Retinopathy Of Prematurity In Infants Research Articles

Early and late complications of hyperglycemic extremely low birth-weight infants

Introduction: During recent decades, the perinatal mortality of extremely low-birth weight infants has decreased. An important task is to recognize complications of prematurity. Aim: We made an attempt to explore the relationship between complications of prematurity and neonatal hyperglycemia. Method: From 1 January 2014 to 31 December 2017, 188 infants with birth weight below 1000 g were admitted. For each infant, the frequencies of hyperglycemia (blood glucose >8.5 mmol/l), retinopathy of prematurity, intraventricular hemorrhage, and bronchopulmonary dysplasia were determined. Animal studies were performed in Sprague Dawley rats. Hyperglycemia was achieved by intraperitoneal injection of streptozotocin (100 mg/kg). On the 7th day of life, aorta sections were prepared and stained with hematoxylin eosin. Wall thickness was measured using QCapture Pro 7 image analysis software. Results: The mean ± SD gestational age and birth weight were 27.1 ± 2.2 weeks and 814.9 ± 151.9 g; 33 infants (17.5%) died. Hyperglycemia was confirmed in 62 cases (32.9%), and insulin treatment was given to 43 infants (22.8%). The gestational age and birth weight of the hyperglycemic infants were significantly lower (p<0.001), the incidence of severe retinopathy (p = 0.012) and the mortality of insulin-treated patients were higher (p = 0.02) than in normoglycemic infants. Among survivors (n = 155), we found by logistic regression analysis that hyperglycemia was a risk factor for severe retinopathy (p<0.001). In the rat model, neonatal hyperglycemia caused significant thickening of the aortic wall. Conclusion: Our studies indicate that hyperglycemia is common in extremely low birth-weight infants. Monitoring of these infants for retinopathy of prematurity, kidney dysfunction, and hypertension is recommended. Orv Hetil. 2019; 160(32): 1270-1278.

Prevalence and Risk Factors of Retinopathy of Prematurity in Iran.

PurposeThe present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants.Methods A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age 28 weeks), extremely low-birth-weight ( 1000 g), and multiple-gestation (MG) infants.ResultsThe prevalence of ROP was 27.28% ( = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion ( < 0.0001, < 0.0001, and = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP ( < 0.0001) were observed in EP and ELBW infants. Birth weight ( = 0.088), history of transfusion ( = 0.066), and intubation ( = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age ( = 0.037) and history of transfusion ( = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight ( = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis.ConclusionROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.

A Quantitative Severity Scale for Retinopathy of Prematurity Using Deep Learning to Monitor Disease Regression After Treatment

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, but treatment failure and disease recurrence are important causes of adverse outcomes in patients with treatment-requiring ROP (TR-ROP). To apply an automated ROP vascular severity score obtained using a deep learning algorithm and to assess its utility for objectively monitoring ROP regression after treatment. This retrospective cohort study used data from the Imaging and Informatics in ROP consortium, which comprises 9 tertiary referral centers in North America that screen high volumes of at-risk infants for ROP. Images of 5255 clinical eye examinations from 871 infants performed between July 2011 and December 2016 were assessed for eligibility in the present study. The disease course was assessed with time across the numerous examinations for patients with TR-ROP. Infants born prematurely meeting screening criteria for ROP who developed TR-ROP and who had images captured within 4 weeks before and after treatment as well as at the time of treatment were included. The primary outcome was mean (SD) ROP vascular severity score before, at time of, and after treatment. A deep learning classifier was used to assign a continuous ROP vascular severity score, which ranged from 1 (normal) to 9 (most severe), at each examination. A secondary outcome was the difference in ROP vascular severity score among eyes treated with laser or the vascular endothelial growth factor antagonist bevacizumab. Differences between groups for both outcomes were assessed using unpaired 2-tailed t tests with Bonferroni correction. Of 5255 examined eyes, 91 developed TR-ROP, of which 46 eyes met the inclusion criteria based on the available images. The mean (SD) birth weight of those patients was 653 (185) g, with a mean (SD) gestational age of 24.9 (1.3) weeks. The mean (SD) ROP vascular severity scores significantly increased 2 weeks prior to treatment (4.19 [1.75]), peaked at treatment (7.43 [1.89]), and decreased for at least 2 weeks after treatment (4.00 [1.88]) (all P < .001). Eyes requiring retreatment with laser had higher ROP vascular severity scores at the time of initial treatment compared with eyes receiving a single treatment (P < .001). This quantitative ROP vascular severity score appears to consistently reflect clinical disease progression and posttreatment regression in eyes with TR-ROP. These study results may have implications for the monitoring of patients with ROP for treatment failure and disease recurrence and for determining the appropriate level of disease severity for primary treatment in eyes with aggressive disease.

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.

Analysis of the clinical characteristics and refraction state in premature infants: a 10-year retrospective analysis.

To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity (ROP) who were or not treated. The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed. A total of 562 screened premature infants (all Chinese, 1124 eyes), were recruited with a 378:184 male-to-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55% (93/562 cases). The incidences in boys and girls were 16.14% (33/378 cases) and 17.39% (32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP (stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP (30.99%, 172/555 cases), and myopic refraction (including myopia and myopia combined with astigmatism) was more common in premature infants with ROP (48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction (including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment (63.63%, 7/11 cases). The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.

Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061.

Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061.

Knowledge, attitude, and practice study on awareness of retinopathy of prematurity among pediatricians in Goa

Context: The improvement in neonatal care has led to more number of premature infants surviving. This has led to more number of babies requiring screening for retinopathy of prematurity (ROP). Thus, there is a need to bridge the knowledge gap between pediatricians and ophthalmologists for ROP management. Limited studies done among pediatricians across India had shown that there is a need for greater awareness and timely screening of pre-terms for ROP. No such study was carried out in Goa and adjoining Western India. Hence, the present study was undertaken. Aims: The aim of the study is to assess the knowledge, attitude, and practices about ROP among practicing pediatricians in Goa. Settings and Design: This is a cross-sectional study. Materials and Methods: A pretested pro forma was given to 58 pediatricians, which contained 19 questions related to their educational and practice profile, about the risk factors for ROP, screening protocol, referral criteria, facilities for referral, treatment options, and problems faced by them for referral of babies requiring treatment for sight-threatening ROP. Statistical Analysis Used: Percentages and proportions are used for analysis. Results: Among the 58 pediatricians, 75.86% were practicing in government hospitals including Goa Medical College and Hospital, whereas 14 (24.13%) were private practitioners. 50% had been practicing for 5–10 years. All participants had heard about ROP and were aware of the most common risk factors for ROP. 87.93% were aware of the timing of first screening of preterm infants for ROP; 84.48%were aware of referral to an ophthalmologist for screening and management of ROP. 77.58% had knowledge about the treatment modalities. 56.89% reported that they faced barriers to referral. Conclusions: There is a very high level of awareness among pediatricians in Goa about the risk factors and screening of ROP.

Resultados de la Oclusión Ocular Precoz en Recién Nacidos Prematuros de muy bajo peso y su relación con la Retinopatía de la Prematuridad

Objetivos. Demostrar si la oclusión ocular se relaciona con la incidencia de retinopatía en los recién nacidos prematuros en el Instituto Materno Perinatal. Materiales y métodos. El estudio analítico cuasi-experimental, comprende a todos los prematuros de muy bajo peso al nacer (&lt; 1301 grs) y menor de 32 semanas, nacidos entre el 1º de Enero del 2005 al 31 de Diciembre del 2007. Se consideró 201 pacientes que cumplieron con los criterios de inclusión, éstos fueron divididos en dos grupos, uno a los que se les ocluyeron ambos ojos con antifaz de tela negra (estudio) y otro sin oclusión expuesto a la luz natural del ambiente (control). Resultados. Se comparó la incidencia de ROP en ambos grupos, presentando algún grado de ROP 25 de 97 pacientes con ojos ocluidos (25,8 %) y 34 de 104 pacientes con ojos no ocluidos (32,7 %). Conclusiones. Se concluye que la oclusión no disminuye la incidencia para desarrollar retinopatía en nacidos prematuros de muy bajo peso pero si tiene efecto protector para casos severos de ésta enfermedad.

LATE COMPLICATIONS UNFAVORABLE RESULTS OF CICATRICAL RETINOPATHY OF PREMATURITY

Purpose. The study of the frequency and structure of complications in IV-V degree of retinopathy of prematurity and the development of tactics for their prevention and treatment. Material and methods. A total of 134 patients (268 eyes) with IV-V degree of cicatricial retinopathy of premature infants aged 6 months - 17 years were examined. In addition to the standard ophthalmological examination, ultrasound methods were used: biometrics, echography, biomicroscopy. Results. Late complications were detected on 153 (57,1%) from 268 eyes with IV-V degrees of cicatrical ROP. The main types of complications were: flat anterior chamber, corneal and lens opacities, secondary glaucoma, progressive phthisis bulbi. Conclusions. All patients with cicatricial ROP require constant follow-up and differentiated tactics of prevention and treatment of late complications.

Screening Examination of Premature Infants for Retinopathy of Prematurity.

This policy statement revises a previous statement on screening of preterm infants for retinopathy of prematurity (ROP) that was published in 2013. ROP is a pathologic process that occurs in immature retinal tissue and can progress to a tractional retinal detachment, which may then result in visual loss or blindness. For more than 3 decades, treatment of severe ROP that markedly decreases the incidence of this poor visual outcome has been available. However, severe, treatment-requiring ROP must be diagnosed in a timely fashion to be treated effectively. The sequential nature of ROP requires that infants who are at-risk and preterm be examined at proper times and intervals to detect the changes of ROP before they become destructive. This statement presents the attributes of an effective program to detect and treat ROP, including the timing of initial and follow-up examinations.

Demographic profile and ocular characteristics of stage 5 retinopathy of prematurity at a referral center in Northwest China: implications for implementation

BackgroundSevere retinopathy of prematurity (ROP) with extremely unfavorable prognosis among infants can do great damage to individuals and bring tremendous social-economic burden. The purpose of this study is to describe the demographic and ocular characteristics of infants who presented with stage 5 ROP in order to identify reasons why they have become blind, and to identify contributing factors in order to focus great attention on the current ROP program and to inspire more effort in ROP screening in middle income countries.MethodsA retrospective review of consecutive infants with stage 5 ROP from December 2010 to December 2016 in Department of Ophthalmology, Xijing Hospital. Various parameters retrieved included birthweight, gestational age, age at initial examination, postmenstrual age, screening details, check-up details and reasons for consultation. Ocular findings were recorded and also detected by ultrasonography.ResultsA retrospective review of 20 consecutive infants with stage 5 ROP are included. Mean birthweight was1712.3 ± 512.97 g and mean gestational age at birth was 32.1 ± 2.21 weeks. Median age at first consultancy was 9.7 month. Median postmenstrual age first consultancy was 52 weeks. All infants were never screened for ROP before they came to the referral center. Of twenty stage 5 ROP infants, 13 cases presented with bilateral stage 5 features. Of the 40 eyes of 20 infants, 33 eyes were diagnosed as stage 5. Leukocoric pupil, closed funnel configuration of retinal detachment (RD), posterior synechia, extraretinal fibrovascular proliferation and retinal folds were the most significant indicators of bad prognosis. Ten eyes appeared no fixation to light, while 30 eyes exhibited following to light or following to toys.ConclusionsOur study shows that in relatively less-developed regions of China, more needs to be done to spread awareness about the disease among pediatricians, neonatologists and ophthalmologists as well as parents of premature infants. Thus, a comprehensive control system which is a whole network of propaganda, screening, treatment and follow-up are encouraged especially in less developed areas in China as well as worldwide.

Evaluation of Risk Factors Affecting Development of Retinopathy in Premature Infants

Evaluation of Risk Factors Affecting Development of Retinopathy in Premature Infants

Риск развития тяжелой формы ретинопатии недоношенных в зависимости от гематологических показателей, гестационного возраста и некоторых лечебных факторов

Риск развития тяжелой формы ретинопатии недоношенных в зависимости от гематологических показателей, гестационного возраста и некоторых лечебных факторов

Preferences and Trends in Practices Caring Premature Infants for Retinopathy of Prematurity (ROP): A Web-based Survey

Objectives: To study preferences in treatment, follow-up and conclusion of examination in infants treated with and without bevacizumab (IVB) and/or laser photocoagulation for retinopathy of prematurity (ROP).Methods: A 22 question web survey was administered to physicians to understand practice patterns for treatment of type1 ROP, determine timeframe of conclusion of examinations with and without IVB/laser, and to approximate incidence of ROP recurrence post-treatment.Results: The survey revealed that 73% pediatric ophthalmologists reported not personally performing injections and 54.1% reported not performing laser. In infants with persistent avascular retina without pre-threshold disease, 54.2% continued examination &gt; 50 weeks PMA, 23.3% discontinued at 50 weeks PMA, 3.2% preferred prophylactic laser and 5.1% fluorescein angiography and laser prior to concluding exams. 46.3% of physicians preferred IVB as primary monotherapy, 37.3% laser, and 16.4% both IVB and laser in type 1 ROP. Of those who preferred IVB, 20.4% concluded examination at ? 55 weeks PMA, whereas 79.6% continued evaluation &gt;55 weeks PMA (60 to ? 80 weeks). Of those who preferred both IVB and laser, 50.6% concluded examination at ? 50 weeks PMA, whereas 49.4% continued &gt; 50 weeks (60 to ? 80 weeks). 21.1 % of respondents reported recurrence with IVB and 8.8% with dual therapyConclusions: Treatment preferences and conclusion of examination in ROP varies considerably without and with treatment. Though a longer follow-up is recommended with IVB, this survey reveals extended examinations beyond 50 weeks PMA in infants with persistent avascular retina requiring no treatment and in the laser treated subgroup. The survey highlights low rates of performing treatments personally by pediatric ophthalmologists, and distinctlyvariable practice patterns in ROP care

Retinopathy of Prematurity Trends in Taiwan: A 10-Year Nationwide Population Study

To investigate the 10-year epidemiology and risk factors of retinopathy of prematurity (ROP) in Taiwan using the National Health Insurance Research Database. All premature infants (n = 34,192) from 2002 to 2011 were screened, and those with length of stay (LOS) longer than 28 days who survived after the initial discharge were enrolled (n = 11,180). The annual incidence of ROP and the risk factors associated with it were analyzed. A total of 4096 ROP infants, 36.6% of premature babies with LOS longer than 28 days, were identified. The numbers of newborns, premature infants, and cases with ROP decreased over time, but the proportion of extremely low birth weight infants increased over time (P < 0.01 for test of trend in number). Also, the proportion of ROP infants receiving treatment increased over time (P < 0.01 for test of trend in number). However, the incidence of ROP was steady throughout the study period. Multivariable analysis revealed that low birth weight, male sex (odds ratio [OR] = 1.12, P = 0.007), and multiparity (OR = 1.17, P = 0.002) were positively associated with ROP, whereas necrotizing enterocolitis (OR = 0.72, P = 0.002) had a negative association with ROP. The average incidence of ROP from 2002 to 2011 in Taiwan showed no significant change over the 10-year period. Proportion of treatment-requiring ROP increased. Low birth weight, multiparity, and male sex were independent risk factors of ROP.

Efficacy of intravitreal injection of Ranibizumab for the treatment of retinopathy of prematurity

Objective To observe the efficacy and safety of intravitreal injection of Ranibizumab (IVR) for the treatment of retinopathy of prematurity (ROP). Methods The data of 62 eyes of 32 cases of threshold or prethreshold ROP from Dec. 2015 to Mar.2017 were analyzed retrospectively. All the infants received IVR ( 0.25mg) within 48 h after diagnosis.Follow-up examinations were performed every week at the first month after injection. The follow-up plan was made according to review results. Infants with no response or recurrence after injection, received the second time IVR or combined laser photocoagulation. The follow-up time was 8-23 weeks. Results The injection was effective in 60 eyes of 31 cases (96.77 %). Among them 23 cases only received IVR .One case without obvious improvement was referred, and the second time IVR combined retinal photocoagulation were performed in the outer court. Recurrence with retinal proliferation in 8 cases were referred in outer court and received photocoagulation.There were 3 cases of retinal hemorrhage after IVR. No other complication was observed. Conclusion IVR is safe and effective for ROP infants. For the cases with bad general condition and who seems hardly to tolerate anesthesia, IVR has a distinct advantage. Some cases of recurrence or no response need combined retinal photocoagulation. Key words: Ranibizumab, intravitreal injection; Retinopathy, prematurity

Increased circulation mobilization of endothelial progenitor cells in preterm infants with retinopathy of prematurity

Retinopathy of prematurity (ROP) is a result of increased pathological neoangiogenesis of the retina in preterm infants. Cells responsible for the pathogenesis of ROP are unclear, but some evidence indicates that bone marrow derived cells are involved in this disorder. Endothelial progenitor cells (EPCs), play a role in angiogenesis in response to tissue ischemia or endothelial damage. In this study, the number of cEPCs in preterm infants with ROP was determined to identify whether the circulation mobilization of EPCs is associated with ROP. We evaluated 99 participants in this study: 22 preterm infants with ROP, 35 preterm infants without ROP, and 42 full-term infants. The release of EPCs in the circulation was first quantified. Thereafter, cEPCs were harvested and cultivated, then the biological features of these cells including migratory, proliferative, and tubulogenic activities were analyzed. The mRNA levels of some proangiogenic factors were also measured in preterm infants. Our results showed greater numbers of cEPCs in infants with ROP, which was associated with increased serum concentrations of angiogenic factors and with augmented proliferative, migratory, and tubulogenic activity of these cells. Western blotting showed increased protein levels of VEGF and HIF-α in cEPCs harvested from ROP infants. This study showed that ROP in preterm infants is associated with increased mobilization of EPCs into the circulation. Therefore, increased cEPCs along with elevated levels of angiogenic factors and tubulogenesis suggest that these cells may play a role in the development and progression of ROP.

Development of a scale for grading pre-plus and plus disease using retinal images: A pilot study

When screening infants for retinopathy of prematurity, evaluating posterior pole vascular characteristics (ie, the presence or absence of pre-plus or plus disease) is subjective and prone to error. ROPtool, a semiautomated computer program, measures retinal vessel tortuosity and dilation. In this pilot study, we created an abbreviated pictorial scale of varying vascular tortuosity and dilation based on expert perception of vascular characteristics. We used ROPtool to evaluate the experts' ability to arrange these images in order of increasing vascular tortuosity and dilation. ROPtool values confirmed successful arrangement of images in order of increasing vascular tortuosity and dilation. This pictorial scale could serve as a reference to decrease subjectivity when diagnosing pre-plus or plus disease.

Correlation of Retinopathy of Prematurity with Bronchopulmonary Dysplasia.

Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.MethodologyInfants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared.ResultsIn neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children. Children with BPD also received more blood transfusions compared to children without BPD.ConclusionsNewborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.

Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between...