Retinopathy In Children Research Articles

Changes in Retinal Ganglion Cell (RGC) and Retinal Nerve Fiber Layer (RNFL) Thickness in Children with Type 1 Diabetes Mellitus at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Type 1 diabetes mellitus (DM) is a chronic metabolic disorder that causes hyperglycemia and increases the risk of morbidity and mortality. Diabetic retinopathy, a microvascular complication that often occurs in DM patients, can cause visual impairment and even blindness. Regular eye examinations are important for early detection of diabetic retinopathy. Optical coherence tomography (OCT) is a non-invasive method that can be used to measure the thickness of retinal layers, including RGC and RNFL. It is thought that thinning of the retinal layer can be a sensitive biomarker in detecting diabetic retinopathy in type 1 DM patients. This study aims to determine changes in RGC and RNFL thickness in children with type 1 DM. Methods: This cross-sectional design analytical observational study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital Padang in November 2023-March 2024. A total of 46 eyes from 46 people, divided into two groups: the type 1 DM group and the control group, were recruited in this study. RGC thickness was measured using AS-OCT GC-IPL thickness analysis and RNFL with optic disc RNFL thickness analysis. Data analysis was carried out using the unpaired T-test. Results: The results showed RGC depletion in the type 1 DM group (RGC 83.48 ± 3.75) compared to the control group (RGC 86.70 ± 4.87) with a value of p = 0.016 (p < 0.05). There was no statistical difference in RNFL thickness between the type 1 DM group (RNFL 102 ± 11.80) and the control group (RNFL 100.96 ± 10.97) with a value of p = 0.581 (p> 0.05). Conclusion: This study found RGC thinning in type 1 DM patients, but did not find differences in RNFL thickness between the two groups. This RGC depletion is thought to be caused by apoptosis of retinal neuronal cells due to chronic hyperglycemia. Examination of RGC thickness with OCT can be developed as an early detection of diabetic retinopathy in children with type 1 DM.

Three-Year Follow-Up Study Investigating Changes in Retinal Vascular Morphology and the Relationship with Diabetic Retinopathy in Children with Type 1 Diabetes Mellitus.

This study aimed to investigate changes in retinal microvascular morphology and associated factors, and their relationship with diabetic retinopathy (DR) in children with type 1 diabetes mellitus (T1DM). Thirty-eight children enrolled in this 3-year follow-up study underwent complete ophthalmic examinations including fundus photography. Retinal vascular parameters were measured automatically and compared between baseline and follow-up. Multiple linear regression was used to investigate factors affecting changes in vascular parameters. Binary logistic regression was used to analyze the relationship between retinal microvascular morphology and DR. The caliber of all retinal vessels (within 1-1.5 papillary diameter [PD] from the center of the optic disc, p = 0.030; 1.5-2 PD, p = 0.003), arterioles, and venules (1.5-2 PD, p = 0.001) was narrower in nearly all regions in the follow-up group compared with the baseline group. Vascular tortuosity increased in the central part of the retina and decreased in the periphery. The density (1-1.5 PD, p = 0.030) and fractal dimension (p = 0.037) of retinal vessels were increased at the end of the follow-up compared with baseline. Retinal vascular caliber was independently correlated with DR (odds ratio 0.793 [95% confidence interval 0.633-0.993]; p = 0.044). Retinal microvascular morphology in children with T1DM varied with the disease course. Narrower retinal vessels may be an independent risk factor for DR. Results of this study emphasized the importance of regular follow-up of fundus vascular morphology for the detection of early DR in children with T1DM.

Quantifying peripapillary vessel density and retinal nerve fibre layer in type 1 diabetic children without clinically detectable retinopathy using OCTA.

To quantify changes in radial peripapillary capillary vessel density (ppVD) and the peripapillary retinal nerve fiber layer (pRNFL) in children with type 1 diabetes without clinical diabetic retinopathy by optical coherence tomography angiography (OCTA), providing a basis for early retinopathy in children with type 1 diabetes. This was a retrospective study. A total of 30 patients (3-14y) with type 1 diabetes without clinical diabetic retinopathy (NDR group) were included. A total of 30 age-matched healthy subjects were included as the normal control group (CON group). The HbA1c level in the last 3mo was measured once in the NDR group. The pRNFL thickness and ppVD were automatically measured, and the mean pRNFL and ppVD were calculated in the nasal, inferior, temporal, and superior quadrants. The changes in ppVD and pRNFL in the two groups were analyzed. Compared with CON group, the nasal and superior ppVDs decreased in the NDR group (all P<0.01). The thickness of the nasal pRNFL decreased significantly (P<0.01), while the inferior, temporal and superior pRNFLs slightly decreased but not significant in the NDR group (all P>0.05). Person and Spearman correlation analysis of ppVD and pRNFL thickness in each quadrant of the NDR group showed a positive correlation between nasal and superior (all P<0.01), while inferior and temporal had no significant correlation (all P>0.05). There was no significant correlation between the HbA1c level and ppVD and pRNFL in any quadrant (all P>0.05). There was no significant correlation between the course of diabetes mellitus and ppVD and pRNFL in any quadrant (all P>0.05). ppVD and pRNFL decrease in eyes of children with type 1 diabetes before clinically detectable retinopathy and OCTA is helpful for early monitoring．.

Rates, Risk Factors, and Progression of Diabetic Retinopathy in Children with Type 1 Diabetes: A 15‐Year Retrospective Study from a Regional Center in New Zealand

Rates, Risk Factors, and Progression of Diabetic Retinopathy in Children with Type 1 Diabetes: A 15‐Year Retrospective Study from a Regional Center in New Zealand

Machine Learning-Based Integration of Metabolomics Characterisation Predicts Progression of Myopic Retinopathy in Children and Adolescents

Myopic retinopathy is an important cause of irreversible vision loss and blindness. As metabolomics has recently been successfully applied in myopia research, this study sought to characterize the serum metabolic profile of myopic retinopathy in children and adolescents (4-18 years) and to develop a diagnostic model that combines clinical and metabolic features. We selected clinical and serum metabolic data from children and adolescents at different time points as the training set (n = 516) and the validation set (n = 60). All participants underwent an ophthalmologic examination. Untargeted metabolomics analysis of serum was performed. Three machine learning (ML) models were trained by combining metabolic features and conventional clinical factors that were screened for significance in discrimination. The better-performing model was validated in an independent point-in-time cohort and risk nomograms were developed. Retinopathy was present in 34.2% of participants (n = 185) in the training set, including 109 (28.61%) with mild to moderate myopia. A total of 27 metabolites showed significant variation between groups. After combining Lasso and random forest (RF), 12 modelled metabolites (mainly those involved in energy metabolism) were screened. Both the logistic regression and extreme Gradient Boosting (XGBoost) algorithms showed good discriminatory ability. In the time-validation cohort, logistic regression (AUC 0.842, 95% CI 0.724-0.96) and XGBoost (AUC 0.897, 95% CI 0.807-0.986) also showed good prediction accuracy and had well-fitted calibration curves. Three clinical characteristic coefficients remained significant in the multivariate joint model (p < 0.05), as did 8/12 metabolic characteristic coefficients. Myopic retinopathy may have abnormal energy metabolism. Machine learning models based on metabolic profiles and clinical data demonstrate good predictive performance and facilitate the development of individual interventions for myopia in children and adolescents.

Risk factors for the development of retinopathy in premature infants

Background. Retinopathy of prematurity is one of the disabling conditions in premature babies. Despite the fact that the main predictors for the development of retinopathy of prematurity are known, the factors that can potentially cause it require further study. The purpose was to determine risk factors for the development of retinopathy in premature newborns for better control. Materials and methods. A retrospective analysis of 50 medical records of inpatient premature babies with a gestational age of 28–34 weeks and the medical charts of their mothers was carried out. Two groups were distinguished: the first one — 29 children with retinopathy, the second one — 21 patient without retinopathy. Results. The vast majority of children — 38 (76.0 %) were born at a gestational age of 28–31 weeks. Differences between groups were not significant. The analysis showed that 14 (48.3 %) premature children were diagnosed with stage I retinopathy, 6 (20.7 %) — with stage II, 5 (17.2 %) — with stage ІІІ and 4 (13.8 %) — with stage IV. The most influential risk factors for the development of retinopathy of prematurity were identified. The presence of retinopathy significantly correlated with gestational age of less than 34 weeks (ρ = 0.64, p &lt; 0.001), need for oxygen subsidy ≥ 40 % (ρ = 0.59, р &lt; 0.001), development of bronchopulmonary dysplasia (ρ = 0.34, р &lt; 0.01), sepsis (ρ = 0.59, р &lt; 0.001), intraventricular hemorrhages (ρ = 0.56, р &lt; 0.001). It was also found that the presence of a burdened maternal history in the form of chronic foci of infection and chorioamnionitis is a significant risk factor for the development of retinopathy (ρ = 0.56, р &lt; 0.001). Moreover, the presence of an infection in the mother increased the risk of retinopathy stage III–IV in a child by 3.8 times (p &lt; 0.05), and stage I–II retinopathy — by 5 times. With a combination of chorioamnionitis and chronic foci of infection, the risk of developing severe retinopathy was almost 95 % (р &lt; 0.007). Conclusions. Burdened maternal history in the form of chronic foci of infection and/or choriamnionitis is an important risk factor for the development of retinopathy in children. Chorioamnionitis is a predictor of severe retinopathy. Treatment of chronic foci of infection in pregnant women should be considered as a mandatory measure to prevent retinopathy in premature newborns.

Hydroxychloroquine retinopathy in children

Hydroxychloroquine (HCQ, Plaquenil) is an anti-malarial medication commonly used to treat various auto-immune conditions. HCQ has limited systemic toxicities, but may cause irreversible retinopathy in adults. There is limited data on HCQ retinopathy in children and no specific screening guidelines for children. We set out to identify and describe children with evidence of HCQ toxicity.

Correlation of Asymmetric Dimethyl Arginine Level to Sickle Retinopathy in Children With Sickle Cell Disease.

Asymmetric dimethyl arginine (ADMA) is a competitive inhibitor of nitric oxide synthetase especially in L-arginine deficiency, which is the case in sickle cell disease (SCD). we aimed to assess the level of ADMA in children with sickle retinopathy and to correlate it to the degree of retinopathy. In this cross-sectional study 40 children with SCD were included, 20 of them with sickle cell retinopathy (SCR) (group I), 20 with normal fundus examination (group II), and another 20 healthy children served as controls (group III). We measured ADMA level by ELISA and performed fundus examination. Seventeen of the 20 children included in group I had Grade I retinopathy (85%), 2 children had Grade II retinopathy (10%), and 1 child had Grade III retinopathy (5%). ADMA was significantly higher in SCD than controls ( P -value <0.001), and it was even higher in patients with SCR compared those without retinopathy ( P -value <0.002), and there was positive linear correlation between ADMA and the grade of retinopathy. The type of retinopathy detect in the studied patients was the nonproliferative type. In conclusion, ADMA is elevated in children with SCD, and its level is even higher in those who develop SCR.

Результаты применения функциональных методов исследования у детей с сахарным диабетом 1 типа в зависимости от уровня гликированного гемоглобина

Aim: to assess correlations between ocular ultrasound (US) biometry and optical coherence tomography (OCT) and hemoglobin A1c (HbA1c) in children with type 1 diabetes (T1D). Patients and Methods: 79 children were enrolled. The control group included 52 age-matched healthy children. Axial length (AL, mm) and lens thickness (LT, mm) were measured by US. Central corneal thickness (CCT) and central macular thickness (CMT) were measured by OCT (Cirrus 2000, Carl Zeiss Meditec, Germany). Correlation analysis to assess the relationship between HbA1c, US, and OCT was performed. Results: 55.7% of the participants were boys (n=44) and 44.3% were girls (n=35). Children were assigned into six groups depending on HbA1c levels. Group 1 (HbA1c &lt;6.0%) included 8 children, group 2 (HbA1c 6.1–7.0%) 29 children, group 3 (HbA1c 7.1–8.0%) 21 children, group 4 (HbA1c 8.1–9.0%) 8 children, group 5 (HbA1c 9.1–10%) 5 children, and group 6 (HbA1c &gt;10%) 8 children. The mean AL was 22.7±1.1 mm. The greatest AL was reported in groups 2 and 4, while the least AL was reported in groups 3 and 6. The greatest LT was reported in groups 4 and 6. In group 1, LT was similar to those in the control group. In all groups but group 2, CCT was greater than in controls. CMT demonstrated a negative correlation with HbA1c levels in the study groups. CMT was the greatest in children with T1D of 5 years’ durati Conclusion: in children with T1D, US and OCT findings correlate with HbA1c levels and T1D duration. Ocular biometry, CCT, and CMT measurements are useful tests illustrating the level of compensation of systemic disease. Dynamic assessment of these parameters will help develop indicators of diabetic retinopathy in children with T1D. Keywords: diabetes, ultrasound, optical coherence tomography, glycated hemoglobin. For citation: Abdulina V.R., Stepanova I.S. Functional tests in children with type 1 diabetes and their correlation with hemoglobin A1c levels. Russian Journal of Clinical Ophthalmology. 2022;22(2):99–102 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-99-102.

Dietary Intake, Gut Microbial Abundance, and Altered Serum Bile Acid Pool are Associated with Diabetic Retinopathy in Children and Adults with Diabetes Mellitus

Dietary Intake, Gut Microbial Abundance, and Altered Serum Bile Acid Pool are Associated with Diabetic Retinopathy in Children and Adults with Diabetes Mellitus

Clinical and genetic features of retinoschisis in 120 families with RS1 mutations

Background/aimsX-linked retinoschisis (XLRS), associated with RS1, is the most common type of X-linked retinopathy in children. This study aimed to identify clinical and genetic features of retinoschisis in 120 families...

Diabetic Retinopathy in Children with Type 1 Diabetes-Occurrence and Screening Using Optical Coherence Tomography.

Purpose: To describe the occurrence of diabetic retinopathy, the principles for pediatric care of patients with diabetes, and the utility of optical coherence tomography. Pediatric patients with type 1 diabetes should be screened for diabetic retinopathy upon the lapse of 5 years following the diagnosis. The patients in the time of puberty, who should be screened promptly after the diabetes diagnosis, and patients with type 2 diabetes are the exceptions. Special attention must be paid not only to retinopathy, but also to other possible concomitant conditions, such as cataract, refractive errors, or neuropathy. New techniques, such as optical coherence tomography angiography (OCTA), may contribute greatly to the early detection of retinopathy, facilitating the decision to modify the treatment. The application of modern insulin pumps with continuous glucose monitoring systems has greatly diminished the incidence rate of early symptoms of diabetic retinopathy in the pediatric population.

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Risks and Prevalence of Diabetic Retinopathy in Children and Young People with Type 1 Diabetes Mellitus

Diabetic retinopathy is a progressive ophthalmic microvascular complication of diabetes and is one of the commonest complications of Type 1 diabetes (T1D). The prevalence of diabetic eye disease varies within different population and age groups, and many risk factors are associated with the development and progression of diabetic retinopathy in T1D. This review discusses the current prevalence of diabetic retinopathy in children and young people (0-18 years) with T1D and the risk factors associated with the presence of diabetic eye disease in this population.

Venous stasis retinopathy in a ten-year-old boy with ocular hypertension: a case report

BackgroundCentral retinal vein occlusion is a variable disease pattern. Preliminary stages of a complete occlusion of the central vein, wich are subsumed under the term venous stasis retinopathy, may occur as transient blurred vision and with subtle alterations of the fundus. Course and prognosis are benign, visual acuity usually recovers. By now, venous stasis retinopathy in children due to Valsalva maneuver has not been described in literature yet.Case presentationWe present an impressive case of venous stasis retinopathy in a 10-year-old boy with ocular hypertension and megalocornea due to increased intraocular pressure provoked by Valsalva maneuver. Main symptom was transient blurred vision in the left eye. The intraocular pressure was 28 mmHg, fundus exam revealed tortuous veins and a flame shaped hemorrhage at 7 o’clock. Total recovery under topical antiglaucomatous therapy could be observed after 1 month.ConclusionsAcute increase in intraocular pressure, provoked by Valsalva maneuver is a risk factor for venous stasis retinopathy. Further general and vascular risk factors should be ruled out by extensive examination. Children with ocular hypertension might be at higher risk for impending vein occlusion as shown in this case.

Screening for retinopathy in children with type 1 diabetes in Denmark

Background/objective Children with type 1 diabetes (T1D) are screened regularly for retinopathy with fundus photography to prevent visual impairment. According to Danish national guidelines, screening should take place at age 12, 15, and 18 years after minimum 3 years of diabetes. As glycemic control has improved, prevalence of retinopathy is expected to be decreased. The aim of this study is to investigate the prevalence, degree, and progression of retinopathy in children with T1D and to explore if screening at 12 years is currently indicated in Denmark. Methods Data on all Danish children with onset of T1D from 2003 to 2013 (n = 2943) were collected from the "DanDiabKids" registry. For children with registered screenings (n = 2382), prevalence of retinopathy at 12, 15, and 18 years was determined. In children with retinopathy, subsequent screenings were studied to reveal if retinopathy was persistent or temporary. Results Prevalence of retinopathy at 12, 15, and 18 years was 0.9%, 2.3%, and 3.1%, respectively. Minimal background retinopathy was seen in over 90% and 100% at 12 years. In available re-screenings, retinopathy resolved spontaneously in 87.5% of all cases and 100% of cases at 12 years. Conclusions The prevalence of retinopathy in Danish children with T1D was low. At 12 years, prevalence was 0.9% and exclusively minimal background retinopathy with 100% remission in re-screenings. Thus, screening at this age does not seem to have significant clinical relevance. We propose more individualized screening selection before the age of 15.

Prevalence of diabetic retinopathy in children and adolescents at an urban tertiary eye care center.

Diabetic retinopathy (DR) is a serious complication that can progress to sight-threatening disease. The prevalence of DR in youth with diabetes has been reported to be 3.8% to 20%. We aimed to evaluate the prevalence of DR among youth with diabetes at a large ophthalmologic referral center. Secondary goals were to determine the risk factors for DR and severity of disease. Retrospective chart review of 343 patients with diabetes, <21 years of age, seen at a tertiary referral eye care center from 2013 to 2018. The study included 343 patients, of which 293 had type 1 diabetes (T1D) and 50 had type 2 diabetes (T2D). Thirteen of 343 patients had DR, with an overall incidence of 3.8% (3.4% in T1D and 6% T2D). DR severity included nine with mild non-proliferative, three moderate non-proliferative, and one with proliferative DR. Patients with hemoglobin A1c (HbA1c) > 8% had a higher risk of DR (P = .049). In this cohort, none of the patients with an HbA1c <8% had DR. In the multivariate analysis, a higher systolic blood pressure was marginally associated with risk for DR (P = .07). We found lower prevalence of DR in youth with diabetes than previously reported. The incidence of DR was higher among patients with T2D and occurred with a shorter duration of disease, as compared with T1D. While the incidence of DR in youth with T1D is low, with the increasing incidence of T2D in adolescents and early risk for DR, early screening must be emphasized.

La rétinopathie drépanocytaire chez l’enfant : à propos de 42 cas

This was a retrospective study including all children diagnosed with sickle cell retinopathy. Epidemiological, clinical and therapeutic characteristics, as well as clinical course, were analysed retrospectively by chart review. Two groups were defined: Group 1 (Goldberg stage 1 and 2); Group 2 (Goldberg stage 3, 4 and 5). In order to identify factors independently associated with severe sickle cell retinopathy, we conducted a logistic regression analysis in descending order. The frequency of sickle cell retinopathy was 14.48%. Forty-two patients (84 eyes) were included; among them 23 boys and 19 girls, aged 10 to 17 with a mean age of 14±1.98 years. Twenty patients were of genotype SS, 11 patients of genotype SC, 8 Sβ and 3 SO Arab. The three patients in group 2 were all of SS genotype. The majority of patients (32) had an HbF level of less than 15%. All our patients had sickle cell retinopathy distributed as follows: 62% at stage 1; 31% at stage 2; 5% at stage 3 and 2% at stage 4. Multivariate analysis revealed a single risk factor independently linked to severe involvement - an HbF level<15%. Retinopathy is a frequent complication of sickle cell disease which may lead to blindness. The HbF level is negatively correlated with severe involvement.

Screening for retinopathy in children with type 1 diabetes in Denmark

Children with type 1 diabetes (T1D) are screened regularly for retinopathy with fundus photography to prevent visual impairment. According to Danish national guidelines, screening should take place at age 12, 15, and 18 years after minimum 3 years of diabetes. As glycemic control has improved, prevalence of retinopathy is expected to be decreased. The aim of this study is to investigate the prevalence, degree, and progression of retinopathy in children with T1D and to explore if screening at 12 years is currently indicated in Denmark. Data on all Danish children with onset of T1D from 2003 to 2013 (n = 2943) were collected from the "DanDiabKids" registry. For children with registered screenings (n = 2382), prevalence of retinopathy at 12, 15, and 18 years was determined. In children with retinopathy, subsequent screenings were studied to reveal if retinopathy was persistent or temporary. Prevalence of retinopathy at 12, 15, and 18 years was 0.9%, 2.3%, and 3.1%, respectively. Minimal background retinopathy was seen in over 90% and 100% at 12 years. In available re-screenings, retinopathy resolved spontaneously in 87.5% of all cases and 100% of cases at 12 years. The prevalence of retinopathy in Danish children with T1D was low. At 12 years, prevalence was 0.9% and exclusively minimal background retinopathy with 100% remission in re-screenings. Thus, screening at this age does not seem to have significant clinical relevance. We propose more individualized screening selection before the age of 15.

Angiopoietin-2 as a Marker of Retinopathy in Children and Adolescents With Sickle Cell Disease: Relation to Subclinical Atherosclerosis.

Angiopoietin-2 (Ang-2) is a multifaceted cytokine that functions in both angiogenesis and inflammation. A proangiogenic state has been found in adults with sickle cell disease (SCD), mainly because of elevated Ang-2 levels. We determined Ang-2 level in 40 children and adolescents with SCD compared with 40 healthy controls and assessed its relation to retinopathy as well as carotid intimamedia thickness (CIMT). Hematologic profile, serum ferritin, and serum Ang-2 were measured. CIMT was assessed using high-resolution ultrasound. Fundus examination was performed followed by fundus fluorescein angiography. Optical coherence tomography angiography (OCTA) was used to find small vascular changes not clinically manifested. Ang-2 levels and CIMT were significantly higher in SCD patients compared with controls. The incidence of nonproliferative retinopathy was 45%. SCD patients with retinopathy were older in age with a history of sickling crisis of >3 attacks per year and had a higher incidence of sickle cell anemia than sickle β-thalassemia. Ang-2 cutoff value 9000 pg/mL could significantly detect the presence of retinopathy among SCD patients with 100% sensitivity and specificity. Serum Ang-2 levels were positively correlated with HbS and CIMT. Logistic regression analysis revealed that Ang-2 and HbS significantly contribute to retinopathy among patients with SCD. Elevated Ang-2 highlights the role of angiogenesis in the pathophysiology of SCD and may be considered a promising marker for screening of patients at risk of sickle retinopathy and vascular dysfunction.