Retinopathy Of Prematurity Examinations Research Articles

Timing and Substrate of Enteral Feeding as Risk Factors for Developing Retinopathy of Prematurity

Objective Enteral feeding has advantages over parenteral nutrition, so the objective is to evaluate the effects of timing and substrate of enteral feeding on the risk of developing retinopathy of prematurity (ROP). Study Design Retrospective cohort study of 7,483 premature infants undergoing ROP examinations at 29 North American and Canadian hospitals, 2006–2012 (The G-ROP Study). Multivariable regression evaluated associations between enteral feeding by week of life and any or severe ROP, adjusting for birth weight and gestational age. Results 3,224 (43.1%) had ROP and 931(12.4%) severe ROP. Compared to no enteral feeding, any enteral feeding was independently protective for ROP in all weeks 1–6; odds ratios 0.50–0.74 ( P < .0001 to P < .02) for any ROP and 0.43–0.59 ( P < .02 to P = .0001) for SEVERE ROP. Conclusion In this cohort, any substrate of enteral feeding during each of the first SIX weeks of life was associated with lower odds of ROP and severe ROP.

Frequency and risk factors of retinopathy of prematurity: a 5-year single-center study in a Tertiary Care Hospital

Aim Our study aimed to determine the frequency of retinopathy of prematurity (ROP) in a cohort of premature infants screened for ROP, to confirm the efficacy of our screening program used in the NICU to avoid childhood blindness. In addition, we aimed to study the associated risk factors affecting ocular status including birth weight (BW), gestational age (GA), mechanical ventilation, length of intensive care unit (ICU) stay, and number of ROP follow-up. Methods This was a retrospective cohort study conducted from March 2016 to March 2021. Data were retrieved from the records of preterm infants admitted to the neonatal intensive care unit in King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The included data: Comprised perinatal data such as sex, BW, GA, multifetal gestation, and delivery type. Neonatal course: Need for surfactant, oxygen therapy, and mechanical ventilation (MV) duration. Neonatal complications: Chronic lung diseases [(respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD)], sepsis, neonatal jaundice, patent ductus arteriosus (PDA), hydrocephalus, and intraventricular hemorrhage (IVH). ROP examination: stage, zone, plus disease, extent, treatment, and number of the follow-up. Results In all, 337 preterm infants met the screening criteria and were included in the study. The majority (52%, n=177) were male; 148 (43.9%) were products of multifetal gestation, the mean GA was 29.35±2.77, and the median BW was 1195.1±338 gm. Caesarean section was the main mode of delivery in 80.5% of our sample (269 babies). ROP was detected in 181 (53.7%) infants, of which 110 (32.6%) had Stage 1, 57 (17%) Stage 2, and 14 (4.15%) had Stage 3. The majority (89.4%) were involved in zone 2–3, and five patients had the plus disease (1.48%). The number of ROP follow-up ranged between 2 and 25 visits either in the NICU or in the eye clinic following their discharge with a mean of 2.347. Conclusion The incidence of ROP in our sample was high relative to other local studies, which was related to the relatively high number of multifetal gestations with high chance of low birth weight as our center is an expert facility in in vitro fertilization. Male patient had a high incidence of development of different stages of ROP. Preterm babies with complicated neonatal course like NEC, Chronic Lung Disease, and IVH had high incidence of development of ROP.

Prevalence of strabismus in premature infants in an age-related perspective.

was to investigate the prevalence of strabismus in premature infants; to identify diagnostic indicators for predicting strabismus at the age of 3-8 years. The material was the data of 84 premature infants who underwent ophthalmological examination at the age of 6 months - 3 years and again - at 3-8 years. All children underwent ophthalmic examination for retinopathy of prematurity (ROP) in infancy. An increase in the frequency of strabismus occurrence among preterm infants was observed in 3-8 years compared to the data from 6 months - 3 years - from 13.3% to 20.0% in children without ROP, from 5.9% to 23.5% in children with self-resolving ROP, from 22.7% to 45.5% in children with ROP after laser retinal photocoagulation. The presence of strabismus and structural changes of eye at ages 6 months - 3 years increase the risk of strabismus at ages 3-8 years, OR = 6.5 (95% CI 3.8-11.3), (p < 0.001); OR = 4.2 (95% CI 2.8-6.2), (p = 0.005). The increase in the risk of developing strabismus at ages 3-8 years is associated with the presence of anisometropia, (p = 0.047), amblyopia, (p < 0.05). Children with higher visual acuity at ages 3-8 years have a decreased risk of strabismus, (p < 0.05). The frequency of strabismus occurrence among preterm infants has increased by ages 3-8 years. Strabismus, structural changes of eye at ages 6 months - 3 years increases the risk of strabismus at ages 3-8 years. Anisometropia and amblyopia increase in the risk of strabismus, higher visual acuity decreases risk of strabismus.

Determinants of compliance with outpatient examinations for infants at risk for retinopathy of prematurity

PurposeTo assess the level and the determinants of compliance with outpatient retinopathy of prematurity (ROP) examination appointments at a tertiary academic center. MethodsThe medical records of babies scheduled for outpatient ROP examination between January 1, 2022, and December 31, 2022, were reviewed retrospectively. Data collected included appointments scheduled and attended, birth weight, gestational age, ROP staging at discharge, maternal ethnicity (self-identified), household type, proximity to hospital and median family income (US Census based on home zip codes). Univariate and multivariable analyses were performed. A P value of <0.05 was considered significant. ResultsThe records of 66 babies were analyzed. Forty-nine babies (74%) attended all scheduled ROP examination appointments (fully compliant). The mean appointment compliance rate was 86%, with a 1.5% no-show rate. Seven children (11%) required the intervention of Child Protective Services. One baby was never seen in the clinic. In unadjusted analysis, maternal ethnicity (P = 0.028) and median family income lower than the national average (P = 0.049) were sociodemographic factors associated with lower compliance. Clinical factors associated with lower compliance were lower gestational ages (P = 0.005) and lower birth weight (P = 0.006). In multivariable logistic regression adjusting for all candidate predictors, only birth weight remained significantly associated with lower compliance (P = 0.036). ConclusionsClinical and sociodemographic factors may be associated with compliance with outpatient ROP examination recommendations. Extremely low-birth-weight babies were at the greatest risk for noncompliance.

Outcomes for non-treatment-requiring infants evaluated for retinopathy of prematurity

To evaluate the rates of visually significant disorders in patients without treatment-requiring retinopathy of prematurity (ROP) at initial follow-up after completion of ROP examinations. The medical records of all babies evaluated for retinopathy of prematurity between June 2015 and September 2020 were reviewed. Patients with documented gestational age, birth weight, and single versus multiple birth status who did not require ROP treatment and who followed-up with our institution's pediatric ophthalmologist were included. A total of 304 patients were included. Of these, 15 (4.9%) had strabismus (12 [4.0%] with esotropia, 3 [0.9%] with exotropia), 30 (9.9%) had myopia, 174 (57.2%) had hyperopia, 54 (18%) had astigmatism, 4 (1.3%) had amblyopia, 5 (1.6%) were labeled amblyopia suspects, 1 (0.3%) had congenital glaucoma, and 1 (0.3%) had congenital cataract. Nineteen (6.3%) had a condition requiring intervention at the first evaluation following completion of ROP examinations, and in 5 (2%), this was a condition that would typically not have been identified without evaluation by a pediatric ophthalmologist. In our population of infants evaluated for retinopathy of prematurity who did not require ROP treatment, the incidence of other ocular disorders requiring intervention at the first non-ROP evaluation was about 6%. This study highlights the need for further research that may aid in the creation of an evidence-based follow-up strategy for premature infants who never undergo ROP treatment.

The possible effect of light exposure reduction via eye patches after the examination for retinopathy in premature infants? An observational study in preterm neonates

Objectives: This study aimed to examine whether infants with and without eye patches differ in terms of vital signs and clinical status after retinopathy of prematurity examination. Methods: Premature infants hospitalized in study center between June 2021-April 2022 were included. Group 1 is consisted of infants whose eyes were not closed after retinopathy of prematurity examination. Those infants whose eyes were closed eye-patches consisted of group 2. Vital signs were followed for 24 hours following the examination. Demographic, medical and follow-up data were all recorded prospectively. Vital signs were evaluated in accordance with birth week and weight. Pain score was evaluated by Neonatal Pain, Agitation, and Sedation Scale. Results: Pain scores were found to be lower in group 2 (p &amp;lt; 0.020). Although the systolic blood pressure, diastolic blood pressure, and mean blood pressure values of group 2 were found to be lower than group 1, they were within normal limits (all p &amp;lt; 0.05). Vomiting was not observed at all in Group 1 (p = 0.036). There was no significant difference between the groups in terms of fever, respiratory rate, heart rate, SpO2, and blood glucose values. Conclusions: This study showed that using an eye patch in infants after an eye examination reduces pain and increases comfort of infants. Although their pain scores are lower, taking necessary precautions are recommended for these patients in terms of vomiting. Thus, eye patches can be suggested as a non-pharmacological pain-reducing method after get advanced stagnation by the support of more studies with a larger number of participants.

The effects of mydriatic eye drops on cerebral blood flow and oxygenation in retinopathy of prematurity examinations.

Mydriatic eye drops used during retinopathy examination have been associated with cardiovascular, respiratory, and gastrointestinal side effects. The aim of our study was to investigate the effects of the drops used for pupil dilatation on cerebral blood flow and cerebral oxygenation. The study included 62 infants who underwent retinopathy screening exams. Vital signs, heart rate (HR), arterial oxygen saturation (SpO2), and mean arterial pressure (MAP) were recorded. Cerebral oxygenation and middle cerebral artery blood flow velocity were evaluated using near-infrared spectroscopy (NIRS) and Doppler ultrasonography, respectively, and the cerebral metabolic rate of oxygen (CMRO2) was also calculated. The mean gestational age of the infants included was 31.29 ± 1.42weeks, and the mean birth weight was 1620 ± 265g. Heart rate was found to be significantly decreased after mydriatic eye drop instillation; however, there were no significant differences regarding blood pressure and oxygen saturation levels (HR: p < 0.001; MAP: p = 0.851; SpO2: p = 0.986, respectively). After instillation while cerebral regional oxygen saturation (rScO2) measurements were significantly decreased at the 60th minute (p = 0.01), no significant difference was found in Vmax and Vmean of MCA before and after mydriatic eye drop instillation (p = 0.755, p = 0.515, respectively). Regarding CMRO2 measurements, we also did not find any statistical difference (p = 0.442). Conclusion:Our study has shown that although eye drops may affect heart rate and regional cerebral oxygen saturation, they do not alter cerebral blood flow velocities and metabolic rate of oxygen consumption. Current recommendations for mydriatic eye drop use in retinopathy exam appear to be safe. What is Known: • Mydriatic eye drop installation is recommended for pupil dilatation during ROP screening exams. • It's known that mydriatics used in ROP examination have affects on the vital signs, cerebral oxygenation and blood flow. What is New: • This is the first study evaluating the changes in cerebral oxygenation and blood flow velocity after mydriatic drop instillation using NIRS and Doppler US concomitantly. • While the eye drops may affect heart rate and regional cerebral oxygen saturation, they do not alter cerebral blood flow velocities and metabolic rate of oxygen consumption.

Outbreak of adenovirus D8 in a neonatal intensive care unit involving multiple simultaneous transmission pathways

Adenovirus (ADV) outbreaks in neonatal intensive care units (NICU) can lead to durable transmission and serious adverse outcomes. This study describes the investigation and control of an ADV-D8 outbreak in an NICU, associated with ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. Cases were observed in neonates, parents and nurses. The outbreak investigation was performed including sampling patients, parents and health care workers as well as the environment for molecular detection of ADV DNA. The investigation was also conducted in the guest house where some parents were temporary residents. A retrospective cohort study focused on neonates hospitalized during the epidemic period to assess the risk associated with ROP examination. Fifteen cases were identified in neonates; all but one presented with conjunctivitis. Two healthcare workers and 18 parents acquired conjunctivitis. ADV DNA was identified on the RetCam and on the freezer shared by parents. All ADV-positive samples were typed as ADV-D8. ADV infections occurred more frequently in neonates who had ROP examinations (37.8% (14/37) vs (0.9% (1/110); P<0.001) (relative risk 41.6; (5.7-305.8)). The RetCam was disinfected between two examinations using a disinfectant that was virucidal on ADV after a 30-min contact. This outbreak was significantly associated with ROP examination with a RetCam that had a disinfection protocol ill-adapted to rapid patient turnover. In addition, nosocomial transmission via the parents to neonates and parent-to-parent transmission is likely to have played a role in the dissemination of cases. No further cases were observed after the new disinfection procedure was enforced.

Skin conductance measurement as a selective and continuous pain assessment method during eye examinations for retinopathy of prematurity

BackgroundAssessing and managing pain in newborns is important for normal development and reduction of morbidity. AimTo assess whether skin conductance measurements (SCM) can be used as an objective method for measuring procedural pain during screening for retinopathy of prematurity (ROP) in preterm infants and to identify painful components of the examination. Methods65 separate SCM were performed in 33 infants born at <32 weeks gestational age (wGA) eligible for ROP screening (median 26+4 wGA, range 23+3 to 31+3; median weeks postmenstrual age 37+2, range 31+0 to 49+6). SCM was measured before, during and after eye examination (fundoscopy and/or wide-field digital retinal imaging [WFDRI]), and compared to changes in heart rate (HR), pulse oximetry saturation (SpO2) and behavioral state measured with the Neonatal Pain, Agitation and Sedation Scale (N-PASS). ResultsA major increase of SCM could be seen during both fundoscopy and WFDRI (p<0.01, respectively). No correlation was found between SCM and wGA. N-PASS changed significantly during ROP examination (p<0.01). While N-PASS could only distinguish painful response from baseline during fundoscopy and WFDRI, SCM detected responses during each stage of the investigations i.e. the application of mydriatics, fundoscopy, anesthetic drops, speculum and WFDRI. HR increased only during digital retinal imaging (p = 0.049), while SpO2 decreased only during fundoscopy (p = 0.042). ConclusionSCM may be used as a continuous and objective method to evaluate pain and its intensity during screening for ROP, enabling the separation of the different painful components of the investigation. Selecting and grading the different painful stages improves the possibility to assess and continue to improve pain management more specifically in these patients.

The role of informational videos in parental education concerning retinopathy of prematurity examinations

To assess the effectiveness of educational videos in improving parental experience and understanding of the retinopathy of prematurity (ROP) examination and the importance of timely follow-up. A prospective nonrandomized study was conducted with the parents of 142 patients who received ROP examinations. The analysis compared two groups of parents. Parents in the video group viewed two educational videos about the ROP examination created at our institution that explained the purpose and importance of the examination and timely follow-up. The second (control) group only received standard print materials on ROP examinations. Surveys evaluating parent satisfaction, preparedness, and understanding of follow-up were administered to all participating parents at their first outpatient appointment. The χ2 and t tests were used to determine differences between the groups. Parents in the video group were more likely to state that the ophthalmologist spoke to them regarding results of the eye examination (P = 0.027), report that staff explained how the examination would be performed (P = 0.003), report being very satisfied (P = 0.011), and demonstrate increased knowledge of the necessity of the examinations (P = 0.018) compared with the print-only group. In our study cohort, use of educational videos increased parental knowledge, preparedness, and satisfaction.

Photographic Gel Artifact Simulating International Classification of Retinopathy of Prematurity Notch: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Report no. 16

To report a series of fundus photographs taken for retinopathy of prematurity (ROP) screening that contain artifacts with imaging characteristics mimicking a notch, a recently refined classification metric in the International Classification of Retinopathy of Prematurity, third edition. Retrospective case series. Infants requiring ROP screening in neonatal intensive care units from the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) and TeleROP telemedicine screening programs. Preterm infants meeting ROP examination criteria were screened with 130° wide-angle imaging systems. The images were taken by a trained nurse in the neonatal intensive care unit and transferred to an ROP specialist using a Health Insurance Portability and Accountability Act-compliant picture archiving and communication system for interpretation. Presence of an artifact that appeared consistent with a notch. We identified a total of 17 cases in ROP screening with artifact findings that had imaging characteristics similar to a notch. The artifactual appearance of the pseudo-notch was created by the camera illumination system within the gel-lens interface when the lens was not well apposed to the cornea. In telemedicine screening for ROP, we present fundus images of eyes with a pseudo-notch appearance; review of overlapping images can help differentiate between notch and artifact. Pediatric retinal specialists need to be aware that artifacts play a confounding role in screening for ROP, that can be mitigated through the use of overlapping and redundant images. Proprietary or commercial disclosure may be found after the references.

Effects of fentanyl and sucrose on pain in retinopathy examinations with pain scale, near-infrared spectroscopy, and ultrasonography: a randomized trial.

This study aimedto compare the efficacy of intravenous, intranasal fentanyl and oral sucrose inreducing the pain response during retinopathy of prematurity examinations using premature infant pain profile (PIPP) scores. The study included 42 infants who underwent retinopathy screening examinations. The infants were divided into three groups: oral sucrose, intranasal fentanyl, and intravenous fentanyl. Vital signs (heart rate, arterial oxygen saturation, and mean arterial pressure) were recorded. The PIPP was used to determine pain severity. Cerebral oxygenation and middle cerebral artery blood flow were evaluated using near-infrared spectroscopy and Doppler ultrasonography, respectively. The data obtained were compared between groups. There was no significant difference between the three groups regarding postconceptional and postnatal ages or birth weights and weight at the time of examination. All babies had moderate pain during the examination. No correlation was observed between analgesia method and pain scores (P = 0.159). In all three groups, heart rate and mean arterial pressure increased, whereas oxygen saturation decreased during the exam compared with pre-examination values. However, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation (sPO2) values did not differ between groups (HR, P = 0.150; MAP, P = 0.245; sPO2, P = 0.140). The cerebral oxygenation (rSO2) values between the three groups were found to be similar [rSO2: P = 0.545, P = 0.247, P = 0.803; fractional tissue oxygen extraction (FTOE): P = 0.553, P = 0.278]. Regarding cerebral blood flow values, we also did not find any difference between the three groups [mean blood flow velocity (Vmean): P = 0.569, P = 0.975; maximum flow velocity (Vmax): P = 0.820, P = 0.997]. Intravenous and intranasal fentanyl and oral sucrose were not superior to each other in preventing pain during the examination for retinopathy of prematurity (ROP). Sucrose may be a good alternative for pain control during ROP examination. Our findings suggest that ROP exam may not affect cerebral oxygenation or cerebral blood flow. Larger scale studies are needed to determine the best pharmacological option to reduce pain during ROP exams and evaluate the effects of this procedure on cerebral oxygenation and blood flow.

Efficacy of Oral Dextrose versus Acetaminophen versus Placebo on Pain Relief during Retinopathy of Prematurity Eye Examinations: A Randomized, Double-Blind Controlled Clinical Trial.

To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination. In this prospective randomized, double-blind controlled clinical trial study performed in the ophthalmology clinic of Shafa Hospital (referral hospital for eye disease), Kerman, Iran, 105 premature neonates with birth weight ≤2000 g and gestational age between 28 and 34 weeks were studied. Pain score measurement with Premature Infant Pain Profile-Revised (PIPP-R) during ROP examination in three intervention groups, acetaminophen group (15 mg/kg oral acetaminophen), dextrose group (one cc of oral dextrose 50%), and placebo group (one cc of distilled water), was done. Out of 105 infants, 33 infants received acetaminophen drops, 35 infants received dextrose drops, and 37 infants received placebo. The mean pain score of the group receiving acetaminophen was 11.39, dextrose 12.17, and placebo 11.54. The acetaminophen group had a lower average PIPP-R score. This difference was not significant between the three groups (P = 0.38). Acetaminophen and dextrose in comparison with distilled water did not show a significant difference in reducing neonatal pain during ROP examinations. However, the PIPP-R score in the acetaminophen group was lower compared to the other groups.

Risk of Retinopathy of Prematurity Among Preterm with Neonatal Sepsis in a Tertiary Care Hospital a Prospective Study

Objective: To determine the risk of retinopathy of prematurity (ROP) among preterm with and without sepsis admitted in a neonatal intensive care unit of a tertiary care hospital of Karachi, Pakistan. Methodology: In this prospective cross-sectional study conducted at Aga Khan University Hospital from October 2021 to March 2022. All the preterm born at gestation &lt;32 weeks with birth weight of &lt;1.5kg and were &lt;28 days old of either gender was included. Examination for ROP was performed. Information about maternal and neonatal confirmed sepsis, risk factors predisposing to sepsis, ROP status were noted. Babies were followed in the outpatient clinics. The first examination was performed at 28th days and was subsequently followed at one or two week’s interval as per the Ophthalmologist. Results: Of 125 neonates, the mean age was 4.34 ±0.79 weeks. There were 72 (57.6%) males and 53 (42.4%) females. Stage 0 and 1 were most common stages reported as 49 (39.2%) and 55 (44%) neonates respectively. Zone 1 disease was observed in 15 (12.0%) whereas ROP plus disease in 7 (5.6%) neonates. Neonates with ROP stage &lt;2 had significant association with maternal risk factors for sepsis (p-value 0.026), neonatal risk factors for sepsis (p-value 0.047), and neonatal culture proven sepsis (p-value 0.010). Similarly, zone 1 disease had a significant association with presence of maternal risk factors for sepsis (p-value 0.033), neonatal risk factors for sepsis (p-value 0.045), and antibiotics taken &gt;48 hours (p-value 0.027). Conclusion: A considerably higher risk of ROP was observed among hospitalized neonates with neonatal sepsis. Keywords: Neonates, sepsis, retinopathy of prematurity, Preterm

G-ROP criteria for predicting retinopathy of prematurity among neonates with different birth weight percentiles

The Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study showed that adding postnatal weight gain to birth weight and gestational age detected 100% of cases with type 1 retinopathy of prematurity (ROP) while reducing the ROP examinations by 30%. The purpose of this study was to investigate whether being small for gestational age (SGA) affects the sensitivity and specificity of the G-ROP model. We applied the G-ROP criteria for premature infants. The infants were classified as three subgroups: SGA, appropriate for gestational age (AGA), and large for gestational age (LGA). The performance of G-ROP criteria was assessed for each group for ROP. There were 41 (10.5%) SGA, 312 (80%) AGA, and 37 (9.5%) LGA neonates. Twenty-six (6.7%) neonates were treated for ROP, and the G-ROP model identified all of them. The sensitivity of the model for treatment-requiring ROP (TR-ROP) was found to be 100% in the whole patient group and for each subgroup. The specificity for TR-ROP was 46.4% for the whole group, 50% for SGA, 44% for AGA, and 63.6% for LGA. By applying the G-ROP model, the number of ROP examinations could be reduced by 25% for the whole group, 27% for SGA, 24% for AGA, and 31% for LGA, without missing TR-ROP. The sensitivity and specificity of the G-ROP model for TR-ROP in SGA infants were similar to the whole group. The model did not miss any cases of TR-ROP.

Association of Optical Coherence Tomography–Measured Fibrovascular Ridge Thickness and Clinical Disease Stage in Retinopathy of Prematurity

Accurate diagnosis of retinopathy of prematurity (ROP) is essential to provide timely treatment and reduce the risk of blindness. However, the components of an ROP examination are subjective and qualitative. To evaluate whether optical coherence tomography (OCT)-derived retinal thickness measurements at the vascular-avascular junction are associated with clinical diagnosis of ROP stage. This cross-sectional longitudinal study compared OCT-based ridge thickness calculated from OCT B-scans by a masked examiner to the clinical diagnosis of 2 masked examiners using both traditional stage classifications and a more granular continuous scale at the neonatal intensive care unit (NICU) of Oregon Health & Science University (OHSU) Hospital. Infants who met ROP screening criteria in the OHSU NICU between June 2021 and April 2022 and had guardian consent were included. One OCT volume and en face image per patient per eye showing at least 1 to 2 clock hours of ridge were included in the final analysis. Comparison of OCT-derived ridge thickness to the clinical diagnosis of ROP stage using an ordinal and continuous scale. Repeatability was assessed using 20 repeated examinations from the same visit and compared using intraclass correlation coefficient (ICC) and coefficient of variation (CV). Comparison of ridge thickness with ordinal categories was performed using generalized estimating equations and with continuous stage using Spearman correlation. A total of 128 separate OCT eye examinations from 50 eyes of 25 patients were analyzed. The ICC was 0.87 with a CV of 7.0%. Higher ordinal disease classification was associated with higher axial ridge thickness on OCT, with mean (SD) thickness measurements of 264.2 (11.2) μm (P < .001), 334.2 (11.4) μm (P < .001), and 495.0 (32.2) μm (P < .001) for stages 1, 2, and 3, respectively and with continuous stage labels (ρ = 0.739, P < .001). These results suggest that OCT-based quantification of peripheral stage in ROP may be an objective and quantitative biomarker that may be useful for clinical diagnosis and longitudinal monitoring and may have implications for disease classification in the future.

Effect of Topical Anesthesia on Reducing Pain Associated with Mydriatic Eye Drops during Retinopathy of Prematurity Screening

Introduction: The study aimed to investigate the effectiveness of topical anesthetic drops in reducing the pain associated with mydriatic eye drops prior to the retinopathy of prematurity (ROP) examination. Methods: Premature infants who underwent first-time ROP examinations in an outpatient setting were included in this randomized controlled trial. The study group included the infants who were administered topical anesthesia prior to the first mydriatic drops, and the control group included the infants who were given preservative-free artificial tear drops. Pain assessment was performed using the premature infant pain profile (PIPP). Results: A total of 66 infants, 35 in the control group and 31 in the study group, were included in the study. The PIPP scores of the infants during the first, second, and third mydriatic drops were 5.3 ± 2.0; 4.9 ± 1.7; and 4.0 ± 1.8, respectively, in the study group and 5.3 ± 1.7; 5.6 ± 1.8; and 4.6 ± 1.8, respectively, in the control group. No significant difference was found in the scores between the two groups. The PIPP score after the third drop was significantly lower than that after the second drop in the control group, and the PIPP score after the third drop was significantly lower than that obtained after the first and second drops in the study group. Discussion/Conclusion: This study showed no significant benefit of the topical anesthetic drop in the prevention of pain associated with mydriatic eye drops. The decrease in the pain response observed in repeated administrations is a novel finding.

The role of hepatic and renal functions in the development of retinopathy of prematurity: Is proteinuria a new risk factor?

To investigate the association of hepatic and renal parameters with the development of retinopathy of prematurity (ROP) in premature infants with a gestational age ≤ 32weeks. Medical records of 240 preterm infants were reviewed retrospectively, 85 of them were grouped as type 1, type 2 ROP, and control group. The 4th week hepatic and renal function test results of the groups, on the day of their first ROP examinations, were compared for the risk of development of ROP and the development of type 1 ROP. In this study, 12, 35, and 38 infants were enrolled in the type 1, type 2 ROP, and control group, respectively. The average gestational age and birth weight were higher; however, the duration of oxygen treatment was lower in the control group (p < 0.001). The blood glucose level was significantly higher in the type 1 ROP group than in the other groups (p = 0.023). The mean of total serum bilirubin of the type 1 ROP group was significantly lower than those of the type 2 ROP and control group (p = 0.032). Proteinuria was present in 85.7% of preterms with treatment-requiring ROP and proteinuria increased the risk of ROP by 3.9 times (OR with 95% CI 3.9 (1.19-12.75), p = 0.042). We found significantly higher blood glucose and lower total bilirubin level in the type 1 ROP group. Moreover, our findings suggest that proteinuria may not be only a comorbidity factor but also related to a higher frequency of ROP and type 1 ROP in preterm infants.

Neonatal vital signs using noncontact laser speckle contrast imaging compared to standard care in retinopathy of prematurity screening

The current standard screening for retinopathy of prematurity (ROP), indirect ophthalmoscopy (IO), is widely considered to induce physiologic stress in infants.1-3 This study aims to characterize the stress associated with ROP examination by assessing changes in vital signs during standard examination and XyCAM, a new noninvasive retinal imager that utilizes laser speckle contrast imaging (LSCI) to capture information on ocular blood flow dynamics without directly contacting the eye. We tested the hypothesis that LSCI examination will cause less physiologic stress to the infants as indicated by more stable heart rate, respiratory rate, and oxygen saturation.

The role of informational videos in parental education concerning retinopathy of prematurity examinations

Increased parental involvement in care of their preterm infants has led to a need for improved information delivery. This study examines the usefulness of educational videos in preparing parents for their infant’s ROP examination over print materials.