Development Of Retinopathy Of Prematurity Research Articles

Prevalence and Risk Factors of Retinopathy of Prematurity (ROP): A Cross-Sectional Study

Background and Aim: Despite considerable progress made in the treatment of Retinopathy of prematurity (ROP), it is still a common cause of reduced vision in children in developed countries, and its prevalence is increasing. This is a preventable disease and responds to treatments appropriately if diagnosed at early stages, but in case of delayed diagnosis and treatment, it may lead to blindness. The aim of the present study is to describe the incidence, severity, and risk factors of ROP in a tertiary healthcare center.
 Material and Methods: This was a prospective, observational, nonrandomized study conducted in a tertiary-level neonatal intensive care unit (NICU) of a teaching hospital in Gujarat. A total of 130 preterm neonates admitted in the NICU during the study period were screened for ROP as per the guidelines of NNF of India. Screening was done under topical anesthesia, and findings were documented according to the International Classification for Retinopathy of Prematurity recommendations. The data were analyzed for gestational age, birth weight, and systemic factors predisposing to ROP.
 Results: Of the 130 neonates, 37 neonates were found to have ROP, with the incidence of ROP being 28.4%. The mean birth weight (1388 ± 312 g) and the mean gestational age (32.21 ± 2.50 wk) Out of the 37 neonates with ROP, 14 had a gestational age of > 32 weeks and/or birth weight of > 1500 g. ROP was classified into type 1 and type 2 as per the ETROP study, 14 (39.39%) neonates had type 1 or treatable ROP; there were no cases of APROP in our study; ROP regressed without any intervention in 13 neonates; 7 neonates were defaulters; and 11 neonates were treated with laser.
 Conclusion: ROP is strongly associated with smaller, more immature, and sicker neonates. However, in our study, about 40% of neonates who developed ROP were of higher gestation (> 32 wk) and birth weight (> 1500 g). The analysis of risk factors for ROP development will help to understand and predict it in severe preterm infants.

Thrombocytopenia as Type 1 ROP Biomarker: A Longitudinal Study.

This study aimed to prospectively evaluate the association between the appearance and evolution of retinopathy of prematurity (ROP) and selected blood parameters, focusing on platelets count. In total, 157 preterm consecutive babies screened for ROP were included and classified in: ROP necessitating treatment (group ROP1), ROP regressed without therapy (group ROP2) and no ROP (group no-ROP), divided in two phases for each group depending on gestational age. Blood parameters were weekly gathered and referred to postmenstrual age, ROP severity and phase. Platelet count mean values were statistically lower (p < 0.001) during both phases in ROP1 group (179 × 109/L vs. 213 × 109/L in phase 1 and 2, respectively) vs. other groups (ROP2: 286 × 109/L vs. 293 × 109/L; no ROP: 295 × 109/L vs. 313 × 109/L). Platelet count at birth <181 × 109 was statistically associated with Type 1 ROP development and evolution (sensibility = 76.47%, 95% confidence interval 60.0–87.6; specificity = 66.12%, 95% confidence interval 57.3–73.9). In ROP 1 group, a platelets count mean value “spike” (392.6 × 109/L) was documented at 36 weeks of corrected gestational age, preceding the need for treatment performed at a median of 38.1 ± 3.2 weeks. Early birth thrombocytopenia is confirmed as a biomarker of development and progression of ROP requiring treatment. The increase of platelets count at 35–37 weeks of corrected gestational age can be considered a possible clinical biomarker anticipating Type 1 ROP progression in preterm infants.

Association between FVL G1691A, MTHFR C677T and A1298C Polymorphisms with Risk for Retinopathy of PrematurityAssociation between FVL G1691A, MTHFR C677T and A1298C Polymorphisms with Risk for Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is an important cause of preventable blindness in children. The aim of this study was to examine the association of the polymorphisms at Factor V Leiden (FVL) and methylene tetrahydrofolate reductase (MTHFR) gene with risk of ROP. Methods: A total of 106 neonates with ROP and 110 healthy neonates were enrolled. The FVL G1691A and MTHFR C677T and A1298C polymorphisms were genotyped by PCR-RFLP assay. Results: There was a significant association between FVL G1691A polymorphism and an increased risk of ROP. However, the MTHFR C677T and A1298C polymorphisms were not associated with risk of ROP. Conclusion: FVL G1691A polymorphism may be risk factor for development of ROP in neonates. However, there was no significant association between MTHFR C677T and A1298C polymorphisms and risk of ROP. However, it is critical that larger and well-designed studies in different ethnicities are needed to confirm our conclusions.

Risk Factors, Complications and Immediate Outcome of Very Low Birth Weight Neonates in a level-III NICU

Background: Last two decades have witnessed a steady improvement in the quality of perinatal care in Bangladesh. Around 4-8% of all live births are very low birth weight (VLBW) &amp; low birth weight (LBW)is 10.6%. The present study was done to determine risk factors, complications and immediate outcome in VLBW babies. Methods: It was a prospective cohort study conducted in a level-III NICU of Ad-din Hospital over two years period (April 2019-March 2021). 356VLBW babies (birth weight &lt;1500 g) were assessed for demographic characteristics, risk factors (both maternal &amp; fetal) and neonatal complications. The American Academy of Pediatrics protocol for neonatal resuscitation was followed for the management of VLBW. Screening for retinopathy of prematurity was done. Data were entered in predetermined proforma and statistical analysis was done. Results: Out of 356 VLBW babies, 268 (75.2%) survived. Maternal risk factors associated with birth of VLBW babies were primiparity (46.8 %), poor socio-economic status (40.86%), multiple gestations (36.83%), Premature rupture of membrane (PROM) (21.6 %), hypertension (20 %) and under nutrition (17 %). Significant morbidities were found Jaundice (43.31%), Respiratoy Distress Syndrome (RDS) (28.08 %), apnoea (26.34%), birth asphyxia (20.43%), and sepsis (22.5 %). Mortality was higher among males (20.43%) than females (12.9%). None below 26 weeks of gestation and birth weight of 750g survived. RDS was the main cause of death (46.15%) followed by birth asphyxia (23%), sepsis (19.2%) and Intraventricular Haemorrhage (IVH) (11.5%). Antenatal steroid improved the survival (77.4%) and reduced the incidence of RDS, Necrotizing Enterocolitis (NEC) and IVH. Retinopathy of Prematurity (ROP) was detected in 30.9 % VLBW babies. Conclusions: Higher birth weight, gestational age, female sex and antenatal steroids improved survival amongst babies. Antenatal steroids reduced incidence of RDS, NEC and IVH when preterm delivery was inevitable. Judicial use of supplemental oxygen and blood products prevent development of ROP. Bangladesh Crit Care J September 2021; 9 (2): 94-100

The possible effect of pentoxifylline on development and severity of retinopathy of prematurity

Background and aim Retinopathy of prematurity (ROP) is the major ocular problem of preterm infants that occurs with abnormal proliferation of immature retinal vessels. Although pentoxifylline (PTX) was reported to inhibit vasculogenesis and neovascularization in experimental studies, there is no clinical data about the effects of PTX treatment on the development and severity of ROP. This clinical study aimed to investigate the possible effects of PTX on the development of ROP. Materials and methods A single-centre retrospective study was conducted including preterm infants who were hospitalised in the neonatal intensive care unit between 2015–2017 years. Infants were divided into two groups in terms of PTX administration for adjuvant therapy, as PTX and non-PTX groups. Results A total of 211 infants were included in the study [gestational age 29 (27–31) weeks, birth weight 1140 (960–1340) g]. From these, 97 infants (46%) were given PTX treatment. The two groups were similar in terms of demographic data and baseline clinical characteristics. Any stage of ROP was detected in 47.4% of infants in the PTX group, which was significantly higher than those in the non-PTX group (27.2%) (p = 0.002). The incidence of advanced-stage ROP in the PTX group (10.3%) was also higher than in the non-PTX group (2.6%) (p = 0.021). Repeated usage of PTX was not found to be related to the development of ROP (p = 0.059). The time of PTX administration was similar between the ROP and no-ROP groups (median; one vs one week, p = 0.825). Surfactant therapy, duration of hospital stay, and PTX treatment were found as significant risk factors for ROP in the logistic regression analysis. Conclusions In contrast to the experimental studies and also promising results of PTX treatment in some neonatal morbidities, it may be associated with increased incidence and stage of ROP.

Efficacy of water-based vitamin E solution versus placebo in the prevention of retinopathy of prematurity in very low birth weight infants: A randomized clinical trial.

Background:Vitamin E has antioxidant properties, which help in scavenging free radicals, thereby reducing oxidation of lipids and proteins. This study aims to evaluate the efficacy of oral vitamin E supplementation in preventing retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) and decreasing oxidative stress 15 and 28 days post-intervention.Methods:Ninety VLBW infants were randomly assigned to two groups:1.Treatment (treatment group (T), n = 48) or2.Placebo (control group (C), n = 42).Each group received 25 IU of vitamin E (T) or placebo (C).Results:The incidence of ROP in groups T and C was 12.5% (n=6) and 31% (n = 13), respectively (RR: 0.40; 95% CI: 0.10–0.96). There were no differences in mortality between groups. As expected, the vitamin E concentration was significantly increased 28 days post-intervention in group T.Conclusion:Oral supplementation with vitamin E may effectively prevent ROP development in VLBW infants with RDS. Oxidative damage markers were significantly lower, whereas total antioxidant capacity was increased in group T. However, levels of other antioxidants as vitamin A and C were not measured in two groups.

Incidence and Risk Factors for Retinopathy of Prematurity (ROP) in Biggest Neonatal Intensive Care Unit in Itay Elbaroud City, Behera Province, Egypt.

Aim of the WorkTo evaluate the incidence and risk factors for development of retinopathy of prematurity (ROP) in the biggest neonatal intensive care unit (NICU) in Itay Elbaroud City, Behera province, Egypt.MethodsWe studied data of 240 newly born infants with gestational age (GA) ≤34 weeks or birth weight (BW) ≤2000 g or infants with unstable course who were admitted to the biggest NICU in Itay Elbaroud City, Behera province, Egypt, between October 1, 2018 and October 31, 2020. There is no standard screening system in Egypt. Furthermore, we had screened babies more than 1500 g, more than 32 weeks and found signs of ROP, so we decided to expand our inclusion criteria to include babies up to 2000 g of birth weight and up to 34 weeks gestational age in addition to older and heavier babies with unstable course in NICUs. Clinical information about perinatal neonates was collected by reviewing medical charts. The main outcomes are the incidence and severity of ROP. The relationship of clinical risk factors and the development of ROP were analyzed.ResultsThe overall incidence of ROP was 34.1%, and the overall incidence of type 1 ROP was 26.3% of infants. ROP was significantly associated with GA (odds ratio; OR: 6.8; (3.7–12.3), BW (OR: 4.1; 2.3–7.3), apnea, supplementary oxygen administration, and thrombocytopenia.ConclusionThe incidence of ROP is high in Itay Elbaroud city, Behera Province, Egypt. Immaturity, low birth weight, low gestational age, oxygen administration, apnea, thrombocytopenia, and jaundice are important risk factors for development of ROP.

Correlation between systemic immune-inflammation index and routine hemogram-related inflammatory markers in the prognosis of retinopathy of prematurity

Purpose:To evaluate the prognostic potential of systemic inflammatory index in the course of retinopathy of prematurity (ROP).Methods:This is a retrospective case-control study. 303 infants with a gestational age of ≤35 weeks were screened with and without ROP at birth and 1 month after the birth of complete blood counts (CBC) were included in this study. Serum neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte (PLR), and systemic immune-inflammation index (SII) was calculated at birth and one month after. LMR was calculated by dividing the absolute lymphocyte count by the absolute monocyte count. NLR and PLR were determined by dividing the absolute neutrophil count or the absolute platelet count by the absolute lymphocyte count, respectively. The SII was calculated by the formula = neutrophilxplatelet/lymphocyte. All statistical analyses were performed using SPSS 22 (SPSS for Windows, version 22.0; SPSS, Inc. Chicago, IL, USA).Results:A total of 303 infants were included 145 with ROP and 158 without ROP. The NLR, LMR, PLR and SII values were 0.56 ± 1.17/0.51 ± 1.04 (P = 0.997), 13.7 ± 18/9.49 ± 13.1 (P = 0.014), 31.69 ± 68/24.1 ± 37.7 (P = 0.268), 131.42 ± 326/124.66 ± 267 (P = 0.935) in with ROP and without ROP infant at birth respectively. The NLR, LMR, PLR, and SII values were 0.68 ± 1.27/0.34 ± 0.99 (P = 0.001), 2.58 ± 6.01/2.46 ± 14.5 (P = 0.706), 47.5 ± 78.33/33.55 ± 42.4 (P = 0.035), and 253 ± 681/114 ± 345 (P = 0.001), respectively in with ROP and without ROP infant at 1 month after birth.Conclusion:The NLR, PLR, and SII seem an independent predictor of the development of ROP.

HYPERGLYCEMIAAS AN INDEPENDENT RISK FACTOR FOR RETINOPATHY OF PREMATURITY (ROP): A COHORT STUDY

OBJECTIVE: Retinopathy of prematurity (ROP) is a severe morbidity that can lead to blindness in premature babies. Neonatal hyperglycemia has been related to the growth of ROP in a variety of studies. However, there aren't many observational trials to show whether hyperglycemia is linked to ROP in the absence of other comorbidities. The aim of this research was to see if hyperglycemia in premature babies is linked to ROP in a different way. STUDY DESIGN: Premature infants (&lt;1500 g or⩽ 32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 hours daily for rst 7 , days of live. For any glucose reading &lt;50 or&gt;150 mg dl 1 serum sample was sent to the laboratory for conrmation. Hyperglycemia was dened as any blood glucose level⩾ 150 mg dl − 1. ROP patients were compared with non-ROP patients in a bivariate analysis. Variables signicantly associated with ROP were studied in a logistic regression model. RESULT:Atotal of 100 patients were enrolled with gestational age &lt;32weeks and birth weight &lt;1500g. Forty-eight patients (48%) were identied with hyperglycemia. On eye examination, 30 cases (30%) had ROP (19 with stage 1, 10 with stage 2 and 1 with stage 3). There were more cases of ROPin the hyperglycemia group compared with the euglycemia group (45.83% vs 15.38%, P = 0.007). Patients who developed ROP had signicantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all signicant variables, average blood glucose in the rst week of life was the factor independently associated with ROPwith an odds ratio of: 1.77 (95% condence interval: 1.08 to 2.86), P= 0.024 CONCLUSION: In a prospective cohort study of premature infants, elevated average blood glucose concentrations in the rst week of life is an independent risk factor associated with the development of ROP.

Haemoglobin Levels in Early Life among Infants with and without Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder attributed to an ischaemic stimulus in preterm infants. Haemoglobin, the main component for oxygen transportation, may be implicated in ROP development. This retrospective study compared the mean weekly haemoglobin levels between infants with and without ROP over the first six weeks of life. Premature infants of less than 32 weeks gestational age and less than 1.5 kg birth weight were grouped into age and birth weight-matched ROP cases and controls. Weekly mean haemoglobin levels were documented. An independent t-test was used to analyze the difference in mean haemoglobin levels between infants with ROP and infants without ROP. Adjustment for confounders was performed using one-way analysis of covariance. There was a statistically significant difference in adjusted mean haemoglobin levels between the ROP and non-ROP group during the first week of life (p = 0.038). No significant intergroup differences were observed at the other weeks. Haemoglobin monitoring during the first week of postnatal life may be useful to guide ROP screening in premature infants.

Lipid supplement reduced ROP in premature infants

Hellström A, Nilsson AK, Wackernagel D, Pivodic A, Vanpee M, Sjöbom U, et al. Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity: A Randomized Clinical Trial. JAMA Pediatr 2021:e205653. https://doi.org/10.1001/jamapediatrics.2020.5653 Among premature infants, what is the therapeutic benefit of supplemental arachidonic acid (AA) and docosahexaenoic acid (DHA), compared with no supplementation, in reducing the incidence of retinopathy of prematurity (ROP)? Randomized control trial. 3 centers in Sweden. Infants born <28 weeks' gestational age. AA:DHA vs none. Primary outcome: incidence of severe ROP (stage 3 and/or type 1 ROP). The treatment group demonstrated less ROP, 16 of 101 (15.8%) in the AA:DHA group vs 35 of 105 (33.3%) in the non-treatment group, absolute risk reduction 17.5% (6.0%-29.0%), number needed to treat 5.7 (3.5-16.6). There were no differences between the groups in bronchopulmonary dysplasia, intraventricular hemorrhage, sepsis, or death rates. AA:DHA reduced ROP development without increasing major morbidities.

Clinical features of premature twin babies with intersibling asymmetry of retinopathy of prematurity severity

ObjectiveTo report the clinical features of premature twin babies showing intersibling asymmetry in their severity of retinopathy of prematurity (ROP) and analyze risk factors associated with development of severe ROP between twin siblings with discordant ROP severity. MethodsA retrospective study of records of 105 premature twin pairs was conducted. The criteria for discordant ROP with an intersibling difference in ROP severity were as follows: (i) two or more stages of difference in ROP between siblings, (ii) one sibling having treatment-requiring ROP and the other having no ROP or ROP that regressed spontaneously, or (iii) one sibling having aggressive posterior ROP and the other having staged or no ROP. Twin siblings were classified into two groups according to the severity of ROP (no or less ROP and more severe ROP). We examined ocular features in twins having intersibling asymmetry of ROP and analyzed perinatal risk factors for ROP. ResultsOf 105 twin pairs, 32 pairs (30.5%) showed intersibling asymmetry of ROP severity, and 15 pairs (14.3%) showed ROP asymmetry in terms of need for ROP treatment. The development of more severe ROP was associated with longer duration of oxygen supplementation and greater frequency of total blood and packed red blood cell transfusion (p = 0.020, p = 0.045, and p = 0.036, respectively). Longer duration of oxygen supplementation remained a statistically independent risk factor of severe ROP using multivariate logistic regression analysis. ConclusionsOphthalmologists caring for premature infants should be aware of the variable courses and progressions of ROP between twin babies. Longer duration of oxygen supplementation and greater frequency of blood transfusions were associated with higher ROP severity in twins.

The prenatal phase of retinopathy of prematurity.

To explore the current literature on prenatal inflammation-associated risk factors for retinopathy of prematurity (ROP). Subjective summary of selected experimental and epidemiological publications that support the authors' central hypothesis that the aetiology of ROP begins before birth. Based on current evidence we suggest that, contrary to current aetiological models, the process of ROP development begins with a prephase in utero. This beginning is likely initiated by inflammatory responses that are associated with intrauterine infection. We propose a novel aetio-pathogenetic model of ROP and suggest that the effects of postnatal exposure to inflammatory stressors (resulting from infection or hyperoxia or both) as well as those of other pre- and postnatal contributors to the complex pathogenesis of ROP might be modified by the prenatal phase of the disease.

Prognostic Value Estimation of Monoamines Systemic Level in Retinopathy of Prematurity in Experiment.

The aim of the investigation was to study a systemic level of L-DOPA, dopamine, and norepinephrine, and assess their prognostic value in retinopathy of prematurity (ROP) development on an experimental disease model.Materials and MethodsThe investigation was carried out on infant Wistar rats (n=36) divided into a study group (rat infants with experimental ROP, n=17) and a control group (n=19). The animals of both groups were sacrificed on days 14, 21–23, and on days 28–30. The choice of the indicated periods corresponded to the key stages of ROP development in an experiment and was based on the findings of our previous histological studies. Dopamine, L-DOPA, and norepinephrine levels in infant rat blood plasma samples were determined.ResultsOn day 14 of the experiment (the period corresponds to the pathological neovascularization induction in the applied model and preclinical ROP in children), mean L-DOPA level in infant rats with ROP (0.31 ng/ml) was significantly decreased compared to that in the controls (0.42 ng/ml) (p≤0.01). On days 21–23 of the experiment (the period corresponds to the growth of pathological extraretinal neovascularization in the applied model and ROP stage 3 in children) the systemic level of L-DOPA was still statistically reduced in the study group (0.87 ng/ml) compared to the control group (1.53 ng/ml) (p≤0.01). On days 28–30 of the experiment (the period corresponds to the regress of neovasculature in the applied model and a spontaneous ROP regress stage in children) the L-DOPA level in blood plasma in the study group (0.33 ng/ml) showed an insignificant upward tendency in reference to the controls (0.21 ng/ml). Mean dopamine and norepinephrine levels had no difference in the groups under study of infant rats within all follow-up periods.ConclusionLow systemic level of L-DOPA at the preclinical stage of experimental ROP should be considered as a laboratory prognostic criterion of a developing pathological process; it will enable to use the criterion when working out the measures to optimize the existing screening system for the disease in children.

Evaluation of maternal factors for the development of retinopathy of prematurity

Background: Since Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, the identification of contributed risk factors is crucial. In recent years, great attention has been paid to maternal factors. The reason is that maternal factors can directly affect fetus via intrauterine hypoxia. However, the results of this studies are conflicting. The purpose of this study was to evaluate the effect of maternal factors on the development of ROP. Methods: In a prospective study, 150 premature infants with the gestational age of less than 32 weeks and birth weight of less than 1500 grams were examined. They divided into two groups based on ophthalmologic examination; those with ROP and those without ROP. Variables of study including maternal age, injection of corticosteroid in the last week of pregnancy, history of maternal diabetes mellitus, preeclampsia, hypertension, anemia, thyroid, renal, cardiovascular and rheumatologic diseases were compared between groups. Results: Forty-seven infants (31.33 %) had ROP. The mean age of gestational age was 27.89 weeks in ROP group and 29.06 weeks in non-ROP group. The mean birth weight was 1180.53 grams in ROP group and 1079.44 grams in non-ROP group. There were no statistically important differences regarding to maternal factors between two groups. Conclusion: The above mentioned maternal factors have no effect on the development of ROP.

Characteristics and associated factors of early refractive parameters in premature infants

Objective: To investigate the characteristics and associated factors of early refractive parameters in premature infants. Methods: Case-control study. Premature infants who underwent the first fundus screening in the ophthalmic clinic of Xiamen children's Hospital from May 2018 to February 2019 were collected. The screening time was 4 to 6 weeks after birth or corrected gestational age from 31 to 32 weeks. The premature infants who were diagnosed with mild retinopathy of prematurity (ROP) in one eye or both eyes but did not receive any treatment were divided into ROP group and divided into zone Ⅱ subgroup and zone Ⅲ subgroup according to the region of ROP; the premature infants without ROP were divided into non-ROP group. The gestational age, birth weight, spherical equivalent, anterior chamber depth, vitreous depth, axial length, lens thickness and corneal refractive power were recorded and compared. Independent sample t-test, multiple linear regression analysis and Pearson correlation analysis were used. Results: A total of 180 premature infants, 101 males and 79 females, with gestational age of (30.82±3.10) weeks, corrected gestational age of (37.21±1.44) weeks and birth weight of (1 577.85±572.12) g were included in this study. Ninety premature infants were included in the ROP group (162 eyes, of which 85 right eyes were included in the analysis) and 90 in the non-ROP group (90 right eyes). There was no significant difference in the distribution of gestational age, birth weight and corrected gestational age between the ROP group and non-ROP group (all P>0.05), but there was significant difference in the spherical equivalent between the two groups [(1.90±1.39) D vs. (3.04±1.88) D, t=-4.653, P<0.01], and ROP group was relatively smaller. In the ROP group, the anterior chamber depth was (1.82±0.23) mm, the lens thickness was (4.54±0.18) mm, and the corneal refractive power was (43.99±0.99) D. In the non-ROP group, the anterior chamber depth was (1.91±0.94) mm, the lens thickness was (4.23±0.50) mm, and the corneal refractive power was (43.72±0.92) D. The difference between the two groups was statistically significant (all P<0.01). In ROP group, the anterior chamber depth was shallower, the lens was thicker, and the corneal refractive power was higher. In ROP group, the corneal refractive power of 48 right eyes in zone Ⅱ subgroup and 37 right eyes in Zone Ⅲ subgroup were (43.92±0.78) D and (43.39±1.05) D respectively, and the spherical equivalent were (2.08±0.95) D and (2.52±1.12) D respectively. The corneal refractive power of zone Ⅱ subgroup was higher and the spherical equivalent was smaller, and the differences were statistically significant (all P<0.05). Multiple regression analysis showed that birth weight, gestational age and corneal refractive power were the influencing factors of spherical equivalent (P<0.01). The results of Pearson correlation analysis showed that the gestational age (r=0.182), birth weight (r=0.223) and corneal refractive power (r=-0.125) of premature infants were closely related to the spherical equivalent (all P<0.05). Conclusions: In premature infants, the larger spherical equivalent is related to greater gestational age and heavier birth weight. The refractive parameters of mild ROP are characterized by shallow anterior chamber, thick lens, high corneal refractive power and small spherical equivalent. The spherical equivalent is closely related to the development of ROP. (Chin J Ophthalmol, 2021, 57: 353-357).

English

BACKGROUND Retinopathy of prematurity (ROP) is one of the leading causes of ocular morbidity and mortality throughout the world. Prematurity, low–birth, and oxygen therapy are considered to be the common risk factors. The maldeveloped retina in those affected are very much prone to develop refractive error, neo-vasculopathy, and neurosensory detachment. The purpose of our study was to find out the incidence and ascertain the risk factors of retinopathy of prematurity among the neonates attending the sick neonatal care unit and OPD of Calcutta National Medical College &amp; Hospital. METHODS This is an institution based cross-sectional observational study conducted in the sick newborn care unit of a tertiary care hospital. Informed consent was obtained from the parents along with proper birth history. Indirect ophthalmoscopy with a + 20 dioptre (+ 20 D) lens with a paediatric scleral depressor was performed in each eye under the guidance of the neonatologist after pupillary dilatation. If either eye was found to have ROP, the baby was considered as an ROP case in the study and each eye was considered as a single case. RESULTS 50.27 % babies (N = 91) were delivered by Lower Uterine Segment Caesarean Section (LSCS) and 55. 24 % babies were &lt; 32 weeks of gestational age whereas 21.45 % (N = 39) babies were having &lt; 1500 gm birth weight. Phototherapy was needed in 50 % of the babies (N = 92) whereas hyperbilirubinemia was present in 59.66 % of total babies. Bradycardia, apnoea, and sepsis were present in 29.83 % (N = 54), 25.41 % (N = 46), 41.98 % (N = 76) of the babies respectively. When compared in the two independent groups (ROP present and absent), low gestational age and low birth weight of the babies were found to be statistically significant (P &lt; 0.05) for the development of ROP. After adjusting with different factors in the regression model we have found that low birth weight and oxygen therapy after birth were statistically significant with the development of ROP (P &lt; 0.05). CONCLUSIONS ROP screening, specifically for those babies with low-birthweight, low gestational age, and those who received oxygen therapy for other systemic reasons, is mandatory to have an early diagnosis and treatment done. KEYWORDS ROP, Low-Birthweight, Gestational Age, Oxygen Therapy

Incidence and Risk Factors Associated with Retinopathy of Prematurity in Peru.

PurposeThe purpose of this research is to determine retinopathy of prematurity (ROP) prevalence and possible risk factors associated with ROP development in newborns admitted to a neonatal unit of a Peruvian National Reference Hospital.Patients and MethodsThis retrospective study included 216 preterm infants. The data were collected between January 2016 and December 2018. All infants were examined according to Peruvian guidelines for screening and treatment of ROP. The association of clinical risk factors and the development of ROP was analyzed and predictive factors were determined.ResultsThe study subjects were 216 preterm infants of which 72 had some stage of ROP (32 stage 1; 23 stage 2 and 17 stage 3) and 144 preterm infants without ROP. The incidence of ROP in preterm infants less than 32 weeks was 60.9%, while for those weighing less than 1500 g it was 71.6%. The factors associated with ROP were gestational age below 32 weeks, birth weight below 1500 grams, neonatal sepsis, oxygen therapy, mechanical ventilation, hyaline membrane disease, bronchopulmonary dysplasia, persistence of ductus arteriosus and intraventricular hemorrhage. Exclusive breastfeeding was found to play a protective role against ROP. Binary logistic regression analysis found that only gestational age below 32 weeks (OR, 2.637; 95% CI, 1.04–6.69), weight below 1500 grams (OR, 4.377; 95% CI, 1.75–10.92), neonatal sepsis (OR, 6.517; 95% CI, 2.81–15.14), vaginal delivery (OR, 3.748; 95% CI: 1.54–9.14), and the presence of hyaline membrane disease (OR, 3.58; 95% CI, 1.47–8.74) are predictors of ROP.ConclusionThe incidence of ROP among very low birth weight infants was 71.6%. Infants with weight below 1500 grams, neonatal sepsis, presence of hyaline membrane disease whose mother had vaginal delivery are at risk for the development of ROP. Thus, preventing premature births and encouraging exclusive breastfeeding are two main ways to prevent ROP.

The Protective Effects of Endogenous PACAP in Oxygen-Induced Retinopathy

Pituitary adenylate cyclase–activating polypeptide (PACAP) is a neuropeptide having trophic and protective functions in neural tissues, including the retina. Previously, we have shown that intravitreal PACAP administration can maintain retinal structure in the animal model of retinopathy of prematurity (ROP). The purpose of this study is to examine the development of ROP in PACAP-deficient and wild-type mice to reveal the function of endogenous PACAP. Wild-type and PACAP-knockout (KO) mouse pups at postnatal day (PD) 7 were maintained at 75% oxygen for 5 consecutive days then returned to room air on PD12 to develop oxygen-induced retinopathy (OIR). On PD15, animals underwent electroretinography (ERG) to assess visual function. On PD16, eyes were harvested for either immunohistochemistry to determine the percentage of the central avascular retinal area or molecular analysis to assess angiogenesis proteins by array kit and anti-apoptotic protein kinase B (Akt) change by western blot. Retinas of PACAP-deficient OIR mice showed a greater central avascular area than that of the wild types. ERG revealed significantly decreased b-wave amplitude in PACAP KO compared to their controls. Several angiogenic proteins were upregulated due to OIR, and 11 different proteins markedly increased in PACAP-deficient mice, whereas western blot analysis revealed a reduction in Akt phosphorylation, suggesting an advanced cell death in the lack of PACAP. This is the first study to examine the endogenous effect of PACAP in the OIR model. Previously, we have shown the beneficial effect of exogenous local PACAP treatment in the rat OIR model. Together with the present findings, we suggest that PACAP could be a novel retinoprotective agent in ROP.

Retinopathy of prematurity incidence and treatment modalities in moderate and late preterm infants: a study from two tertiary centers

ObjectiveThe aim of this study was to evaluate the incidence, severity, and treatment modalities of retinopathy of prematurity (ROP) in moderate and late preterm infants with a gestational age (GA) >31 + 6 weeks. MethodsROP screening results of preterm infants with GA >31 + 6 weeks to 36 + 6 weeks between March 2013 and January 2019 were evaluated retrospectively. Infants were divided into 2 groups according to GA as 32–33 + 6 weeks (moderate preterm) and 34–36 + 6 weeks (late preterm). In these groups, any ROP and severe ROP (requiring treatment) development rates and ROP types and treatment modalities were evaluated. ResultsA total of 4156 preterm infants, 1875 (45.1%) female and 2281 (54.9%) male, were included. Overall, 1466 (35.2%) of the infants were moderate preterm and 2690 (64.8%) were late preterm. The incidences of any ROP and severe ROP were 22% and 2.5%, respectively. The rate of severe ROP was 5.3% in moderate preterm infants and 0.9% in late preterm infants. Significant correlations were determined between duration of hospital stay, birth weight (BW), and GA with ROP development (r = +0.415, r = −0.258, r = −0.199, respectively; p < 0.001 for all). Of 102 patients (2.5%) requiring treatment, 64 (62.7%) had laser, 34 (33.3%) had intravitreal bevacizumab (IVB), 2 (1.9%) had sequential IVB and laser, and 2 (1.9%) had vitreoretinal surgery. ConclusionROP seems to still be an important health problem in moderate and late preterm infants in our country according to data from screening high-risk preterm infants with a GA >31 + 6 weeks. In this cohort, ROP development correlates with GA, BW, and duration of hospitalization significantly.