infants (>1500-gm birth weight) was low, and treatment was required in a rare instance. In an urban NICU, the burden of ROP screening and treatments shifts to small and low-birth-weight infants.

Variability in Plus Disease Diagnosis using Single and Serial Images

To assess changes in retinopathy of prematurity (ROP) diagnosis in single and serial retinal images. Cohort study. Cases of ROP recruited from the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) consortium evaluated by 7 graders. Seven ophthalmologists reviewed both single and 3 consecutive serial retinal images from 15 cases with ROP, and severity was assigned as plus, preplus, or none. Imaging data were acquired during routine ROP screening from 2011 to 2015, and a reference standard diagnosis was established for each image. A secondary analysis was performed using the i-ROP deep learning system to assign a vascular severity score (VSS) to each image, ranging from 1 to 9, with 9 being the most severe disease. This score has been previously demonstrated to correlate with the International Classification of ROP. Mean plus disease severity was calculated by averaging 14 labels per image in serial and single images to decrease noise. Grading severity of ROP as defined by plus, preplus, or no ROP. Assessment of serial retinal images changed the grading severity for > 50% of the graders, although there was wide variability. Cohen's kappa ranged from 0.29 to 1.0, which showed a wide range of agreement from slight to perfect by each grader. Changes in the grading of serial retinal images were noted more commonly in cases of preplus disease. The mean severity in cases with a diagnosis of plus disease and no disease did not change between single and serial images. The ROP VSS demonstrated good correlation with the range of expert classifications of plus disease and overall agreement with the mode class (P= 0.001). The VSS correlated with mean plus disease severity by expert diagnosis (correlation coefficient, 0.89). The more aggressive graders tended to be influenced by serial images to increase the severity of their grading. The VSS also demonstrated agreement with disease progression across serial images, which progressed to preplus and plus disease. Clinicians demonstrated variability in ROP diagnosis when presented with both single and serial images. The use of deep learning as a quantitative assessment of plus disease has the potential to standardize ROP diagnosis and treatment.

Predicting ROP Severity by Artificial Intelligence: Pragmatic Versus Knowledge-Based Approach.

Retinopathy of prematurity (ROP) blindness is largely preventable, with many countries having already established programs for its timely identification. However, ∼93% of infants screened do not develop ROP severe enough to require treatment.1 As reported in this issue of Pediatrics by Coyner et al.2 artificial intelligence (AI) is innovative methodology to optimize the timing of ROP examinations. For example, it can predict whether an eye will not require treatment, reducing the number of examinations needed while also predicting which eyes need closer surveillance. This is an important development because it would make ROP programs more effective and efficient, thus reducing the burden on infants, families, and the health care team.From the earliest descriptions, congestion and tortuosity of the posterior retinal vessels were recognized as prominent features of serious ROP.3 In the first international classification of ROP in 1984,4 the term “plus disease” was included to describe progressive vascular incompetence. Two decades later, after the recommendations of the Early Treatment for Retinopathy of Prematurity trial,5 plus disease became the major driver for treatment. With focus now directed to the timely identification of plus disease, the historical dichotomous categorization of normal versus plus disease was deemed inadequate and led to the introduction of an intermediate level, “preplus disease,” in 20056 and the subsequent critical acknowledgment in the 2021 classification7 that the vascular changes associated with ROP do not progress stepwise but are a continuous spectrum.However, categorizing the plus spectrum is subjective and subject to significant variation.8–10 In the late 1990s, the introduction of digital imaging into the NICU provided the opportunity to objectively measure what had long been seen, and this development spawned several methods of retinal vessel measurement.11,12 Despite revealing great early promise, these methods have yet to be incorporated into routine ROP screening worldwide.AI has recently been used to help interpret the complex images captured to monitor for ROP and other patient-specific risk factors. Coyner et al1 report the use of this technology to explore the spectrum of ROP-related vascular changes, and using deep learning (a type of machine learning that can be used to develop predictive rules), the Oregon team developed i-ROP (an algorithm to detect plus disease),13 from which a vascular severity score (VSS) was derived from zone I (the area closest to the optic disc).13,14 Coyner et al1 have devised a risk model to predict ROP requiring treatment using 2 components: gestational age and VSS. Based on images obtained at 32 to 33 weeks’ postmenstrual age, the model had 100% sensitivity and 80.8% negative predictive value to predict (on average, >1 month in advance of the diagnosis) an eye which would later require treatment. This is an exciting and important development. As a result, instead of a stepwise progression through normal, preplus, and plus disease, VSS permits a sliding scale and detailed analysis of the entire plus spectrum, which hopefully will permit fine tuning of the model in the future.To paraphrase Lord Kelvin (1883), when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, your knowledge is of a meager and unsatisfactory kind. Herein lies a dilemma: Terms such as AI and deep learning are now in common parlance, so much so that few of us are brave enough to express ignorance. By expressing it (VSS) in numbers, it is not clear that, currently, we fully understand what is being measured or if it has advanced our scientific understanding. Hopefully, this will become apparent in the future. Pragmatically, however, there is no doubt that AI-related techniques, including deep learning–derived VSS, are effective and will likely be important in ROP screening. For this to be incorporated into routine clinical practice, some challenges need to be overcome: a short processing time will be essential preferably within the time span of the NICU ward rounds. In addition, this research is North America based and needs to be validated in other countries in which neonatal care may well be more variable and larger infants develop sight-threatening ROP over a shorter time period. Coyner et al1 have introduced us to a new and exciting era of efficient ROP identification.

Update on International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3)

In 1984, a consensus classification of acute retinopathy of prematurity (ROP) was created by the International Classification of ROP (ICROP). In 2005, this was revisited to incorporate advances. Now, a third edition is required because: (1) There are concerns about subjectivity in critical elements of ROP classification. (2) Innovations in imaging are raising questions about validity of traditional ophthalmoscopic tenets. (3) Major advances in treatment (eg, anti-VEGF agents) are creating new challenges regarding classification of post-treatment regression and reactivation.

Fundus fluorescein angiography in retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a potentially blinding disease of immature retinal vasculature. ROP regresses in majority of the cases and very few go on to develop ROP needing treatment. Fundus fluorescein angiography (FFA) is the gold standard technique to study retinal vasculature. The present study was undertaken with the objective to identify the FFA findings associated with the progression of ROP. Prospective single centre study in a tertiary care hospital of 99 eyes of 50 preterm babies. Fundus fluorescein angiography (FFA) was performed in all babies using RetCam 3 at the first detection of ROP. The babies were followed up for the progression of ROP. The FFA predictors for the progression of ROP were evaluated using the Mann-Whitney U test and Fisher's test. Thirty-eight eyes were Type 1 ROP at initial presentation and were lasered. Amongst the rest, 24 eyes showed features of stage 3 ROP with intense leakage on FFA and were designated as FFA-treatable ROP and were also lasered. Amongst the rest of the 37 eyes, the disease progression was seen in 13 eyes and the disease regression was seen in 24 eyes. The baseline FFA findings associated with the progression of ROP were delayed retinal arterial perfusion (p = 0.037) and popcorn lesions (p = 0.042). The post hoc analysis was done using a validated FFA scoring system. FFA may be added in the classification of ROP and delayed retinal arterial perfusion and popcorn lesions on FFA may predict the progression of ROP.

Retinopathy of Prematurity in the University of Calabar Teaching Hospital, Calabar, Nigeria: An Early Report of a Screening Service.

Background:Retinopathy of prematurity (ROP) is an important cause of childhood blindness worldwide. This blindness is avoidable through regular screening of preterm infants and prompt intervention for those with the condition.Aims/Objectives:This study aimed to determine the pattern of presentation of ROP and the risk factors for its development among preterm infants in the Neonatal Unit of the University of Calabar Teaching Hospital, Calabar, Nigeria.Design of Study:This study is a prospective, longitudinal study.Settings:The study was carried out in the Special Care Baby Unit, Sick Baby Unit, and Neonatal Clinic of the Department of Paediatrics and Child Health, University of Calabar Teaching Hospital, Calabar, Nigeria.Materials and Methods:All preterm infants whose mothers had given informed consent to participate were enrolled. Ocular examination was performed by a trained ophthalmologist. ROP was staged and documented using the revised version of the International Classification of ROP. Data were entered into a questionnaire and analysed using IBM SPSS version 22.Results:Of the 53 neonates recruited into the study, ROP was detected in 11 (21%) neonates, of which 9 (82%) had stage 1 disease, 2 (18%) had stage 2, and none had stage 3. ROP was more common in females, 7 (63.6%), than their male counterparts 4 (36.4%). ROP was higher among those with gestational age (GA) ≤30 weeks [9 (81.8%)] when compared with those with GA >30 weeks [2 (18.2%)] (P = 0.016). Other risk factors for ROP assessed by this study were found not to be significantly associated with the occurrence of ROP.Conclusion:ROP was present in 21% of the neonates, and the majority had stage 1 disease. This finding emphasizes the need for screening of all preterm neonates for ROP in order to forestall avoidable blindness which could result from this condition.

Retinopathy of Prematurity: A Clinical Approach

Retinopathy of prematurity (ROP), previously known as retrolental fibroplasia, was first described by Terry in 1942 (1). It is a vasoproliferative disorder that is a leading cause of childhood blindness in the United States, causing 550 new cases of infant blindness each year (2). It occurs principally in premature infants treated with high concentrations of oxygen. There are two phases of ROP: (i) an acute phase in which normal vasculogenesis is interrupted, and (ii) a chronic phase in which vascular membranes proliferate into thevitreous. This proliferation can lead to retinal detachment, scarring of the macula, and significant visual loss (3).This article summarizes the incidence, pathophysiology, and classification of ROP. Current protocols for evaluating and treating ROP, as well as long-term sequelae, are also described.

Study of prevelance of retinopathy of prematurity in tertiary care hospital

Retinopathy of prematurity (ROP) is a disorder seen in preterm babies. ROP is a potentially preventable cause of irreversible total blindness in premature infants. Recent advancements in neonatal care have led to an increase in the survival of low birth weight infants, resulting in a rise of ROP incidence. Globally, ROP is estimated to affect more than 50,000 infants annually. In India, every year, 500 children are estimated to become blind from ROP. If left untreated it can be a third epidemic which can be prevented by appropriate screening.To find the prevalence of ROP To identify the risk factors for ROP.Reterospective study analysis was done for 2.5 years at tertiary care hospital where after taking permission from institutional ethical committee 293 babies were enrolled in this study who were referred from paediatrician as per the standard guidelines of “Rashtriya Bal swasthya karyakram”. All babies were dilated with combination drops of Tropicamide 0.8%w/v and Phenylephrine hydrochloride 5%w/v. All the high risk term babies and preterm babies(&amp;#60;32 weeks) and &amp;#60;2 kg weight were examined 4 weeks postpartum and babies with &amp;#60;=28 weeks were examined at 2 weeks postpartum by Viteroretinal surgeon till the retina matures. Grading was done by following International classification of ROP. All babies retina were examined up to Ora Serrata, Collected data were analysed by Chi-square test.Among 293 babies Prevalence of ROP identified was 32%. 93 babies were very low birth weight (31.7%)(&amp;#60;1.0 kg BW), 35 babies were low birth weight (46%)(1 to 2.5 kg BW) as per the standard guidelines of World Health Organization for birth weight. ROP was found in 52 out of 93 very low birth weight babies(55%) and 40 out of 135 low birth weight babies(29%). P value was less than 0.0001 which was statistically significant. ROP was found in 80 Out of 157 pre term babies (50%). Logistic regression was performed to ascertain the effect of birth weight and gestational age.ROP occurs mostly in extreme low birth weight and preterm infants. In middle-income-countries like India, high rates of premature birth, and increasing resuscitation of premature infants, often with suboptimal standards of care, have resulted in a third epidemic of ROP. It is essential to screen premature babies and babies with low birth weight. Awareness regarding ROP screening is a key factor for it’s prevention.

Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines.

To evaluate the incidence and clinical indications for which eyes were treated for retinopathy of prematurity (ROP) outside the guidelines set by International Classification of ROP (ICROP). Medical records of the patients treated at a single tertiary care ophthalmology hospital for ROP from January 2016 to December 2019 were retrospectively analysed to evaluate the indications for which they were treated. Out of 241 eyes, 33 eyes (13.7%) were treated outside the guidelines. The reasons for the treatment outside the guidelines were structural changes (n = 24, 72.7%), persistent stage 3 ROP that did not show any sign of regression for 6weeks (n = 7, 21.2%) and active ROP with fellow eye being treated (n = 2, 6.1%). The recorded specific structural changes were tangential traction with temporal vessel straightening concerning for macular distortion and ectopia (n = 5, 15.2%), and stage 3 neovascularisation or ridge with anteroposterior traction with risk of progression to stage 4 disease (n = 19, 57.6%). Pre-plus disease was present in 11 eyes (33.3%).After the treatment, ROP stages regressed and retinal vessels grew either until the ora or at least into zone III in all the treated eyes. None of the eyes showed worsening of structural changes after treatment. The mean follow-up of the patients was 12.4 ± 11.7months. Experts occasionally recommend treatment in eyes with disease milder than type 1 ROP. This study may help paediatric retinal practitioners in decision-making in borderline cases.