Forms Of Retinopathy Of Prematurity Research Articles

Оптимизация ранней диагностики развития и прогрессирования ретинопатии недоношенных

Purpose. To develop easy-to-use methods for early diagnosis of the development and progression of retinopathy of prematurity (ROP). Мaterial and methods. The extracellular peroxidase activity (EPA) of blood serum was studied by spectrophotometry in 93 premature newborns aged 3–4 weeks of life and the thickness of the retinal neuroepithelium (NES) of the paramacular zone by measuring it at a distance of 500 μm from the border of the foveola in 82 premature infants (162 eyes ) using optical coherence tomography (OCT) of the retina on the RetinaScan — 3000 device (NIDEK) in the Macula Multi Cross mode. Results. Determination in premature newborns at 3–4 weeks of life of the level of blood serum VPA less than 1887.1 c.u. allows predicting the development of ROP in 76.4 % of cases. At the same time, there is an inverse correlation (R = –0.94; p < 0.05) between the value of the VPA and the pathology of the upper respiratory tract (respiratory distress syndrome, respiratory failure, asphyxia). The study of the thickness of the paramacular zone of NES showed an increase in its values, regardless of the stage and form of ROP. At the same time, the average thickness index was higher by 39.0 μm in infants with ADHD compared with stage I of the classical form, by 39.3 μm — by stage II, by 35.8 μm — by stage III (p < 0.05). Stabilization of the pathological process was accompanied by a decrease in the NES thickness index (p < 0.05). Conclusion. Examination of the values of extracellular peroxidase activity in the blood serum at 3–4 weeks of life of a premature newborn, as well as monitoring the thickness of the retinal neuroepithelium in the paramacular zone, allow timely diagnosis of retinopathy of prematurity. Keywords: retinopathy of prematurity, diagnostics, extracellular peroxidase activity, retinal neuroepithelial thickness

New trends in intravitreal anti-VEGF therapy for ROP.

Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.

Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10.

To evaluate the effectiveness and future implications of COVID-related risk stratification for managing retinopathy of prematurity (ROP). A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low-risk babies developed in conjunction with the Indian ROP Society for care during the COVID-19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain. New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty-seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low-risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up. New risk stratification during the COVID-19 pandemic was an efficient and safe strategy in managing low-risk ROP babies.

Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt

BackgroundThe third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking.MethodsRetrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions.ResultsOf the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30–34) weeks, and the median (IQR) BW was 1600 (1350–2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample.ConclusionThe incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.

Perspective noi asupra retinopatiei de prematuritate

Retinopathy of prematurity (ROP) is a comorbidity associated with premature birth, with an incidence that varies depending on gestational age, treatment applied in neonatal intensive care unit and risk factors related to each newborn. Retinopathy has been studied since the use of free-flowing oxygen in the incubator when this condition was first mentioned. Studies published over time have tried to identify the optimal levels for oxygenation in favor of ROP prevention but without affecting survival, a topic that is still widely debated today. Gradually, various risk factors were identified regarding the occurrence of severe forms of ROP. Screening for retinopathy prematurity has been identified as one of the most effective measures to prevent blindness in former premature infants. The correct identification of the categories of newborns that should benefit from this dynamic follow-up fully contributes to limiting the cases of retinal detachment. The ongoing study of risk factors and their inclusion in studies to verify the correlation with the incidence of ROP has the potential to improve outcomes in the fight against ROP in preterm infants.

Тактика и результаты лечения при увеальных осложнениях лазеркоагуляции при ретинопатии недоношенных

A pronounced inflammatory process from the anterior and posterior parts of the eye may occur, as a complications after laser coagulation in retinopathy of prematurity (ROP), in which there is a need for surgical treatment. Purpose. To determine the optimal tactics for the treatment of uveal complications of laser coagulation in ROP. Material and methods. For 2014-2020 we examined and performed surgical intervention in 21 children with uveal complications after laser coagulation (27 eyes), Most of the children were deeply premature (born at 24-26 weeks of gestation) with a birth weight of 500 g to 900 g with concomitant pathology from the central nervous system. Сomplicated cataracts developed for all children. All children underwent surgical treatment: reconstruction of the anterior chamber, microinvasive cataract extraction, vitrectomy (if necessary, schvartectomy). A single surgical intervention was performed on 24 eyes. In 3 eyes with a post-aggressive form of ROP and a history of sepsis, reoperative treatment was required. All children had no primary IOL implantation. IOL implantation was performed in one childe at an older age. Results. As a result of the treatment, in 89% of cases (24 eyes), there was a complete relief of the inflammatory process and restoration of the transparency of the media after a single surgical intervention. In childe who underwent secondary IOL implantation in the long term, there was a complicated course of early postoperative period and repeated reconstructive surgery required. Conclusions. Uveal complications after laser coagulation of the retina for ROP are observed mainly in children born in early gestation (24-26 weeks) with low birth weight (less than 1000 g). When carrying out the surgical treatment of uveal complications - cataract extraction, which has developed as a result of laser coagulation for ROP, vitrectomy is mandatory, and, if necessary, schwartectomy. When deciding on the secondary implantation of IOLs, it is necessary to take into account the high probability of an unfavorable course of the postoperative period in children with previous uveitis after laser treatment for retinopathy and prematurity. Key words: retinopathy of prematurity, uveal complications, cataract.

Evaluation of refractive errors in retinopathy of prematurity screening.

Aim To evaluate the frequency of refractive errors in premature children in retinopathy of prematurity (ROP) screening to find mutual connection of the prematurity level, disease activity and refractive errors. Methods A retrospective study was conducted in the Eye Clinic of the University Clinical Centre Sarajevo, between December 2013 and January 2017. A total of 126 patients of gestational age ≤ 34 weeks and birth weight ≤ 2000 g underwent ROP screening program. The patients were divided into three groups: patients without ROP (n=15), patients with spontaneous regression (n=106) and those with active form of ROP (n=5). Results There were 68 (54.0%) patients with refractive errors: 45 (35.7%) had hyperopia, 17 (13.5%) myopia and six (4.8%) astigmatism. There were three (60.0%) patients with an active form of ROP who had refractive errors: two (40.0%) had myopia and one (20.0%) hyperopia. The group without active ROP had hyperopia as most frequent refractive error, with 10 (66.7%) patients. The average birth weight of the patients without refractive errors was 1403.9±43.4 g compared to 1390.3±104.2 g of the patients with refractive errors (p=0.498). The average gestational age was 29.7±0.3 weeks in patients without and 29.0 ± 0.3 weeks in patients with refractive errors (p=0.126). Conclusion The birth weight and the gestational age were significantly lower in patients with the active form of ROP. Lower gestational age and birth weight of premature children increase the chance for the development of refractive errors such as hyperopia in all premature children and myopia in patients with active form of ROP.

SOME OF THE RISK FACTORS FOR RETINOPATHY OF PREMATURITY

Retinopathy of prematurity (ROP) remains the main cause of visual impairment in preterm infants. The study was aimed to assess the impact of some of the risk factors (gestational age, body weight of children at birth, associated diseases in children, maternal age at delivery, maternal smoking during pregnancy, multiple pregnancies) on the occurrence of ROP in the sample of premature infants. We statistically processed the results (Student’s t test and the χ test) of 93 preterm infants of both sexes: 39 boys and 54 girls, examined by indirect ophthalmoscope (Haine 500, Germany) in mydriasis. The examination included all premature neonates with birth weight ≤ 2000g and/or gestational age ≤37 weeks, as well as neonates >37 weeks which have associated risk factors (oxygen, ventilation, sepsis, etc). Among 93 premature infants, with normal findings on the retina there were 72 children (77.42%), while in 21 (22.58%) children we found ROP. Ophthalmological findings: the first stage of ROP was found in 15.05%, the second stage of ROP in 2.15% and third stage of ROP in 5.38% of the examined children. There were no patients with an aggressive form of ROP. Children with ROP were statistically of lower gestational age 32.10 ± 2.70 compared to children without ROP 35.37 ± 1.72 (p<0.001). Children with ROP had at birth significant lower body weight of 1741g ± 579.19 than children without ROP 2168.75 ± 528.58 (p<0.01). Mothers of the children with ROP were, at the time of giving birth, over 29 ± 6.09 years old compared to mothers of children without ROP who were 26.42 ± 5.75 years old (p=0.0773). The presence of other diseases was significantly more prevalent in children with ROP 52.38% vs. 2.78% (p<0.001). The number of mothers of children with ROP who smoked during their pregnacy was considerable 57.14 % vs. 37.50% (percent of non-smoking mothers), though the difference was not statistically significant. Knowing the risk factors and their mechanisms of action requires a comprehensive approach to the complex problem of preventing prematurity, ROP, and appropriate ROP treatment. Acta Medica Medianae 2014;53(3):5-10.

Screening for retinopathy of prematurity in South of Iran

Purpose:The purpose of this study is to report the screening data for retinopathy of prematurity (ROP) at a screening center in Southern Iran.Materials and Methods:A chart review was performed of all screened neonates who were referred to Poostchi screening center affiliated to Shiraz University of Medical Sciences from February 2006 to January 2010. Statistical analysis of data was performed with the Chi-square and independent t-test where appropriate. A P < 0.05 was considered statistically significant.Results:Of 787 infants referred, 293 (37.2%) had some form of ROP and 77 cases (9.8%) had plus disease, only 6 (2%) patients progressed to advanced ROP stages 4 and 5. The mean gestational age (GA) of patients with ROP (ROP group) was statistically significantly lower at 29.46 ± 2.31 weeks compared to patients without ROP (non-ROP group) (31.56 ± 2.03 weeks) (P < 0.05). The mean GA of patients with plus disease was statistically significantly lower at 28.92 ± 2.18 weeks compared to patients without plus disease (30.98 ± 2.30 weeks) (P < 0.05). The mean birth weight in the ROP group was statistically significantly lower at 1248.46 ± 301.75 g compared to the non-ROP group (1485.79 ± 268.66 g) (P < 0.05). The mean birth weight of patients with plus disease was statistically significantly lower at 1207.92 ± 334.79 g compared to patients without plus disease (417.99 ± 293.19 g) (P < 0.05). There was no difference in the occurrence of ROP or plus disease between single or multiple births, normal vaginal delivery, and caesarian section and between clomiphene users and nonusers (P > 0.05, all cases).Conclusion:Greater cooperation between ophthalmologists, neonatologists, gynecologists, and health policy makers is necessary to optimize ROP screening programs. Data from this study can be used by health policy makers for implementation of health programs. These programs must include screening guidelines and effective coordination among the screening centers, antenatal, obstetric, and neonatal care services.

Biomarkers of oxidative stress in babies at high risk for retinopathy of prematurity

Oxygen-induced oxidative stress (OS) has damaging effects in the perinatal period. For now there is a lake of evidence that OS occurs in babies with retinopathy of prematurity (ROP) We tests the hypothesis that a strict oxygen policy may minimize postnatal OS reducing severity of ROP. Multicenter prospective cohort study (72 newborns), using a common clinical management protocol with a strict control of oxygen administration. Assessment of biochemical markers of OS in blood samples at birth and on days 7, 14, and 21. Sixteen babies (22.2 per cent) developed ROP stage 1-2. No severe form of ROP was observed. Birth weight and O2 administration in delivery room were the factors significantly associated with the development of ROP stage 1-2. Prematurity and O2 administration in delivery room are the main factors coming into play in the course of ROP. Because room air is richer in oxygen than intrauterine environment, higher OS can be minimized, as well as incidence and severity of ROP, using standardized management with a restricted oxygen breathing policy.