Developed Threshold Retinopathy Of Prematurity Research Articles

English

BACKGROUND Retinopathy of prematurity (ROP) is a disease affecting the retina of premature infants due to retinal neovascularization and the spectrum of outcome findings in ROP ranges from the most minimal sequelae without affecting vision in the mild cases to bilateral, irreversible, and total blindness in more severe cases.In India children less than 1500 g have almost 38 percent chance of developing any stage of ROP and 7 – 16 % chance of developing threshold ROP or blinding ROP. (2)Laser photocoagulation has replaced cryotherapy as the established treatment for ROP in most centers and this study aims to evaluate the functional and structural outcome in preterm infants who received laser photocoagulation for retinopathy of prematurity. In this study we wanted to find out the structural outcome of retinopathy of prematurity infants who underwent laser photocoagulation. We also wanted to find out the functional outcome of ROP preterm infants who underwent laser photocoagulation and identify the factors affecting the structural outcome in retinopathy of prematurity. METHODS A hospital based descriptive study was conducted among 31 preterm infants with retinopathy of prematurity who received laser photocoagulation treatment after obtaining parental consent in the Retina clinic, Regional Institute of Ophthalmology, Trivandrum. Screening examination was done at 34 weeks or 4 weeks postnatal whichever was earlier. Those infants who were detected to have ROP and were given laser photocoagulation by the ophthalmologist were followed up till retina becomes stable / ROP regresses. Thereafter follow up examinations were performed at 3 months, 6 months and 10 months. Structural outcome was classified as favorable and unfavorable. Visual or functional outcome was assessed by noting the fixation pattern, ocular alignment for strabismus and by performing cycloplegic refraction (retinoscopy) to rule out refractive errors. Data was entered into excel sheet and statistical analysis was done using SPSS trial version. RESULTS The study was conducted in 31 preterm infants with Retinopathy of Prematurity who underwent laser photocoagulation in Regional Institute of Ophthalmology Trivandrum. The structural and functional outcome was assessed at 3months, 6 months and 10 months. Of the 62 eyes of 31 infants, stage2 and 3comprised 48.4%each.3.2% of eyes had stage1 disease affecting zone1.None had stage 4 or 5.Of the 62 eyes, majority had zone 2 disease (83.9%). Only 10 eyes had zone1 disease. Out of the 60 eyes, 54 eyes had a favorable structural outcome at 3months.The functional outcome was assessed in terms of visual behavior by assessing the fixation of light, whether child is following light and by preferential looking pattern. Out of the 30 babies only 1 had an unfavorable visual behavior. The baby was not fixing and following light. Out of the 30 infants, 2 had (6.6%) strabismus at 6months and 10 months. Myopia was the predominant refractive error in the studied group accounting for about 55%. Among the study group 16.7 % had hypermetropia. CONCLUSIONS The incidence of favorable structural outcome in our study was 90%.Low gestational age and low birth weight were associated with an unfavorable structural outcome. There is a high prevalence of refractive errors in our study group accounting for about 71.5 % at 6 months. The refractive errors increased at 10 month follow up to 77%. Among the refractive errors, myopia predominates accounting 55% at 6 months and 61 % at 10 months. KEY WORDS Laser Photocoagulation, Retinopathy of Prematurity

Incidence and risk factors of retinopathy of prematurity in Goa, India: a report from tertiary care centre

Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity (ROP) from a tertiary care center in the western Indian state of Goa, India.Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for a period of 18 months. Babies born at < 34 weeks’ gestation and having a birth weight of <1500gm were screened for ROP and laser photocoagulation was done for those who developed threshold ROP. Group differences between any ROP and threshold ROP were analysed using the chi-square test.Results: Out of the 244 preterm neonates screened, 37 developed ROP (15.16%), and 14 out of them (5.73%) developed threshold ROP requiring laser photocoagulation. Very low birth weight, prematurity, apnea, anemia, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusions, exchange transfusions and days taken to reach full enteral feeds and regain birth weight were significantly associated with the development of ROP.Conclusions: This is the first report of ROP from Goa where less than 1 in 5 babies developed ROP. This is similar to that reported across the rest of the country. Judicious oxygen use, ventilation strategies, transfusions guidelines, control of sepsis, early enteral feeds and adequate nutrition may help prevent the development of ROP in the future.

Red Blood Cell Transfusion and Clinical Outcomes in Extremely Low Birth Weight Preterm Infants

Red blood cell (RBC) transfusion is often considered a life-saving measure in critically ill neonates. The smallest and least mature infants tend to receive the largest amount of transfusions. RBC transfusion itself has also been suggested as an independent risk factor of poor clinical outcome in critical patients. Our aim is to study if there are associations between RBC transfusion and in-hospital mortality, short-term morbidities, and late neurodevelopmental outcome in extremely low birth weight (ELBW) preterm infants. A cohort of ELBW preterm infants admitted to our neonatal intensive care unit from January 2009 to December 2010 were recruited. The number of RBC transfusions within 7 days, 30 days, and 60 days of life were recorded. Clinical outcomes including in-hospital mortality, development of retinopathy of prematurity (ROP), necrotizing enterocolitis, chronic lung disease, and later neurodevelopmental outcome were assessed with follow-up of up to 2 years of age. Multivariable logistic regression was used to estimate the associations between RBC transfusion and clinical outcomes. A total of 98 ELBW preterm infants survived at the time of discharge. Of these survivors, the mean numbers of RBC transfusions were 2.5 ± 1.7, 7.4 ± 3.1, and 11.3 ± 4.5 times within 7 days, 30 days, and 60 days after birth, respectively. The number of transfusions within 7 days of life was correlated with risk of death before 1 month of age (odds ratio: 1.54, 95% confidence interval: 1.04-2.27, p = 0.03) and the number of transfusions within 30 days was correlated with risk of developing threshold ROP (odds ratio: 1.27, 95% confidence interval: 1.04-1.55, p = 0.02). The number of transfusions within 7 days of life was positively correlated with cognitive performance (Mental Developmental Index score) at 18-24 months of corrected age. RBC transfusion has a negative impact on survival in ELBW infants. It increases the risk of developing ROP and affects late neurodevelopment. Decisions of blood transfusion in these very immature infants should be made cautiously taking these deleterious results into consideration.

Intravitreal Bevacizumab for Retinopathy of Prematurity

To evaluate the therapeutic effect of a single intravitreal injection of bevacizumab for treatment of threshold retinopathy in retinopathy of prematurity (ROP). The retrospective study consisted of all infants who developed threshold ROP in fundus zone I or zone II and who consecutively received an intravitreal injection of bevacizumab (0.375 mg, 0.03 mL) in local anesthesia. Twelve infants (23 eyes) were included into the study. The mean birth weight was 625±187 g (mean±standard deviation; range: 450-810 g), mean gestational age was 25.1±1.4 weeks (range: 24.0-28.7 weeks), mean age at the time of intervention was 38.1±3.7 gestational weeks (range: 32.1-45.6 weeks), and mean follow-up was 30.4±25.9 weeks. Three children (6 eyes) showed aggressive posterior ROP. After the injection, all eyes showed a regression of plus disease within 2-6 days, a decrease in pupillary rigidity, a resolution of any tunica vasculosa lentis, and a complete regression of the retinal neovascularization within 2-3 weeks. In none of the children a second intravitreal injection of bevacizumab was performed. A single intravitreal bevacizumab injection of 0.375 mg in 0.03 mL appears to be potentially helpful for the therapy of threshold ROP avoiding side effects of conventional retinal laser coagulation such as irreversible retinal scarring. Long-term effects and side effects may be assessed in future prospective randomized trials.

Is ethnicity a risk factor for severe retinopathy of prematurity?

ObjectiveTo assess the risk of severe retinopathy of prematurity (ROP) requiring treatment in different ethnic groups.DesignRetrospective observational study on ROP screening and treatment. It involved a cross-sectional review of all...

Combined Treatment with Laser Photocoagulation and Cryotherapy for Threshold Retinopathy of Prematurity

To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over -6 diopters. Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.

Visual Acuity at 10 Years in Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Study Eyes

To describe recognition (letter) acuity at age 10 years in eyes with and without retinal residua of retinopathy of prematurity (ROP). Presence and severity of ROP residua were documented by a study ophthalmologist. Masked testers measured monocular recognition visual acuity (Early Treatment of Diabetic Retinopathy Study) when the children were 10 years old. Two hundred forty-seven of 255 surviving Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) randomized trial patients participated. A reference group of 102 of 104 Philadelphia-based CRYO-ROP study participants who did not develop ROP was also tested. More severe retinal residua were associated with worse visual acuity, regardless of whether retinal ablation was performed to treat the severe acute-phase ROP. However, within each ROP residua category, there was a wide range of visual acuity results. This is the first report of the relation between visual acuity (Early Treatment of Diabetic Retinopathy Study charts) and structural abnormalities related to ROP in a large group of eyes that developed threshold ROP in the perinatal period. Visual deficits are greater in eyes with more severe retinal residua than in eyes with mild or no residua. However, severity of ROP residua does not predict the visual acuity of an individual eye because within a single residua category, acuity may range from near normal to blind.

Abstracts

Abstracts

Incidence and risk factor analysis of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a leading cause of infant blindness. This study was designed to screen the high-risk premature infants and investigate the incidence and risk factors associated with the development of ROP. From July 1 2002 to June 30 2003, all premature infants born in Beijing Maternal and Children Healthcare Hospital with birth body weight (BBW) less than 2000 gm or gestational age (GA) less than 34 weeks were enrolled and underwent ophthalmologic examination. The perinatal variables were analyzed to evaluate their correlation with the development of ROP. In 98 premature infants, the incidence of ROP was 17.3% (17 in 98 patients). Four cases with 7 eyes (4.1%) developed threshold ROP. There was significant difference in birth body weight, gestational age, maximal oxygen tension, oxygen use for more than 5 days and sepsis between ROP and Non-ROP groups. Logistic regression analysis indicated that long time use of oxygen was a significant risk factor associated with the development of ROP. GA and BBW were protective factors of ROP. Low birth body weight, young gestational age and long time oxygen usage are the most important risk factors in the development of ROP.

Plan de pesquisa y tratamiento de la Retinopatia del prematuro: Experiencia modelo en Hospital Barros Luco

Retinopathy of prematurity (ROP) is the commonest cause of infantile blindness in Chile. 30-35% of children with a birth weight of less than 1 500 gm present some degree of ROP, 5% develop threshold ROP with a high risk of becoming blind. For this reason a screening programme was implemented. Objectives: To determine the incidence of ROP and maximum stages related to birth weight and gestational age. To describe the incidence of threshold ROP, the outcome of early treatment, and the advantages of this programme. Patients and Methods: A programme designed to detect and treat all children with a birth weight of less than 1 500 gm, using retinal examination from day 30 until maturation of the retinal vessels. The inicial and ultimate examination were registered. A treatment protocol was designed for threshold ROP. Results: 205 children (95,8%) of the study were evaluated, 146 (71,2%) presented with some stage of ROP, of whom 18 (12,3%) developed threshold ROP. An inverse relationship between the incidence of ROP and higher birth weight and gestational age were noted, but not with threshold ROP. 18 children with threshold ROP were treated with laser photocoagulotherapy with a favourable outcome. Conclusions: The incidence of ROP is higher in our centre than in others in Chile, even though the risk factors are similar. The absence and associated advantages justifies the implementation and extension of this plan to other centers.

Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity.

Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP. Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction. In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 +/- 8 minutes/eye. A mean of 117 +/- 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters). The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.

Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity

Purpose Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP. Methods Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction. Results In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 ± 8 minutes/eye. A mean of 117 ± 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters). Conclusions The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.

Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity

Purpose To document perinatal growth characteristics in infants who developed threshold retinopathy of prematurity (ROP) in an attempt to describe prenatal and postnatal growth-related risk factors for threshold ROP. Methods To document birth weight as well as absolute and relative weight gain (g/d and g/kg/d) in the first 6 weeks of life in infants who developed threshold ROP and who were admitted to a single tertiary neonatal intensive care unit between 1996 and 2000. These data were compared (case-control approach) with infants of the same gestational age (GA) who did not developed threshold ROP. Results Small for gestational age (SGA; ie, weight <10th percentile for a given GA) and growth restriction (<25th percentile for a given GA) are risk factors for threshold ROP (relative risk = 3.7 and 4.5, respectively). Absolute weight gain (g/d) is also associated with an increased risk of developing threshold ROP ( P<.05). In contrast, relative weight gain (g/kg/d) is not significantly different between threshold ROP infants and GA-matched controls. Conclusions SGA and a birth weight below the 25 th percentile are risk factors for threshold ROP. Postnatal weight and absolute weight gain (g and g/d, respectively) in the first 6 weeks of life are statistically significant but of less clinical relevance because smaller infants at birth stay relatively smaller during the first 6 weeks of life. Even with normal (ie, same weight as control infants) postnatal relative weight gain (g/kg/d), growth retarded or restricted infants at birth still have an increased risk of developing threshold ROP.

Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity.

To document perinatal growth characteristics in infants who developed threshold retinopathy of prematurity (ROP) in an attempt to describe prenatal and postnatal growth-related risk factors for threshold ROP. To document birth weight as well as absolute and relative weight gain (g/d and g/kg/d) in the first 6 weeks of life in infants who developed threshold ROP and who were admitted to a single tertiary neonatal intensive care unit between 1996 and 2000. These data were compared (case-control approach) with infants of the same gestational age (GA) who did not developed threshold ROP. Small for gestational age (SGA; ie, weight <10th percentile for a given GA) and growth restriction (<25th percentile for a given GA) are risk factors for threshold ROP (relative risk = 3.7 and 4.5, respectively). Absolute weight gain (g/d) is also associated with an increased risk of developing threshold ROP (P<.05). In contrast, relative weight gain (g/kg/d) is not significantly different between threshold ROP infants and GA-matched controls. SGA and a birth weight below the 25(th) percentile are risk factors for threshold ROP. Postnatal weight and absolute weight gain (g and g/d, respectively) in the first 6 weeks of life are statistically significant but of less clinical relevance because smaller infants at birth stay relatively smaller during the first 6 weeks of life. Even with normal (ie, same weight as control infants) postnatal relative weight gain (g/kg/d), growth retarded or restricted infants at birth still have an increased risk of developing threshold ROP.

Threshold retinopathy of prematurity in neonates less than 25 weeks' estimated gestational age

Introduction: The survival rate of extremely premature infants has increased. No recent study has investigated the characteristics of retinopathy of prematurity (ROP) or the incidence of threshold ROP in the most severely premature infants. We undertook this study to determine the risk of developing ROP and threshold ROP in the growing sub-population of infants <25 weeks' estimated gestational age (EGA). Methods: A retrospective review of infants born before the 25th week of gestation between the years 1994 and 1997 was performed. Of 49 infants examined (97 eyes), 42 were born in the 24th week of gestation and 7 were born in the 23rd week. Mean follow-up was 6.3 months (range, 2.5–37 months). Ophthalmology screening examinations were initiated at 5 weeks of age and continued until the infants were no longer at risk for serious ROP. Results: ROP developed in all (97) eyes. Thirty-nine of 97 (40%) eyes in 20 of 49 (41%) infants developed threshold ROP, diagnosed at a mean post-conceptional age of 34 weeks. Thirteen (13%) eyes of 7 (14%) patients developed prethreshold disease and regressed without treatment. Conclusion: There is an increased incidence of threshold disease in infants ≤25 weeks' EGA compared with children of greater EGA. Threshold disease may occur at an earlier post-conceptional age in this subgroup of neonates. (J AAPOS 2000;4:183–5)

Does candidemia predict threshold retinopathy of prematurity in extremely low birth weight (

Extreme prematurity is a risk factor for both candidemia and threshold retinopathy of prematurity (ROP) and may confound the reported association between these conditions. To determine if candidemia is an independent risk factor for threshold ROP. A cohort study was conducted of infants weighing </=1000 g at birth using a prospectively maintained neonatal database. The study included infants admitted to the neonatal intensive care unit at </=3 days of age between January 1, 1993 and December 31, 1997. We excluded infants not screened for ROP because they died, were discharged, or transferred. Threshold ROP (ie, requiring ablative therapy within 72 hours of diagnosis) was defined by the criteria of the American Academy of Pediatrics Section on Ophthalmology ROP subcommittee. Candidemia was defined as Candida species growth from at least 1 blood culture. Cox proportional hazards regression was used to determine independent risk factors for threshold ROP. Six hundred fourteen infants weighing </=1000 g at birth, of which 165 were excluded: 120 died before ROP screening, 40 were admitted >3 days of age, and 5 were discharged or transferred before ROP screening. A total of 449 infants were included in the study; 58 (13%) developed threshold ROP. Candidemia occurred in 58 (13%) infants before developing the worst stage of ROP. Candidemia occurred in 27 of 73 (37%) at 23 to 24 weeks' gestational age (GA), 25 of 197 (13%) at 25 to 26 weeks' GA, and 6 of 129 (5%) at 27 to 28 weeks' GA, 0 of 50 >28 weeks' GA. Similarly, threshold ROP occurred in 25 of 73 (34%) at 23 to 24 weeks' GA, 26 of 197 (13%) at 25 to 26 weeks' GA, and 6 of 129 (5%) at 27 to 28 weeks' GA, and 1 of 50 (2%) >28 weeks' GA. Threshold ROP developed in 19 of 58 (33%) infants with a history of candidemia and 39 of 391 (10%) without candidemia. Proportional hazards analysis indicated that GA in weeks (hazard ratio =.75; 95% confidence interval [CI]:. 61,.93) and non-black ethnicity (hazard ratio = 1.8; 95% CI: 1.05, 3. 08) were significantly associated with threshold ROP. After controlling for GA and other factors, candidemia did not remain significantly associated with threshold ROP (hazard ratio = 1.6; 95% CI:.89, 2.89). Candidemia may not be an independent risk factor for threshold ROP in extremely low birth weight infants. The magnitude of the previously reported association between candidemia and threshold ROP (more than fivefold) is unlikely and much of the clinically observed association appears to be mediated by gestational age.