Development Of Retinopathy Of Prematurity Research Articles

The role of hepatic and renal functions in the development of retinopathy of prematurity: Is proteinuria a new risk factor?

To investigate the association of hepatic and renal parameters with the development of retinopathy of prematurity (ROP) in premature infants with a gestational age ≤ 32weeks. Medical records of 240 preterm infants were reviewed retrospectively, 85 of them were grouped as type 1, type 2 ROP, and control group. The 4th week hepatic and renal function test results of the groups, on the day of their first ROP examinations, were compared for the risk of development of ROP and the development of type 1 ROP. In this study, 12, 35, and 38 infants were enrolled in the type 1, type 2 ROP, and control group, respectively. The average gestational age and birth weight were higher; however, the duration of oxygen treatment was lower in the control group (p < 0.001). The blood glucose level was significantly higher in the type 1 ROP group than in the other groups (p = 0.023). The mean of total serum bilirubin of the type 1 ROP group was significantly lower than those of the type 2 ROP and control group (p = 0.032). Proteinuria was present in 85.7% of preterms with treatment-requiring ROP and proteinuria increased the risk of ROP by 3.9 times (OR with 95% CI 3.9 (1.19-12.75), p = 0.042). We found significantly higher blood glucose and lower total bilirubin level in the type 1 ROP group. Moreover, our findings suggest that proteinuria may not be only a comorbidity factor but also related to a higher frequency of ROP and type 1 ROP in preterm infants.

Evaluation of risk factors, treatment, and outcome of patients with retinopathy of prematurity at tertiary hospital

Retinopathy of prematurity (ROP) is a proliferative vitreoretinopathy affecting premature infants which a leading cause of childhood blindness worldwide. Screening is scheduled according to gestational age and birth weight to detect ROP development and to determine the appropriate timing of treatment. Screening also identified any risk factors for ROP development. Aim of this study is to evaluate risk factors, choice of treatment and outcome based on severity of ROP.

Association of platelet deficiency with severe retinopathy of prematurity: a review.

The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data. A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually. There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity. Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.

The association between amniotic fluid-derived inflammatory mediators and the risk of retinopathy of prematurity.

Prenatal and perinatal infections and inflammation appear to associated with the development of retinopathy of prematurity (ROP). In this study, we evaluated whether inflammatory mediators in amniotic fluid (AF) retrieved during cesarean delivery influence the development of ROP in very low birth weight (VLBW) infants.This retrospective study included 16 and 32 VLBW infants who did and did not develop any stage of ROP, respectively. Each infant with ROP was matched with 2 infants without ROP based on days of ventilation care, gestational age, and birth weight. AF was obtained during cesarean delivery, and the levels of intra-amniotic inflammatory mediators such as interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, matrix metalloproteinase (MMP)-2, MMP-8, MMP-9, and tumor necrosis factor (TNF)-α were measured using a Human Magnetic Luminex assay (R&D Systems, Minneapolis, MN). The differences in the levels of inflammatory mediators according to the presence or absence of ROP were compared.In patients who developed ROP, the level of MMP-2 in the AF was significantly increased (P = .011), whereas the levels of IL-10 and TNF-α were significantly decreased (P = .028 and .046, respectively) compared with those in infants who did not develop ROP. The levels of the other mediators were not significantly different between the 2 groups. Multivariate regression analysis showed that MMP-2 was a risk factor for the development of ROP (odds ratio, 2.445; 95% confidence interval, 1.170-5.106; P = .017).The concentration of MMP-2 in AF is an independent factor in the development of ROP. Further studies are needed to determine whether the levels of inflammatory mediators in AF affect the ROP severity.

Relationship Between Retinopathy and Mean Platelet Volume

OBJECTIVE: Platelet activation is thought to play a role in the angiogenesis process involved in the pathophysiology of retinopathy of prematurity (ROP). We planned this study to investigate whether the mean platelet volume (MPV), used to assess platelet activation, could be used as a biomarker in the diagnosis and treatment of ROP. STUDY DESIGN: In our study, we evaluated infants who underwent ROP examination among infants born at 32 weeks or less and/or 1500 grams or less as well as infants who had more than these values but experienced a bad neonatal period. These patients were divided into two groups as those with and without ROP, and in those with ROP group, as requiring treatment and not requiring treatment. We recorded the patients’ identity, maternal characteristics, antenatal/natal/postnatal features, and complications during follow-up, ROP control times, and complete blood count parameters (platelet count, MPV, platelet count/MPV). Primarily, we evaluated the differences of platelet parameters, especially the MPV values, between treatment requiring ROP and non-treatment requiring ROP groups and secondarily, we evaluated the correlation between scanned parameters and ROP development. RESULTS: Of the 144 patients included in the study, 49 patients (34%) had ROP and 25 patients (16.6%) had ROP requiring treatment. There were statistically significant differences between patients who were diagnosed with ROP and who were not, in terms of gestational age, birth weight, respiratory distress syndrome, surfactant use, duration of oxygen use, intraventricular hemorrhage, patent ductus arteriosus, neonatal sepsis, number of blood transfusions, necrotizing enterocolitis, bronchopulmonary dysplasia and time to catch up birth weight. However, there was no significant difference in terms of MPV, platelet count and platelet/MPV ratio. The gestational week, invasive ventilation day and duration of oxygen use, BPD and time to catch up birth weight were found to be statistically high in treatment-requiring rather than non-treatment-requiring ROP groups. There was no significant difference in MPV, platelet count, platelet/MPV ratio among these groups. A statistically significant difference was found in the most advanced stage ROP and plus existence in the treatment requiring ROP group. CONCLUSION: As a result of our study, we could not find enough data to say that MPV is a marker that can be used in the diagnosis of ROP and in measuring the severity of retinopathy. We suggest that more studies should be done on this subject.

Evaluation of the Effect of Blood Transfusion on Retinopathy of Prematurity at a Tertiary Care Center in Western Saudi Arabia.

IntroductionWe aim to study if there is an association between blood transfusions and the development and severity of retinopathy of prematurity (ROP). We also aim to explore the association with other clinical outcomes.MethodsA cohort of 291 infants admitted to our neonatal intensive care unit (NICU) was retrospectively analyzed. The number and volume of RBC transfusions on Day 7 and Day 30 were recorded. Clinical outcomes including ROP, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis were noted.ResultsThe mean gestational age (GA) and birth weight (BW) of the evaluated infants were 28 ± 2.2 weeks and 1062 ± 242 g, respectively. One hundred and eighteen infants were transfused at a median of nine days post GA. Compared to non-transfused infants, those who were transfused had a lower GA, a lower BW, a longer stay in the NICU, and received significantly more artificial ventilation. These infants also had a higher number of comorbidities, including sepsis and intraventricular hemorrhage. The number and volume of RBCs at Day 30 were significantly higher in infants with any stage of ROP than in those without ROP.ConclusionA higher frequency and volume of RBC transfusion were associated with an increased risk of ROP development. Whether this is a direct consequence of blood transfusion or the infants being at risk due to prematurity or low BW remains to be determined.

Retinopathy of Prematurity: A Review of Risk Factors, Oxygen Targets, Screening Criteria

Retinopathy of Prematurity (ROP) is a disease of immature retinal tissue that is strongly associated with prematurity, low birth weight, and prolonged oxygen exposure. The purpose of this review is to evaluate published literature to determine which factors can be linked to the development of ROP, which factors are protective against ROP, and which factors are still unclear. It also sought to review the major oxygenation trials in premature infants to establish the recommended oxygen saturation targets in premature babies and what criteria are useful in evaluating infants for ROP. Databases (PubMed, Medline, PubMed Central, and Google Scholar) were used to obtain relevant literary articles. Key findings suggested that major risk factors for ROP were prematurity, low birth weight, and prolonged oxygen exposure. Evidence suggests that maternal diabetes, maternal smoking, prolonged rupture of membranes, lack of antenatal steroids, ethnicity, multiple births, low Apgar scores, and sepsis are risk factors for the development of ROP. Evidence suggests that maternal hypertensive disorders, mode of birth, and chorioamionitis are not associated with ROP. Recommendations of oxygen saturations in the neonate include targets of 90-95% and 90-94%. Screening for ROP is dependent on birth weight, gestational age, and risk factors, with recommendations varying according to pediatric societies.

Severe Retinopathy of Prematurity in Big Babies.

Evaluation of babies with gestational age (GA) over 32 weeks and with a birth weight (BW) over 1500 g, who underwent treatment for retinopathy of prematurity (ROP). The data of babies with ROP between June 2015 - 2020 were analyzed retrospectively and cross-sectionally. All infants treated for ROP were evaluated. Big babies who were older than 32 weeks GA with a BW higher than 1500 g were determined. Other treated premature infants formed the control group. We retrospectively scanned 6581 patients who underwent ROP examination. Of these babies, 109 were treated for ROP. Thirteen babies (12%) who were treated for ROP were born over 32 weeks of GA and above the weight of 1500 g. One big infant was excluded because of missing file data. Eleven of these infants had type 1 ROP and 1 had aggressive posterior ROP. The mean GA and BW of big babies was 33.58 ± 0.88 weeks and 1860.83 ± 257.73 g, respectively. The mean GA and BW of the control group was 27.85 ± 2.02 weeks and 1068.28 ± 313.78 g, respectively. Both the big babies and the control group received oxygen treatment for 15.25 ± 11.44 and 19.17 ± 12.11 days (p = 0.29), respectively. Sepsis was seen in one big infant but 18 infants were observed to have sepsis in the control group. Similarly, one big infant had necrotizing enterocolitis (NEC), while in the control group, 12 infants had NEC. Total oxygen intake days, NEC, and sepsis rates were found to be relatively lower in big babies with severe ROP. This could suggest that other factors may have a greater effect on the development of severe ROP in big babies.

Retinopathy of prematurity: A revisit to the incidence, risk factors, and its response to laser therapy

: The debilitating vasoproliferative retinal disorder retinopathy of prematurity (ROP), a prequel to neonatal blindness is known to be increasing in recent years with improved advances in neonatal care and survival. Aim of this study was to study the incidence of ROP, risk factors, and response to the gold standard treatment of laser has been explored in this study.: In this prospective observational study of all neonates referred to the retina clinic of a tertiary care centre, from both in-house referrals and peripheral centres. Demographic data, both maternal and neonatal data were recorded. Neonates complying to inclusion and exclusion criteria were examined under 28 diopter lens and all ROP were documented using RetCam. Laser photocoagulation was performed and later followed up according to ETROP schedule.: 699 neonates were screened in the study and ROP was detected in 13.73% (182/1398) of this population, with mean gestational age 31.82±2.44 weeks and mean birth weight 1425.36±287.73 grams. Neonatal risk factors of gestational age &amp;#60;34 weeks, low birth weight, ventilatory support, RDS, oxygen supplementation, sepsis, birth asphyxia, blood transfusion, and phototherapy were found to have significant association for incidence of ROP and those requiring treatment. When 67.58% regressed spontaneously, all 59 eyes requiring treatment underwent laser therapy. 46 out of these 59 eyes (77.97%) showed regression and remaining seven eyes required further intervention.: Better premature neonates survival rates has shown an increased incidence of ROP over the past decades. Red flag signs like low gestational age, low birth weight, RDS, oxygen supplementation, sepsis, blood transfusion, AGA and twin pregnancy are confirmed to have significant association with the development of ROP. Laser therapy still remains effective in controlling progression of the disease.

Retinopathy of prematurity: contribution of inflammatory and genetic factors.

Retinopathy of prematurity (ROP) is a retinal vasoproliferative disorder that represents an important cause of childhood visual impairment and blindness. Although oxidative stress has long been implicated in ROP etiology, other prenatal and perinatal factors are also involved. This review focuses on current research involving inflammation and genetic factors in the pathogenesis of ROP. Increasing evidence suggests that perinatal inflammation or infection contributes to ROP pathogenesis. Cytokines and chemokines with a fundamental role in inflammatory responses and that significantly contributing to angiogenesis are analyzed. Microglia cells, the retinal-resident macrophages, are crucial for retinal homeostasis, however, under sustained pathological stimuli release exaggerated amounts of inflammatory mediators and can promote pathological neovascularization. Current modulation of angiogenic cytokines, such as treatment with antibodies to vascular endothelial growth factor (anti-VEGF), has shown efficacy in the treatment of ocular neovascularization; however, some patients are refractory to anti-VEGF agents, suggesting that other angiogenic or anti-angiogenic cytokines need to be identified. Much evidence suggests that genetic factors contribute to the phenotypic variability of ROP. Several studies have implicated the involvement of candidate genes from different signaling pathways in the development of ROP. However, a genetic component with a major impact on ROP has not yet been discovered. Most studies have limitations and did not replicate results. Future research involving bioinformatics, genomics, and proteomics may contribute to finding more genes associated with ROP and may allow discovering better solutions in the management and treatment of ROP.

Dysregulated genomic and coding-transcriptomic factors in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a type of vitreous retinopathy in premature children that leads to visual impairment and blindness at early ages. ROP is a lifetime disease that can impose a tremendous economic and psychological burden on the government and society. ROP is characterized by abnormal neovascularization in the retina. ROP is a multifactorial disease that means many factors are involved in the pathogenesis of ROP, such as low birth weight, short gestational age as a primary risk factor for ROP, anemia, intraventricular hemorrhage, inflammation, sepsis, underlying diseases, maternal preeclampsia, and other factors. Some studies suggest that genetic factors play an essential role in ROP pathogenesis and development. In addition, monitoring genetic factors such as genetic polymorphism may pave the way for diagnosis and prognosis ROP, leading to prevention and stopping disease progression in time. Understanding the genomics of diseases opened a new door for treatment. Genetic-based therapeutic approaches are preventive strategies that can effectively prevent the progression of ROP and improve infants' lives. In this study, we reviewed some genetic factors involved in ROP pathogenesis and development, and in the following, we survey some new genetic-based therapeutic approaches for treating ROP in preterm infants.

The Role of Thrombocyte Parameters in Retinopathy of Prematurity Development.

Purpose To investigate the role of thrombocyte parameters in retinopathy of prematurity (ROP) development. Materials and Methods This retrospective study included 120 preterm infants in total. Group 1 was formed by infants who developed type-1 ROP and received treatment. Group 2 was formed by infants who developed ROP and were not treated for ROP. Infants who did not develop ROP and whose retinal vascularization was completed in their follow-up formed Group 3. Gestational age, birth weight, and genders of groups were recorded. Platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) values were obtained from complete blood count. Platelet mass index (PMI) was calculated by multiplying the PLT count by MPV value. Thrombocytopenia was defined as PLT count <150 × 1000/μL. All parameters were compared between the groups. Results There were 40 preterm infants in each group. The mean PLT count was 272.43 ± 122.67 in Group 1, 333.32 ± 133.06 in Group 2, and 310.03 ± 119.41 in Group 3. The difference in PLT count between the groups was not significant (p=0.094). Thrombocytopenia was observed in 25% of Group 1, 10% of Group 2, and 10% of Group 3 (p=0.095). No statistically significant difference was found in terms of MPV, PDW, and PMI values between the groups (p=0.102, p=0.097, and p=0.298, respectively). Conclusions Although PLT count was lower and thrombocytopenia rate was higher in the type-1 ROP group, the differences were not found to be significant. Further prospective studies are required to evaluate the role of thrombocytes in ROP pathogenesis.

Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity.

Background: Retinopathy of prematurity (ROP) is a major cause of childhood blindness. Antenatal corticosteroids (ACS) exposure is known to ameliorate the risk of and mortality of neonatal morbidities. However, the effect of ACS on ROP development is currently unknown. We conducted a meta-analysis with up-to-date evidence to assess the association between ACS exposure and the development of ROP in at-risk preterm infants. Methods: PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library were systematically searched from inception to May 2021, supplemented with manual search from reference lists. Studies with a control group reporting ROP rate in ACS-exposed infants were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated utilizing a random-effects model. The Newcastle-Ottawa Scale was used for assessment of risk of bias in the included studies. Meta-regressions were performed to explore the predictive role of confounders for between-study variance. Results: A total of 63 studies, involving 196,264 infants, were included. Meta-analysis showed ACS exposure was not associated with ROP occurrence (uOR 0.92, 95% CI 0.80–1.07; aOR 0.87, 95% CI 0.7–1.08). Results from extremely immature subgroups revealed significant reduced risks of ROP occurrence in ACS-exposed infants. ACS exposure was associated with significantly lower odds of ROP progression in adjusted analysis (aOR 0.48, 95% CI 0.26–0.89) instead of unadjusted analysis (uOR 0.86, 95% CI 0.68–1.08). Meta-regression showed birth weight and patent ductus arteriosus of the cohort were associated with ROP occurrence, sample size and study design strongly associated with ROP progression in ACS-exposed infants. Conclusion: ACS treatment may decrease, but not prevent, the severity of ROP. Findings from severe ROP should be interpreted with caution owing to limited studies and the possibility of false-positive results. Considering the particular benefits in extremely immature infants, we recommend routine usage of ACS in mothers with threatened delivery to this particular birth cohort to prevent ROP occurrence. Future studies adjusting for major confounders are warranted to mitigate risk of bias in such observational evidence.

Первая доклиническая ангиоспастическая фаза ретинопатии недоношенных

Purpose. To evaluate the role of the first preclinical phase in the pathogenesis of retinopathy of prematurity (ROP). Material and methods. 642 premature babies were examined. The gestational age at the time of birth was up to 30 weeks and the weight was up to 1500 g. Ophthalmological monitoring was carried out from 28–30 weeks of postconceptional gestational age. Indirect ophthalmoscopy, digital calibration of retinal vessels, and studies on a wide-field retinal pediatric camera were performed. Dopplerography data of the blood flow in the brain vessels and in the ocular artery were analyzed in 28 children (56 eyes). The partial pressure of oxygen (pO2) and carbon dioxide (pCO2) in capillary blood was studied using Radiometer ABL800 FLEX gas analyzer (normal levels of pO2 are 40–60 mmHg, pCO2 is 35–45 mmHg). Results. It was revealed that the lower the degree of maturity of the child’s body was, the more often retinal arteriospasm was detected. In children with a postconceptional age of 25–27 weeks, arteriospasm was detected in 82% of cases, at 28 – 29 weeks – in 67%, 30 – 32 weeks – in 54% of cases. The degree of angiospasm correlates with a high index of blood flow resistance in the brain vessels and the ocular artery. The predominance of a high index of blood flow resistance in more premature infants with low body weight was revealed.The index of resistance of brain vessels 0.8 and higher, according to dopplerography, is a critical indicator of the threat of ROP development in a premature baby. Conclusion. During retinopathy of prematurity, it is important to detect the first preclinical, antispasmodic phase of ROP development, which lasts about one month and until now practically does not attract the attention of ophthalmologists. In this phase, the pathogenesis of pathological angiogenesis is formed. Further study of the preclinical phase will radically revise the strategy and tactics of diagnosis and treatment of RP. Key words: retinopathy of prematurity, first preclinical angiospastic ROP phase, active ROP phase, scarring ROP phase, autoregulation of retinal vessels, hypoxic and hypercapnic drives.

Discordant ROP (Retinopathy of prematurity) development in twins less than 32 weeks of gestational age.

Background and aim:Retinopathy of prematurity (ROP), is a vasoprolipherative disorder of the immature retina and a major cause of preventable blindness in childhood. Although the development of ROP is multifactorial, the principal reasons are lower gestational age and lower birth weight. However, in twins their gestational ages were the same, ROP development can be discordant. This study aims to evaluate the etiologic factors of discordant ROP development in twins.Methods:We reviewed the last 5 years' records and found the twins whose discordant ROP development. This discordance was; 1. Different stages of ROP, 2. One sibling treated the other is not, 3. One sibling has aggressive posterior ROP the other is not, 4. One sibling has more influenced area as zones the other is not. We documented some data of these twins, as birth order, birth weight, resuscitation at birth, morbidities, the number of hemotransfusion, age of regaining birth weight, relative weight gain at 28 weeks.Results:We evaluated a total of 26 cases of 13 twins. The mean gestational age and birth weight of the entire study group were 27.7 ± 2, and 1053 ± 364 grams, respectively. We found that more transfused preterm baby in twins is more likely to show severe ROP. Sepsis and the duration of mechanical ventilation may be risk factors for more severe ROP in twins.Conclusion:We can reduce discordant retinopathy in less than 32-weeks premature twins by using methods such as cord milking and by improving non-invasive ventilation modalities. (www.actabiomedica.it)

Clinical Study on Pathogenic Factors and Screening Strategies of Retinopathy of Prematurity

Objective: To investigate the incidence of retinopathy of prematurity (ROP), analyze the risk factors of ROP, and put forward effective screening strategies, to reduce its incidence. Background: Retinopathy of prematurity (ROP) is an eye disease that can happen in new born premature (born early) babies or have weigh less than 3 pounds at birth. ROP happens when abnormal blood vessels grow in the retina. There are multiple risk factors, which are causing the ROP. In our study we will analyses the risk factors of ROP. Methods: From February 2016 to August 2021, 190 premature infants in the neonatal intensive care unit (NICU) who received inpatient care and ophthalmic screening was selected as study subjects. ROP group (n = 32) and non-ROP group (n = 158) were selected, and the clinical data of the two groups were compared. Including oxygen concentration, mechanical ventilation, broncho pulmonic dysplasia, delivery mode (cesarean section, vaginal delivery), blood transfusion, anemia, gestational diabetes, gestational hypertension, fetal distress, preterm birth weight, gestation age, etc. Women were divided into two groups according to whether they had gestational diabetes mellitus (GDM) or not: gestational diabetic (n = 38) and non-gestational diabetics (n = 152). Age, pregnancy times, birth times, oxygen inhalation, birth weight, and gestational age were compared between the two groups. The X2 test for counting data and the t-test for measuring data are then conducted according to the distribution characteristics of the data, The correlation analysis between ROP and a single risk factor was performed by chi-square test, and the analysis of the correlation between many risk factors and ROP was conducted by Logistic regression analysis. Results: 1) The incidence of ROP in the GDM group was higher than that in the non-GDM group (P P > 0.05). 3) Univariate analysis showed that oxygen use, birth weight, gestational age, bronchopulmonary dysplasia, pregnancy-induced hypertension, and fetal distress in the ROP group and non-ROP group were statistically significant (P P > 0.05). 4) Logistic multivariate analysis showed that oxygen use, gestational hypertension, diabetes mellitus during pregnancy, fetal distress, bronchopulmonary dysplasia, birth weight, and gestational age were the main risk factors for ROP. Conclusion: 1) Gestational diabetes mellitus is a high-risk factor for ROP. 2) Oxygen inhalation, birth weight, and gestational age are related to the occurrence and development of ROP. 3) In determining the initial screening time for ROP.

Course and outcome of retinopathy of prematurity in babies of multiple pregnancies

Purpose The aim of this study was to evaluate the course and outcome of retinopathy of prematurity (ROP) in babies of multiple pregnancies (twin and triplet neonates).Patients and methods This is a retrospective study in which we reviewed the records of 128 babies (all twin and triplet neonates), who were admitted to the biggest neonatal ICU in El Mahalla El-Kubra City, Gharbeya province, Egypt over the period between January 1, 2019 and July 1, 2021. The clinical information about perinatal neonates was collected. The main outcome measures were incidence, course, and final outcome of ROP in terms of regression (spontaneous or after treatment) or progression. The relationship of the clinical risk factors and the development of ROP were also analyzed.Results The overall incidence of ROP in twins and triplets was 36%, which was statistically higher in triplets (24/36=66.6%) than in twins (22/92=24%) (P<0.001). The overall incidence of type 1 ROP was 28%. In 30 pairs of twins (30/46=65%), the course was symmetrical in both babies, while in 16 (35%) pairs, the course and outcome were asymmetrical. In six triplets (6/12=50%) the course was symmetrical, while in the other six (50%) triplets the course was asymmetrical.Conclusion ROP can take asymmetrical course in twins and triplets. Even it can happen only in the heavier baby. Therefore, examination of both babies of twins and all babies of triplets is essential in ROP protocols.

Risk Factors for Retinopathy of Prematurity with Specific Emphasis on Postnatal Weight Gain: An Observational Study

Introduction: Retinopathy Of Prematurity (ROP) is a vasoproliferative disorder that affects premature infants with multiple risk factors. Timely screening and treatment can help decrease this preventable cause of blindness. Aim: To assess the risk factors for development of ROP, and to study its association with postnatal weight gain. Materials and Methods: This was an observational study with both prospective and retrospective arms. In the retrospective component, the case files and ROP screening records of the infants were screened, in the duration of July 2019 to February 2020. The prospective data was collected from the ongoing screening sessions, during March 2020 to November 2020. The risk factors for ROP, and postnatal weight gain was observed during the ROP screening programme conducted at the intramural Neonatal Intensive Care Unit (NICU) of Sir Sayajirao Hospital, Vadodara, Gujarat, India. Infants with Birth Weight (BW) &lt;2000 g and Gestational Age (GA) &lt;34 weeks and those with high risk factors {prolonged oxygen exposure, mechanical ventilation, anaemia requiring blood transfusion, Intraventricular Haemorrhage (IVH), Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), recurrent apnea, hypotension requiring inotropes, surgery during first week of life, sepsis and hypoglycaemia} were included in the study. Subjects were followed-up till 44 weeks Post-Menstrual Age (PMA), or till complete vascularisation of retina or regression of ROP on retinal examination whichever was earlier. Risk factors were studied using univariate analysis and multivariate regression. Weight gain was studied using independent sample t-test. Results: A total of 486 neonates were enrolled, who underwent serial ophthalmological examinations. Out of these, 375 infants (198 (52.8%) male and 177 (42.7%) females) underwent examinations until 44 weeks of PMA or till complete retinal vascularisation, or till complete regression of ROP with or without treatment. Out of these, 173 patients had no ROP, 120 patients developed ROP which got spontaneously regressed over time and 82 patients developed severe ROP which required treatment. Mean Gestational Age (GA) in the study population was 34.35 week (±2.64 wk), and mean Birth Weight (BW) was 1.67 kg (±0.45 kg). In the group of severe ROP, mean GA was 32.03 week (±1.33 wk) and mean BW was 1.33 kg (±0.35 kg); and the mean number of positive risk factors were 5.93 (±1.77). Poor postnatal weight gain was associated with more risk of severe ROP. GA &lt;34 week (p-value &lt;0.0001), BW &lt;1750 g (p-value &lt;0.0001), oxygen exposure (p-value &lt;0.0001), IVH (p-value &lt;0.0001), RDS (p-value=0.0111), BPD (p-value=0.0058), hypotension requiring inotropes (p-value=0.0001) and sepsis (p-value &lt;0.0001) were significant risk factors. On multivariate logistic regression, BW &lt;1750 g, GA &lt;34 week, sepsis and hypotension requiring inotropes were most important risk factors for ROP, along with poor postnatal weight gain. Conclusion: Poor postnatal weight gain is associated with increased risk of severe ROP.

Comparison of Clinical Outcomes of Intravitreal Bevacizumab and Aflibercept in Type 1 Prethreshold Retinopathy of Prematurity in Posterior Zone II.

Purpose:To evaluate the efficacy and safety of intravitreal injection (IVI) of bevacizumab (IVB) versus aflibercept (IVA) in premature infants with type 1 prethreshold retinopathy of prematurity (ROP) in the posterior Zone II.Methods:The study was a multicenter, historical cohort of premature newborns diagnosed with type 1 prethreshold ROP in the posterior Zone II, treated with IVB or IVA. Demographic features, complications, and treatment outcomes were then compared between the two groups.Results:Seventy-six patients received aflibercept (the IVA group), and 210 received bevacizumab (the IVB group). The two groups were not significantly different in terms of postmenstrual age (PMA) at the time of ROP diagnosis and other known risk factors for ROP development and progression. All eyes in both the groups responded to IVI; however, recurrence was observed in four eyes (1.9%) in the IVB group and 12 (15.8%) in the IVA group (P = 0.001). Recurrence occurred 9.1 ± 0.83 (5–12) and 15.5 ± 0.98 (12–18) weeks after primary treatment in the IVB and IVA groups, respectively (P = 0.000). In the IVA group, retinal vascularization was completed in 38.18 ± 6.5 weeks (21–48) after IVI, and it happened in 23.86 ± 9.3 weeks (13–60) in the IVB group (P = 0.009). Furthermore, vascularization reached the peripheral retina in 73.25 ± 6.5 (56–84) and 58.75 ± 8.8 (45–93) weeks, PMA in the IVA and IVB groups, respectively (P = 0.03). No acute postoperative complications were observed in the treated eyes in either group.Conclusion:This study shows that both IVA and IVB are effective and well tolerated for the management of type 1 prethreshold ROP in the posterior Zone II; however, IVA needs a significantly longer time for vascularization completion and has a higher recurrence rate compared with IVB.

Epidemiology and treatment of retinopathy of prematurity. The Hannover data in the Retina.net ROP registry from 2001-2017

HintergrundDas Retina.net ROP-Register erhebt Daten von Kindern, die eine seltene behandlungsbedürftige Frühgeborenenretinopathie (Retinopathy of Prematurity, ROP) entwickeln. Ziel dieser Auswertung ist die Untersuchung der Daten zur behandlungsbedürftigen ROP, Epidemiologie, Therapie und deren Änderungen über einen Zeitraum von 15 Jahren an der Medizinischen Hochschule Hannover.MethodenAnalyse der Daten der therapiebedürftigen Fälle der ROP eines Zentrums für die Geburtsjahre 2001 bis 2016 (Therapie in 2002 bis 2017) als Gesamtzeitraum und in 5 Abschnitten.ErgebnisseEs wurden 65 Kinder behandelt (23 weiblich), davon wurden 11 (16,9 %) extern auf ROP gescreent und zur ROP-Behandlung zugewiesen. Für den Zeitraum 2006 bis 2016 lag die Inzidenz der behandlungsbedürftigen ROP unter den gescreenten Kindern bei 4,1 %. Das mittlere Gestationsalter betrug 25,7 Schwangerschaftswochen (SSW) (Standardabweichung [SA] = 1,8), das Geburtsgewicht 763 g (SA = 235), das postmenstruelle Alter bei Behandlung 38,2 Wochen (SA = 3,2), das postnatale Alter 12,4 Wochen (SA = 3,2). Über die Zeit zeigte sich kein signifikanter Unterschied der demografischen Parameter. Am häufigsten (57 Augen bei 31 Kindern) wurde eine Zone II, 3+-Erkrankung behandelt; 58 Kinder erhielten eine Laserkoagulation (N = 114 Augen), 7 Kinder bilateral eine Anti-VEGF-Therapie (Bevacizumab) (N = 14 Augen), welche ab 2014 eingesetzt wurde. Eine Wiederbehandlung bei Wiederaufflammen der behandlungsbedürftigen ROP war in einem Fall nach initialer Laserbehandlung notwendig. Kinder mit behandlungsbedürftiger ROP zeigten häufig neonatologische Komorbiditäten, in mehr als 90 % Beatmung, bronchopulmonale Dysplasie und erhielten Transfusionen.SchlussfolgerungDies ist die erste monozentrische Auswertung über 15 Jahre im Rahmen des Retina.net ROP-Registers. Ab 2014 sehen wir einen Wechsel von der Laserkoagulation zur Anti-VEGF-Therapie (Bevacizumab), während im betrachteten Kollektiv die demografischen Daten und Behandlungsparameter weitgehend konstant waren.