Retinopathy Of Prematurity Stage Research Articles

Comparison of RetCam and Smartphone-Based Photography for Retinopathy of Prematurity Screening.

This study aimed to compare the clinical performance between a smartphone-based fundus photography device and a contact imaging device for retinopathy of prematurity (ROP) screening. All patients were first examined with binocular indirect ophthalmoscopy (BIO), which served as the reference standard. The patients were then assessed by two devices. Imaging quality, ability to judge the zone and stage of ROP, agreement with the BIO results, vital signs, and pain scores were compared between these two devices. In total, 142 eyes of 71 infants were included. For the smartphone-based fundus photography, image quality was graded excellent or acceptable in 91.4% of examinations, although it was still significantly inferior to that of the contact imaging device (p < 0.001). The smartphone-based fundus photography images had moderate agreement with the BIO results regarding the presence or absence of plus disease (Cohen’s κ = 0.619), but evaluating the zone (p < 0.001) and stage (p < 0.001) of ROP was difficult. Systemic parameters, except for heart rate, were similar between the two imaging devices (all p > 0.05). In conclusion, although the smartphone-based fundus photography showed moderate agreement for determining the presence or absence of plus disease, it failed to identify the zone and stage of ROP.

Comparison of Vitamin D Levels in Premature Infants with and without Retinopathy of Prematurity

Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP. This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016-2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants' first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool. Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP. The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.

Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser Photocoagulation

To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. Retrospective clinical cohort study. We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.

Обзор современных патогенетических путей развития ретинопатии недоношенных

The article describes the latest advances in the study of the pathogenesis and risk factors of retinopathy of prematurity (ROP) and the possible methods of its prevention. Limitations in the understanding of the pathogenesis of ROP leads to problems regarding its treatment and prevention. This article highlights the importance of focusing the attention of ophthalmologists on the preclinical stage of ROP and importance of indispensable but usually ignored stages and factors relevant to this stage. The success of new research in identifying comorbidities that affect the pathogenesis of ROP, which opens opportunities for prevention and early screening. It also discusses other recently discovered pathogenetic mechanisms and pathogenic factors that show opportunities for the development of new methods of treatment. Furthermore, the article describes the future potential of genetics in ROP screening and the possibility of genetic counseling. Key words: retinopathy of prematurity, pathogenesis, angiogenesis, vascular autoregulation, hypoxia, platelets, inflammatory factors, growth factors, genetic factors, myeloid cells

Хирургическое лечение регматогенной отслойки сетчатки с массивной пролиферативной витреоретинопатией на фоне рубцовой стадии ретинопатии недоношенных. Клинический случай

Purpose. Demonstration of clinical case of surgical treatment of rhegmatogenous retinal detachment (RD) with massive proliferative vitreoretinopathy (PVR) against the background of cicatricial stage of retinopathy of prematurity (ROP). Material and methods. Patient O. was born at gestational age of 28 weeks with a body weight 1600 g. At age of 4 years, patient diagnosed “retinopathy of prematurity stage II, cicatricial period of the right eye. Subatrophy of the left eye”. At age of 12 years, rhegmatogenous subtotal RD, PVR C 1–12 post, developed against the background of the cicatricial stage of ROP in the right eye. 25G vitrectomy with tamponade perfluorinated compound with replacement for silicone, restrictive laser photocoagulation were performed. Results. Complete attachment of the RD was achieved. The silicone was removed after 6 months. Attachment of the retina was noted during 2 years. Visual acuity (VA) was 0.4. RD recurrence happened 2 years later, VA of the right eye – no light perception. 25G vitrectomy with membrane removal and “Pfocalin” tamponade was performed. During staged surgery: “Pfocalin” was removed, laser photocoagulation and silicone tamponade were performed. VA on the 3rd day – 0.1. Intraocular pressure – 14 mm Hg. After 1 month, the VA of the right eye is 0.1. After 6 months, the VA is 0.2, the retina is attach. Conclusions. 1. Rhegmatogenous RD develops with varying degrees of cicatricial ROP. 2. Despite the successful RD surgery against the background of cicatricial ROP, the stability of visual functions and retinal status, in the long-term period, RD recurrence is possible due to development of severe PVR. 3. The decision to terminate silicone tamponade in such cases should be made on an individual basis. 4. Based on the foregoing, long-term monitoring of patients with regressed stages of ROP is required. Keywords: retinopathy of prematurity, retinal detachment, proliferative vitreoretinopathy.

Применение ранибизумаба в качестве монотерапии тяжелых форм ретинопатии недоношенных в условиях многопрофильного стационара

Currently, the search of the new methods of treatment for such severe vitreoretinal disease as retinopathy of prematurity (ROP) remains relevant. Ranibizumab is the first drug to be approved by the Ministry of Health for the application in Russia. Рurpose. To study the effectiveness of intravitreal use of ranibizumab as monotherapy in children with various stages of ROP. Material and methods. We performed intravitreal introduction of ranibizumab as a monotherapy for ROP in 48 premature infants (96 eyes), among which 45 children were diagnosed with I type of ROP, 3 infants had a post-threshold stage of ROP with the formation of high epiretinal membranes. Results. As a consequence of the conducted studies, we found that the use of intravitreal introduction of ranibizumab in I type of ROP resulted in stabilization of ROP in all children. The complete disappearance of ROP signs after the initial introduction of ranibizumab is observed within 1 to 3 weeks, depending on the intensity of the demarcation ridge. In 1–1.5 months after the initial introduction of ranibizumab, ROP reactivation is registered in 93.3 % of cases. The duration of reactivated ROP ranged from 2 to 6 months. In 8.9 % of cases repeated introduction of ranibizumab was required on average in 7 weeks after the first injection. The introduction of anti-vascular endothelial growth factor in the post-threshold stage of ROP is advisable, as it leads to the normalization of retinal vessels, relief of edema and exudation, and a decrease in the height and density of epiretinal membranes, which can increase the efficiency and safety of subsequent vitrectomy. Conclusion. The application of ranibizumab in I type of ROP leads to complete regression of ROP signs in all children, followed by the reactivation of the process in 93.3 % of cases and the necessity of repeated introduction of the drug in 8.9 % of cases. In post-threshold ROP the introduction of ranibizumab contributes to the preparation for vitrectomy. Keywords: retinopathy of prematurity, intravitreal injections, anti-vascular endothelial growth factor, ranibizumab.

Скрининг, наблюдение и лечение недоношенных детей

Purpose. Тo analyze of the effectiveness of the screening, monitoring and treatment of premature babies. Material and methods. From 2012 to 2021 we observed 2298 preterm infants. Retinopathy of prematurity (ROP) was revealed in 796 cases (34.64 %), 34 of them with aggressive posterior ROP (AP-ROP) (4.27 %). 217 patients (27.26 %) had indications for laser coagulation of the retina (LCR); repeated interventions were performed in 26 cases (11.98 %). In 190 case (87.55 %), an induced regression of the disease occurred. An unfavorable outcome of ROP was diagnosed in 27 cases (12.45 %). 265 children with a cicatricial phase of ROP were dynamic observed. Results and conclusions. The effectiveness of LCR at the threshold stage has reached at 95.12 %. Regression in type-I occurred in 88.33 %. In cases of AP-ROP, the efficiency of LCR was 55.88 %. The total number of children with terminal stages was 109 people (13.69 %). In the cicatricial period of 265 people, 141 revealed ametropia, secondary glaucoma in 7 patients, complicated cataract in 6 and strabismus in 38. Timely screening and monitoring reveals early signs of ROP, if necessary, perform surgical treatment. These activities minimize risk of disability from blindness and low vision. An insignificant number of LCR performed, a small number of patients with terminal stages of ROP indicates the high efficiency of modern conditions for nursing premature babies. Functional results in long-term periods depend on the degree of residual changes, refractive pathology and strabismus. Correction of ametropia, functional treatment, strabismus surgery in the preschool period, allow to develop and maintain visual function in the most of patients with ROP. Keywords: retinopathy of prematurity, laser coagulation of the retina, aggressive posterior retinopathy of prematurity.

Prediction of Retinopathy of Prematurity Using the WINROP (Weight, IGF-1, Neonatal Retinopathy of Prematurity) Algorithm in a South African Population.

AimThis study aimed to assess the efficacy of the WINROP (Weight, IGF-1, Neonatal Retinopathy of Prematurity) screening algorithm in a South African population.MethodsA retrospective record review included infants born between 1 January 2013 and 1 December 2014 who underwent ROP (retinopathy of prematurity) screening. Outcomes of ophthalmology examinations were compared to alarms triggered on WINROP after gestational age, date of birth, and weekly weights were entered. Sensitivity, specificity, positive predictive, and negative predictive values and mean time of alarm were calculated.ResultsRates of ROP were 5.9% for all stages of ROP and 2.3% for severe ROP in the 220 infants included. Mean gestation age was 29.1 ± 1.3 weeks and mean birth weight 1,115.5 ± 201 g. WINROP triggered high-risk alarms in 70.5% of infants at a mean of 30.7 weeks of gestational age. Sensitivity for severe ROP was 100 and 76.9% for all stages of ROP. Specificity was low for both severe ROP and all stages of ROP at 30.2 and 30.0%, respectively.ConclusionRates of ROP are low in this population. The high number of alarms with a low negative predictive value would reduce the number of screens by 29.5%. Alarms were triggered before scheduled screening, possibly helpful in planning discharges and follow-up visits.

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

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

Morphology and Vessel Density of the Macula in Preterm Children Using Optical Coherence Tomography Angiography.

Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case–control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12–12.77), while the age of the control group was 11.78 years (IQR: 8.81–13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.

Anterior Chamber Angle in Adults Born Extremely, Very, and Moderately Preterm with and without Retinopathy of Prematurity-Results of the Gutenberg Prematurity Eye Study.

Purpose: To determine whether prematurity and associated factors affect the anterior chamber angle (ACA) width in adulthood. Methods: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of adults (age 18–52 years) in Germany. All participants were examined with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany) using linear regression analysis to assess the associations of ACA in the different sectors with gestational age (GA), birth weight, birth weight percentile, retinopathy of prematurity (ROP), ROP treatment, placental insufficiency, preeclampsia, and breastfeeding. Results: In total, 516 eyes of 319 preterm and full-term individuals (aged 28.9 ± 8.8 years, 188 females) were examined. ROP treatment was associated with smaller ACA width in the nasal (B = −9.6 [95%CI: −14.7; −4.5] degree; p < 0.001) and temporal positions (B = −11.5 [95%CI: −17.7; −5.3] degree; p = 0.001), whereas non-treated individuals with ROP had an unaltered ACA width, as did individuals with low gestational age without ROP. Conclusion: Advanced stages of ROP following treatment with laser- and cryocoagulation lead to a smaller ACA width until adulthood, and hence may increase the risk of angle closure in later life.

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates.

Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA (p = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332–15.573, p = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP.

Association of Infantile Hemangiomas and Retinopathy of Prematurity: Analysis of the Multicenter KID

Introduction: Retinopathy of prematurity (ROP) and infantile hemangiomas (IHs) both have similar proposed pathophysiological mechanisms. IH is more common in preterm than term infants. Hypoxia-induced mediators like vascular endothelial growth factor have been found elevated in children with hemangiomas. The aim of our study was to determine if there is an association between ROP and IH in preterm infants and to investigate racial/ethnic and gender differences of ROP and IHs in this cohort. Methods: We accessed the national multicenter Kids’ Inpatient Database (KID) Healthcare Cost and Utilization Project (HCUP) including admissions at age ≤28 days. Eligible infants were identified by using ICD-9 codes of ROP and IH in infants with gestational age (GA) ≤32 weeks and/or birth weight ≤1,500 g during the years 2003, 2006, 2009, and 2012. A weight-based analysis was performed using SAS Enterprise Guide 7.1 for complex sample design. Results: In the cohort of 1,068,502 eligible infants, the prevalence of IH was 4.7 per 1,000 preterm admissions (<32 weeks). ROP prevalence was 16% for GA ≤26 weeks, 12.5% for GA 27–30 weeks, and 2.7% for GA 31–32 weeks. IH was significantly higher in infants with ROP; this relationship was consistent among all stages of ROP. Regression analysis showed that females are at increased risk of IH with ROP compared to males (adjusted odds ratio [aOR]: 2.00 [1.85–2.56]). White non-Hispanic premature infants had an increased risk of IH with concomitant ROP compared to both African American (aOR: 3.9 [2.63–4.76]) and Hispanic (aOR: 1.2 [1.14–1.38]) infants. However, African American infants had an increased risk of ROP compared to white non-Hispanic infants (aOR: 1.16 [1.07–1.14]). These genders and racial/ethnic disparities were consistent among GA categories. Conclusions: To our knowledge, this is the largest cohort based on a national multicenter database comparing an association between ROP and IH. A strong association between ROP and IH may suggest similar risk factors and/or pathophysiology. A further role of genetic factors could explain racial/ethnic differences in both conditions despite similar pathogenesis. These findings may open up new bases of research for management and prevention strategies.

English

BACKGROUND Retinopathy of prematurity (ROP) is a disease affecting the retina of premature infants due to retinal neovascularization and the spectrum of outcome findings in ROP ranges from the most minimal sequelae without affecting vision in the mild cases to bilateral, irreversible, and total blindness in more severe cases.In India children less than 1500 g have almost 38 percent chance of developing any stage of ROP and 7 – 16 % chance of developing threshold ROP or blinding ROP. (2)Laser photocoagulation has replaced cryotherapy as the established treatment for ROP in most centers and this study aims to evaluate the functional and structural outcome in preterm infants who received laser photocoagulation for retinopathy of prematurity. In this study we wanted to find out the structural outcome of retinopathy of prematurity infants who underwent laser photocoagulation. We also wanted to find out the functional outcome of ROP preterm infants who underwent laser photocoagulation and identify the factors affecting the structural outcome in retinopathy of prematurity. METHODS A hospital based descriptive study was conducted among 31 preterm infants with retinopathy of prematurity who received laser photocoagulation treatment after obtaining parental consent in the Retina clinic, Regional Institute of Ophthalmology, Trivandrum. Screening examination was done at 34 weeks or 4 weeks postnatal whichever was earlier. Those infants who were detected to have ROP and were given laser photocoagulation by the ophthalmologist were followed up till retina becomes stable / ROP regresses. Thereafter follow up examinations were performed at 3 months, 6 months and 10 months. Structural outcome was classified as favorable and unfavorable. Visual or functional outcome was assessed by noting the fixation pattern, ocular alignment for strabismus and by performing cycloplegic refraction (retinoscopy) to rule out refractive errors. Data was entered into excel sheet and statistical analysis was done using SPSS trial version. RESULTS The study was conducted in 31 preterm infants with Retinopathy of Prematurity who underwent laser photocoagulation in Regional Institute of Ophthalmology Trivandrum. The structural and functional outcome was assessed at 3months, 6 months and 10 months. Of the 62 eyes of 31 infants, stage2 and 3comprised 48.4%each.3.2% of eyes had stage1 disease affecting zone1.None had stage 4 or 5.Of the 62 eyes, majority had zone 2 disease (83.9%). Only 10 eyes had zone1 disease. Out of the 60 eyes, 54 eyes had a favorable structural outcome at 3months.The functional outcome was assessed in terms of visual behavior by assessing the fixation of light, whether child is following light and by preferential looking pattern. Out of the 30 babies only 1 had an unfavorable visual behavior. The baby was not fixing and following light. Out of the 30 infants, 2 had (6.6%) strabismus at 6months and 10 months. Myopia was the predominant refractive error in the studied group accounting for about 55%. Among the study group 16.7 % had hypermetropia. CONCLUSIONS The incidence of favorable structural outcome in our study was 90%.Low gestational age and low birth weight were associated with an unfavorable structural outcome. There is a high prevalence of refractive errors in our study group accounting for about 71.5 % at 6 months. The refractive errors increased at 10 month follow up to 77%. Among the refractive errors, myopia predominates accounting 55% at 6 months and 61 % at 10 months. KEY WORDS Laser Photocoagulation, Retinopathy of Prematurity

Computer-Aided Detection of Retinopathy of Prematurity Severity in Preterm Infants via Measurement of Temporal Vessel Width and Angle.

Retinopathy of prematurity (ROP) is a retinal disorder that occurs in preterm infants with low birth weight and is the leading cause of preventable blindness in children. Early identification of high-risk patients and early diagnosis and timely treatment of ROP can substantially improve patients' visual outcomes. However, manual screening consumes both time and resources. Telescreening using retinal fundus images has the potential to reduce the burden engendered by the necessity of on-site screening. Recently, substantial progress has been made in using computer-aided diagnosis with retinal fundus images, and this approach has attracted considerable attention for the diagnosis of eye diseases. Abnormalities of and alterations in retinal blood vessels may relate to the occurrence and progression of ROP. In this study, we examined the hypothesis that ROP severity may be associated with the angle and width of arteries and veins. We computationally determined the artery–artery and vein–vein angles in the temporal quadrants—the temporal artery angle (TAA) and temporal vein angle (TVA)—under normal conditions and in different ROP stages. We also estimated retinal vessel width—temporal artery width (TAW) and temporal vein width (TVW)—by applying the Radon transform method to fundus images. Our results revealed significant decreases in TAA and TVA and increases in TAW and TVW with increasing ROP severity (all P < 0.0001).In addition, we observed positive TAA–TVA and TAW–TVW correlations (both P < 0.0001). The TAA was negatively correlated with the TAW (r = −0.162, P = 0.0314). These retinal vessel features may be useful in assisting ophthalmologists in the early detection of ROP and its progression.

New trends in intravitreal anti-VEGF therapy for ROP.

Retinopathy of Prematurity (ROP) affects premature newborns, and it can cause childhood blindness and visual impairment if untreated. The understanding of the pathogenetic role of Vascular Endothelial Growth Factor (VEGF) has led to development of therapeutic strategies such as intravitreal anti-VEGF drugs. We reported drug efficacy and ROP recurrence rates, extrapolated from the reviewed studies. Association of Pegabtanib and laser photocoagulation confers efficacy in the regression of ROP stage 3 plus in zone I / II in 89.7% of treated eyes, reducing the recurrence rate to 14.6% compared to 50% of laser therapy alone. Irrespective of the dose, Ranibizumab demonstrated average efficacy greater than 75% on regression of active disease with the highest rates of the dose of 0.1 mg (92.5%). The recurrence, on the other hand, is the highest among this new anti-VEGF agents and is around an average of 41.5%, which records the highest values in the case of Aggressive Posterior Rop (APROP). Aflibercept at a dose of 1 mg demonstrated average efficacy of about 81.9% of treated infants, analyzing significantly fewer studies than Ranibizumab. The recurrence rate stands at an average of 28.9%, especially in the later forms of ROP. Using a dose of 0.25 mg of Conbercept, the disease regression rate is currently on average 83%, with an average recurrence rate of 15.24%, the peak of which was observed in cases of ROP in zone I. Further studies are needed to prove safety at long term, because,at the moment, only short-term data are available.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Swiss cohort

BackgroundCurrently used screening criteria for retinopathy of prematurity (ROP) show high sensitivity for predicting treatment-requiring ROP but low specificity; over 90% of examined infants do not develop ROP that requires treatment (type 1 ROP). A novel weight gain-based prediction model was developed by the G-ROP study group to increase the specificity of the screening criteria and keep the number of ophthalmic examinations as low as possible. This retrospective cohort study aimed to externally validate the G-ROP screening criteria in a Swiss cohort.MethodsData from 645 preterm infants in ROP screening at Inselspital Bern between January 2015 and December 2019 were retrospectively retrieved from the screening log and analysed. The G-ROP screening criteria, consisting of 6 trigger parameters, were applied in infants with complete data. To determine the performance of the G-ROP prediction model for treatment-requiring ROP, sensitivity and specificity were calculated.ResultsComplete data were available for 322 infants who were included in the analysis. None of the excluded infants had developed type 1 ROP. By applying the 6 criteria in the G-ROP model, 214 infants were flagged to undergo screening: among these, 14 developed type 1 ROP, 9 developed type 2 ROP, and 43 developed milder stages of ROP. The sensitivity for predicting treatment-requiring ROP was 100% (CI, 0.79–1.00), and the specificity was 41% (CI, 0.35 –0.47). Implementing the novel G-ROP screening criteria would reduce the number of infants entering ROP screening by approximately one third.ConclusionsThe overall prevalence of treatment-requiring ROP was low (2.15%). Previously published performance parameters for the G-ROP algorithm were reproducible in this Swiss cohort. Importantly, all treatment-requiring infants were correctly identified. By using these novel criteria, the burden of screening examinations could be significantly reduced.

Discordant ROP (Retinopathy of prematurity) development in twins less than 32 weeks of gestational age.

Background and aim:Retinopathy of prematurity (ROP), is a vasoprolipherative disorder of the immature retina and a major cause of preventable blindness in childhood. Although the development of ROP is multifactorial, the principal reasons are lower gestational age and lower birth weight. However, in twins their gestational ages were the same, ROP development can be discordant. This study aims to evaluate the etiologic factors of discordant ROP development in twins.Methods:We reviewed the last 5 years' records and found the twins whose discordant ROP development. This discordance was; 1. Different stages of ROP, 2. One sibling treated the other is not, 3. One sibling has aggressive posterior ROP the other is not, 4. One sibling has more influenced area as zones the other is not. We documented some data of these twins, as birth order, birth weight, resuscitation at birth, morbidities, the number of hemotransfusion, age of regaining birth weight, relative weight gain at 28 weeks.Results:We evaluated a total of 26 cases of 13 twins. The mean gestational age and birth weight of the entire study group were 27.7 ± 2, and 1053 ± 364 grams, respectively. We found that more transfused preterm baby in twins is more likely to show severe ROP. Sepsis and the duration of mechanical ventilation may be risk factors for more severe ROP in twins.Conclusion:We can reduce discordant retinopathy in less than 32-weeks premature twins by using methods such as cord milking and by improving non-invasive ventilation modalities. (www.actabiomedica.it)

Refractive outcomes following yttrium aluminum garnet laser (532 nm green laser) in severe retinopathy of prematurity

To assess the refractive outcomes in eyes with severe Retinopathy of prematurity (ROP) after treatment with the frequency-doubled neodymium-doped yttrium aluminum garnet (Nd-YAG) laser 532 nm (green laser) at 1-2 years of age and compare with eyes that underwent spontaneous regression of ROP and to identify the risk factors associated with the refractive outcomes in laser-treated eyes with severe ROP. Infants who underwent laser treatment with green laser were enrolled in Group 1 and those who had spontaneous regression of ROP were enrolled in Group 2. All these children underwent a visual assessment, refraction using 1% cyclopentolate eye drops and indirect ophthalmoscopy at 1-2 years of age. Data regarding the gestational age, sex, birth weight, inborn (born in our institution) or outborn (born outside and referred to us), stage and zone of ROP and laser spots given were obtained from the treatment records. Data were analyzed using SSPS 19.0 software for Windows (SSPS Inc., Chicago, Illinois, USA). A total of 102 infants were enrolled, 51 in each group. Visual acuity ranged from 0.25-1 cycles per cm in both groups. Spherical equivalent (SE) ranged from - 8.25 D to + 5.50 D in Group 1 and -1.00D to +4.00D in Group 2. Group 1 had an incidence of 23.5% Myopia and 33.4% Astigmatism which was significantly more than Group 2. The linear regression model predicted a decrease in the SE by 0.658D if the number of laser spots increased by 1000 (P < 0.001). No other risk factors (gestational age/birth weight) were found to have a significant association with refractive errors in the lasered ROP group. Eyes with laser-treated severe ROP are frequently associated with myopia and astigmatism when compared to spontaneously regressed ROP. The number of laser spots delivered has a direct association with the amount of refractive error.

Clinical parameters in different stages, zones, and remission/progression statuses of retinopathy of prematurity.

Background:Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in premature infants that causes lifetime visual impairment and blindness in the early ages. In this study, we investigated the differences in the values of clinical laboratory parameters between different ROP and its remission/progression statuses regarding stages and zones.Methods:This historical cohort study includes 828 infants divided into two groups after the first examination containing ROP infants and controls. The biochemical and hematological parameters of the two groups have been collected from the patient’s history.Results:In infants with ROP, the hematopoiesis-related parameters, including the mean level of hemoglobin, total bilirubin, potassium, calcium were significantly less than controls (P=0.039, P=0.001, P=0.001, and P=0.046, respectively). The percentages of reticulocyte and the levels of BUN in ROP patients were significantly higher than in normal infants (P=0.015 and p <0.001, respectively). Moreover, the levels of hemoglobin and BUN were significantly different in the different zones of ROP (P=0.017 and P=0.001, respectively). Also, higher hemoglobin levels, total bilirubin, and CRP were observed in the reduced stages of ROP (P=0.041, P=0.045, and P=0.039, respectively).Conclusion:Laboratory parameters are different in different stages, zones and remission/ progression ROP infants.