Prethreshold Retinopathy Of Prematurity Research Articles

Comparative analysis of risk factors for retinopathy of prematurity in single and multiple birth neonates

AimTo conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates.MethodsIn a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births.Results The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001).ConclusionMultiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.

Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety.

This study aimed to ascertain the efficacy and safety of an additional posterior to the ridge laser for treatable zone 2 stage 3 retinopathy of prematurity (ROP). This study was a retrospective chart review of infants undergoing laser treatment for ROP at a single center from March 2014 to March 2022. The chart review specifically searched for infants treated for zone 2 stage 3 ROP with plus disease, where additional posterior to the ridge laser was performed. Seventy-eight eyes of 45 infants met the inclusion criterion. The mean birth weight and gestational age were 1166.09 ± 329.66 gm and 29 ± 2 weeks, respectively. Group 1 comprised 52 eyes treated for high-risk prethreshold stage 3 ROP, while group 2 comprised 26 eyes treated for threshold ROP. 532-nm frequency-doubled Nd:YAG laser (Nidek, Japan) was used in all eyes. Apart from the standard laser to the avascular retina, an additional three rows of laser were applied posterior to the ridge in all eyes during the primary laser sitting (except in two eyes where it was performed as a rescue treatment 2 weeks after the first sitting). No complications were observed during or immediately after the laser procedure. A favorable outcome was achieved in 98.07% of eyes with prethreshold ROP and 76.92% of eyes with threshold ROP. Overall, a favorable outcome was achieved in 71 (91.02%) of the 78 eyes. Posterior to the ridge laser performed in the primary sitting along with the standard laser for treatable stage 3 ROP in zone 2 is safe and effective. Further prospective studies are needed to study this underutilized approach.

Refractive Changes among Diode Laser-treated Retinopathy of Prematurity Patients: A Retrospective Study.

The purpose of this study was to assess the refractive outcomes of patients who underwent indirect laser photocoagulation for prethreshold type 1 retinopathy of prematurity (ROP) and high-risk type 2 prethreshold ROP in comparison to conservatively managed low-risk prethreshold type 2 ROP. A retrospective analysis was carried out on infants screened for ROP between the years 2015 and 2020. Surviving children who had developed ROP in one or both eyes and received diode laser photocoagulation and those with conservatively managed regressed type 2 ROP who underwent at least one cycloplegic retinoscopy were included in the study. A total of 144 patients were screened for ROP between 2015 and 2020 at our institution. One hundred and thirty patients (260 eyes) fulfilled the study criteria and were included in this study. The treated group consisted of 132 eyes of 66 infants, of which 38 (14.6%) eyes had prethreshold type 1 ROP while 94 (36.2%) eyes had high-risk prethreshold type 2. The nontreated control group consisted of 128 (49.2%) eyes of 64 infants with low-risk type 2 prethreshold ROP. Earlier prematurity was found to be a significant determinant of the mean change in spherical equivalent among different gestational age groups (P = 0.035). In our cohort, we found that myopia is significantly related to Zone II ROP in comparison to Zone III ROP in the treated eyes (22% vs. 9%) (P = 0.002). No statistically significant difference was found in the final refraction among the treated eyes in relation to the birth weight or stage of prematurity. In the present study, the majority of patients who were treated with diode laser for ROP had favorable anatomical and refractive outcomes. In contrast to previous studies that had suggested a trend toward myopia in laser-treated patients, in our study, the majority (71%) were hyperopes. This study suggests that other factors such as the stage and zone of ROP possibly contribute more to the development of myopia than the laser photocoagulation itself.

Outcomes of near confluent laser versus combined less dense laser and bevacizumab treatment of prethreshold ROP Type 1 Zone 2: a randomized controlled trial

BackgroundTo evaluate the results of near confluent laser therapy versus combined less dense laser and intra vitreal bevacizumab in treatment of infants with type 1 retinopathy of prematurity (ROP) in zone II.MethodsThis is a prospective double-blinded randomized clinical trial study. Infants with Type 1 ROP in Zone 2 were randomized into case and control groups. Conventional laser therapy was executed for control group and combination of IVB and laser treatment was employed for the case group.ResultsEighty-six eyes from 43 infants were analyzed in this trial. The first group included 42 eyes from 21 infants receiving a combination of laser ablation and IVB. The second group contained 44 eyes from 22 infants who received only conventional laser therapy. The combined IVB and laser ablation group demonstrated the neovascularization regression (20 out of 21 infants) one week after the procedure. In the conventional laser therapy group, this regression was found in (12 out of 22 infants) within one week after laser therapy (P = 0.001). Plus disease regression was observed in 20 (20/21) of combined treatment group and 7 infants (7/22) of conventional laser treatment group after one week.ConclusionCombined less dense laser and bevacizumab treatment resulted in more rapid regression in comparison with the conventional laser treatment.Trial registrationIRCT20201120049450N1, 27/12/2021.

The Relationship between the Aqueous VEGF Level and the Severity of Type 1 Retinopathy of Prematurity.

Purpose: To analyze the relationship between the severity of type 1 retinopathy of prematurity (ROP) and the level of vascular endothelial growth factor (VEGF) in aqueous fluid. Methods: The aqueous VEGF levels of 49 patients (88 eyes) with type 1 ROP were retrospectively analyzed. These eyes were categorized into three groups according to the severity of disease: aggressive retinopathy of prematurity (A-ROP), threshold of ROP (T-ROP), and type 1 pre-threshold ROP (P-T-1). The differences in aqueous VEGF levels among these three groups were compared. The relationship between the aqueous VEGF level and the retinal changes of ROP, including the vessel tortuosity in zone I, and the location and stage of the ROP lesions, were also analyzed. Results: The aqueous VEGF level of the A-ROP group was the highest among the three groups, followed by those of the T-ROP and P-T-1 groups. The aqueous VEGF level was negatively correlated with the zone and the stage of the ROP diseases, while it was positively correlated with the venous tortuosity in zone I and had no relevance with the artery tortuosity in zone I. Conclusions: The aqueous VEGF level in A-ROP was the highest in type I ROP. The location of the ROP lesions and the venous tortuosity in zone I correlated with the aqueous VEGF level and could indicate the severity of ROP.

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.

Vision-related Quality of Life in Malaysian Children with Threshold and Prethreshold Retinopathy of Prematurity.

PurposeThe prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and prethreshold ROP on VRQoL in Malaysian children.MethodsMulticenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than 7 years old with previous ROP diagnosis were recruited. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent or guardian completed the Children’s Visual Function Questionnaire (CVFQ) for the assessment of child’s general health, general vision, competence, personality, family impact, and treatment difficulty.ResultsEight were categorized with threshold ROP, 16 with high-risk prethreshold ROP, and 26 with low-risk prethreshold ROP. Fifty age-matched controls were also included. Mean visual acuity in logarithm of the minimum angle of resolution was 0.46 in the threshold, 0.08 in high-risk prethreshold, and 0.01 in low-risk prethreshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to prethreshold ROP. Mean total CVFQ score was significantly lower in the ROP group (p < 0.001) compared to the control group. Mean score and all mean subscale scores were significantly lower in the threshold subgroup compared to high-risk and low-risk prethreshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye, family income, and VRQoL (p < 0.05).ConclusionsROP was associated with lower VRQoL in children born prematurely in Malaysia. The threshold ROP group is the most affected. General vision and health domains are their main difficulties encountered. Gestational age, visual acuity of the better eye, and family income affects the VRQoL.

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.

The retinal vascular growth rate in babies with retinopathy of prematurity could indicate treatment need.

Purpose:To analyze the weekly rate of retinal vascular growth in treatment-naïve babies with various stages of retinopathy of prematurity (ROP) and validate if this could be a predictor of treatment need.Methods:Retrospective review of medical charts and retinal images of babies with various stages of ROP. The images were enhanced using red-green image enhancement software. Using the length of the horizontal disc diameter (DD) of each eye, the vessel growth was measured from the disc margin up to the vessel tip in fixed quadrants. The rate of vessel growth was the ratio of vessel length to the number of weeks it took to reach this length. The babies were divided into treatment warranting ROP (group 1), low-risk pre-threshold (type II) ROP (group 2,), and no-ROP (group 3) for analysis. The “no-ROP” group acted as normal control. Group 1 was further subdivided into 1A (threshold ROP), IB (aggressive posterior ROP), 1C (hybrid ROP), and ID (high-risk pre-threshold ROP).Results:Out of 436 eyes, groups 1, 2, and 3 had 238, 108, and 90 eyes, respectively. The mean rate of vascular outgrowth along with 95% confidence interval (CI) was 0.490 [0.487,0.520], 0.612 [0.599, 0.638], and 0.719 [0.703, 0.740] DD/week, respectively, for babies with “treatment warranting,” “low risk pre-threshold” and “no ROP” groups, respectively. In our estimate, more than 80% of eyes with a vessel growth rate of 0.54 DD/week or less required treatmentConclusion:A rate of retinal vascular growth less than 0.54 DD/week can be used to determine treatment requirements in babies with ROP.

Clinical profile on incidence and course of Retinopathy of Prematurity in a tertiary care hospital of Northern India

Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disorder of retina of preterm infants. It remains the leading cause of childhood blindness worldwide. Aggressive posterior retinopathy of prematurity (APROP) is rapidly progressive severe form of ROP.&#x0D; Aims and Objectives: The present study was done to assess incidence and evaluate course of ROP in preterm babies born before 34 weeks and birth weight &lt;1750 grams.&#x0D; Material and Methods: The current study was a two year prospective observational study. Screening of all neonates born with gestational age ≤34 weeks and birth weight &lt;1750 grams was done for ROP at 4 weeks of their postnatal age by indirect ophthalmoscopy and followed up till vascularization was complete. All neonates identified with APROP and ROP with plus disease was treated with double-frequency Nd YAG laser.&#x0D; Results: Of 318 neonates screened, 34.9% neonates (111) were observed to have ROP. 2.5% (8/318) neonates diagnosed with APROP and 4.4% neonates (14/318) having ROP with plus disease including pre-threshold and threshold ROP were treated with double frequency Nd Yag laser. All 14 treatment requiring ROP babies and 6 APROP babies showed total regression while one neonate with APROP succumbed to septicaemia during follow up and one APROP baby had to be referred to higher centre after he developed partial retinal detachment (RD) (Stage 4a).&#x0D; Conclusion: 34.9% had ROP, only 6.28% needed intervention. Laser monotherapy even when administered early has lesser favorable structural and functional outcome in APROP as compared to classical ROP.

Does the number of laser applications for ROP treatment influence the degree of myopia?

To evaluate the relationship between the number of laser shots applied during laser photocoagulation treatment and the degree of myopia at 3 years in children with laser-treated retinopathy of prematurity (ROP). A total of 68 eyes of 34 infants who had developed prethreshold ROP and were treated by diode laser therapy were included in the current study. Cycloplegic retinoscopic refraction testing was performed in the children at the age of 3 years, and the spherical equivalent (SE) was calculated for all the examined eyes. The number of laser shots that had been applied was compared between the eyes with and without high myopia (SE < - 5 diopters (D)). In addition, the relationship between the difference in the SE values between the two eyes in each infant and the difference in the number of laser shots applied between the two eyes was also analyzed. The number of laser shots applied was significantly higher for the eyes with high myopia than for those without high myopia (p = 0.0088), and the number of laser shots applied was significantly positively correlated with the degree of myopia (p < 0.001). A significant correlation was also observed between the differences in the SE values between the two eyes and the differences in the number of laser shots applied between the two eyes (p = 0.0013). The number of laser shots applied in photocoagulation treatment for ROP is significantly associated with the degree of myopia seen subsequently in the children.

Macular Morphology in Patients with Retinopathy of Prematurity

Purpose: To investigate macular morphology by spectral domain optical coherence tomography (SDOCT) in children with history of the retinopathy of prematurity (ROP). Materials and methods: In this cross-sectional study we included 35 eyes of 18 patients, aged 4 to 8 years, with history of ROP. Twenty-one eyes had received treatment for type 1 pre-threshold ROP. The others showed spontaneous regression of the disease. A 7 × 7-mm retinal area was sampled using a 3-dimensional scanning protocol with high-resolution spectral domain optical coherence tomography (SOCT Copernicus REVO). The central foveal thickness, mean macular thickness, macular volume and foveal depression were measured. The macular anatomy and the foveal contour were examined. Results: The mean birth weight was 1338.29 ± 324.05 grams. Mean gestational age at birth was 29.37 ± 2.07 weeks. Twenty-one eyes were treated with laser or cryotherapy. All of them showed regression of the disease. The mean best corrected visual acuity was 20/28. The average central foveal thickness was 262.26 ± 37.39, with 68.57% of preterm > 240 μm and 22.86% > 220 μm. In all eyes, the foveal contour is abnormal. A foveal depression was absent in 25 eyes (71%). Conclusion: In the majority of children with a history of ROP, we found changes in macular morphology, including retention of inner retinal layers and absent foveal depression. In our study foveal hypoplasia was associated with good functional outcome.

Placental CpG Methylation of Inflammation, Angiogenic, and Neurotrophic Genes and Retinopathy of Prematurity.

PurposeExtremely preterm infants are at increased risk for retinopathy of prematurity (ROP). We previously identified several inflammatory proteins that were expressed early in life and are associated with an increased risk of ROP and several angiogenic and neurotrophic growth factors in the neonatal systemic circulation that are associated with a lower risk of ROP. In this paper, we report the results of a set of analyses designed to test the hypothesis that placental CpG methylation levels of 12 inflammation-, angiogenic-, and neurotrophic-associated genes predict the occurrence of prethreshold ROP in extremely preterm newborns.MethodsWe used placental CpG methylation data from 395 newborns from the Extremely Low Gestational Age Newborns study.ResultsMultivariable regression models revealed that placental DNA methylation of 16 CpG sites representing 8 genes were associated with prethreshold ROP. Specifically, CpG methylation in the serum amyloid A SAA1 and SAA2, brain-derived neurotrophic factor (BDNF), myeloperoxidase (MPO), C-reactive protein (CRP), angiopoietin 1 (ANGPT1), and tumor necrosis factor receptor superfamily member 1B (TNFRSF1B) genes was associated with a lower risk of prethreshold ROP. Conversely, CpG methylation at three probes within tumor necrosis factor receptor superfamily member 1A (TNFRSF1A) and in two alternative probes within the BDNF and ANGPT1 genes was associated with an increased risk of ROP.ConclusionsCpG methylation may be a useful marker for improving ROP prediction, opening the opportunity for early intervention to lessen disease severity.

Refractive Status in Children with Laser-Treated Retinopathy of Prematurity: Our Experience in Bulgaria.

BACKGROUND:With the establishment of laser photocoagulation as a standard treatment modality for prethreshold retinopathy of prematurity (ROP), a dramatic reduction of cases with ROP blindness and severe visual impairment have been reported. In the same time, high refractive errors, a common complication in ROP cases and especially in ROP treated infants, have become the main cause of visual and often severe visual impairment.AIM:The purpose of our study was to analyse the long-term refractive status in children at 3.5 years after laser-treatment for type 1 prethreshold ROP.PATIENTS AND METHODS:A retrospective, one centre study of refractive status of 18 children with laser-treated type 1 prethreshold ROP was conducted. The refraction after cycloplegia with 1% cyclopentolate was measured at a mean age of 3.56 years (SD ± 0.34). Hyperopia was subdivided into two groups – low hyperopia (SE < +5.0 D) and high hyperopia (SE ≥ +5.0 D). Myopia was classified as myopia (SE ≥ –0.25D) and high myopia (SE ≥ -5.0 D). Astigmatism was divided into low astigmatism (plus CD ≥ +1.0 D) and high astigmatism (plus CD ≥ +2.0 D).RESULTS:Thirty-three eyes of 18 children were recruited in the study. Three eyes were excluded because of unfavourable anatomical results. The mean gestational age at birth was 27.3 weeks (24-31 weeks, SD ± 1.78), and the mean birth weight – 928.9 g (550-1500 g, SD ± 252.8). The mean spherical equivalent for the whole group was -1.82 D and ranged from -9.00 D to +4.50 D (SD ± 3.48). Hyperopia was observed in 12 (36.4%) eyes. Myopic refraction had 21 (63.6%) eyes. Astigmatism was detected in 18 (54.5%) eyes. Anisometropia had 3 (16.7%) children. Six children (33.4%) had strabismus (4 esotropia; 2 exotropia).CONCLUSION:High per cent of treated infants for vision-threatening ROP have visual significant refractive errors and strabismus that can cause serious visual impairment if not treated properly and on time.

One-year visual outcomes after laser for Type 1 prethreshold retinopathy of prematurity among very low birth weight neonates at a tertiary center in western India – A prospective cohort study

Objective: To evaluate the visual outcomes after laser treatment for retinopathy of prematurity (ROP) among very-low-birth-weight neonates at 1-year corrected age in population of western India.Methods: In this prospective cohort study, 35 neonates received laser treatment for type 1 prethreshold ROP. Structural and refractive status were assessed at 1-year corrected age in these neonates.Results: Total 32 neonates (64 eyes) were followed-up at the age of 1 year. The mean gestational age and birth weight were 27.6 weeks and 900 g, respectively. All 64 eyes reported favorable structural outcome. The mean refractive error was −1.82 D (range: −11 to +4 D). Prevalence of myopia was 62.5% [43.8% low myopia; 18.8% high myopia]. Eight eyes (12.5%) had insignificant hyperopia.Conclusion: We concluded that timely and adequate screening of eyes of preterm neonates followed by early and appropriate laser treatment improves the later visual outcomes. High refractive error is common and may be the cause of visual impairment.

Neonatal Intensive Care Unit-based screening program for retinopathy of prematurity and its treatment in an Indian population.

Purpose:The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP).Methods:A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity.Results:The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only.Conclusion:One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ≥1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.

Intravitreal aflibercept injection in Indian eyes with retinopathy of prematurity.

Purpose:To study the efficacy of intravitreal Aflibercept, an anti Vascular Endothelial Growth factor, (anti-VEGF) in Retinopathy of Prematurity (ROP).Methods:This was a retrospective, interventional consecutive case series of 46 Indian eyes which received intravitreal injection of Aflibercept for High risk Prethreshold ROP, Threshold ROP, and Aggressive-Posterior ROP (AP-ROP).Results:Aflibercept was effective in achieving the primary endpoint, namely regression of ROP following the injection in all 46 eyes (100%) at one week following the injection. 32.6% (15/46) of eyes achieved secondary endpoint namely complete vascularization, with no recurrence of ROP at varying time intervals: as early as 15 weeks to as late as 29 weeks after injection, at intervals ranging from 49 to 64 weeks PCA.Conclusion:Intravitreal Aflibercept was effective in inducing complete regression of all types of ROP in all the eyes in our series. In addition, 32.6% of cases did not need a secondary intervention, with no recurrence of ROP and complete vascularization of the retina. In 81.8% of Zone I ROP eyes, Aflibercept facilitated continuation of retinal vascular development following regression of ROP, resulting in less extensive laser during treatment of ROP recurrence. This is the largest series of Aflibercept in ROP, till date as per MEDLINE search.

Prethreshold retinopathy of prematurity: VEGF inhibition without VEGF inhibitors.

The risk of developing treatment-warranted Type 1 retinopathy of prematurity (ROP) might be reduced in preterm infants by modifying certain systemic factors. There are steps that can be taken both early and late in the course of retinal vascular maturation that may potentially reduce an infant's risk of developing Type 1 ROP. In prethreshold stage 2-3 ROP without plus disease, a combination of supplemental oxygen, correction of severe anemia, and light adaptation to reduce rod photoreceptor oxygen consumption helped us to reduce ROP severity, and encouraged a return to a more physiologic retinal vascular maturation pattern. Thus, it may be possible to reduce the risk of developing Type 1 ROP by making adjustments in certain systemic parameters aimed at reducing retinal hypoxia, thereby gently lowering pathologically elevated levels of vascular endothelial growth factor (VEGF) within the eye.

Aqueous cytokine levels associated with severity of type 1 retinopathy of prematurity and treatment response to ranibizumab.

To determine the aqueous humor levels of cytokines in eyes with type 1 retinopathy of prematurity (ROP) before primary intravitreal injection of ranibizumab (IVR). Forty-nine infants with type 1 ROP (56 eyes of 28 infants in the threshold ROP group and 42 eyes of 21 infants in the type 1 pre-threshold ROP group) received primary IVR and 49 aqueous humor samples were obtained preoperatively. Aqueous humor samples from 15 infants (15 eyes) undergoing congenital cataract surgery were used as controls. The concentrations of 27 cytokines were measured by a multiplex bead assay. Infants with persistent, recurrent, or progressive ROP after IVR were retreated. The preoperative aqueous levels of 16 cytokines were significantly different among type 1 pre-threshold, threshold ROP, and control groups (P < 0.05). The concentrations of vascular endothelial growth factor (VEGF) (P < 0.001), interferon-γ (P < 0.001), interleukin (IL)-10 (P < 0.001), and IL-12 (P < 0.001) were the highest in the threshold ROP group, less in the type 1 pre-threshold ROP group, and the lowest in the control group. Retreatment was given to 55% of infants with ROP within a 48-week follow-up period after primary IVR. Higher VEGF (hazard ratio [HR] = 1.001, P = 0.001) and macrophage inflammatory protein-1β (HR = 1.085, P = 0.022) levels were independently correlated with ROP retreatment. Higher aqueous levels of VEGF and inflammatory cytokines were associated with more severe type 1 ROP and ROP retreatment after primary IVR.

Incidence and risk factors for retinopathy of prematurity: a retrospective cohort study

Background and objectivesAdvances in neonatal care promoted increased survival rates of preterm infants, with a consequent increase in the number of children affected by retinopathy of prematurity (ROP). This study estimates the incidence of ROP and evaluates potential risk factors associated.MethodsA retrospective cohort study of preterm infants born in a tertiary neonatal intensive care unit was conducted from March 2005 to August 2015. Six hundred and thirty-nine newborns were included based on the following criteria: infants born with less than 32 weeks’ gestation or birth weight below 1500 g; or neonates born with 32–37 weeks’ gestation or birth weight above 1500 g and any of the following associated: multiple gestation, respiratory distress syndrome, sepsis, blood transfusions or intraventricular hemorrhage. Neonates were followed up until disease resolution or until treatment criteria was achieved.ResultsA total of 602 newborns were evaluated after applying the exclusion criteria. Mean gestational age was 30.7 ± 2.5 weeks. The incidences of ROP at any stage and of type 1 prethreshold ROP were 33.9 and 5.0% respectively. Logistic regression analysis revealed that risk factors associated with ROP at any stage were extremely low birth weight (ELBW) (odds ratio [OR] = 3.10; 95% confidence interval [95% CI]:1.73–5.55), pulmonary diseases (OR = 2.49; 95% CI: 1.35–4.59), intraventricular hemorrhage (OR = 2.17; 95% CI: 1.10–4.30), and low gestational age (OR = 0.81; 95% CI: 0.73–0.91). The main risk factors associated with type 1 prethreshold ROP were pulmonary diseases (OR = 9.58; 95% CI: 1.27–72.04) and ELBW (OR = 3.66; 95% CI: 1.67–8.00).ConclusionThis study found a significant incidence of ROP (33.9%) in the studied population, and highlighted pulmonary diseases as a significant risk factor for type 1 prethreshold ROP.