Treatment For Retinopathy Of Prematurity Research Articles

Validation of a Published Model to Reduce Burden of Retinopathy of Prematurity Screening

The E-ROP study evaluated 1257 patients screened for retinopathy of prematurity (ROP), and found that no infant born at or after 27 weeks' gestational age and having a birthweight over 750 g developed treatable disease if they had no ROP at 37 weeks' gestational age. The study investigators suggested that there is little value in continued screening of infants meeting these criteria who have no ROP at 37 weeks. We attempted to replicate these published data in a larger multi-center cohort to validate or refute this hypothesis. Retrospective cohort study. We conducted a chart review of every infant treated for ROP from February 2004 through April 2022 at 6 medical centers located in the mid-southern region of the United States. We evaluated gestational age, birthweight, and presence or absence of ROP at 37 weeks' gestational age to determine whether any treated infants would have been "missed" using these screening criteria. Of 6729 infants screened, 298 (4.43%) received treatment. Ten infants who required treatment developed first evidence of ROP after 37 weeks' gestational age. However, only 1 infant was >750 g birthweight and >27 weeks' gestational age. This patient developed zone 2, stage 3 with pre-plus disease and was treated because of limited access to care at a remote hospital; however, ROP was detected at the first examination after 37 weeks, so this infant would have been identified for continued follow-up. Our results, in a cohort 5 times that of the original study, replicated that infants >750 g birthweight and >27 weeks' gestational age did not develop treatable ROP if they had no ROP at 37 weeks, supporting the termination of examination at that time in patients meeting these criteria.

Visual field after anti-vascular endothelial growth factor therapy and laser treatment for retinopathy of prematurity.

To evaluate the visual field after anti-vascular endothelial growth factor (VEGF) therapy and laser treatment for retinopathy of prematurity. Retrospective cohort study. Infants with retinopathy of prematurity treated by anti-VEGF therapy or laser treatment were included in the study. Degrees of visual field in eight directions examined by Goldmann perimeter (intensity, 1000 apostilb; size, V4e = 64 mm2) were compared between the anti-VEGF therapy and laser treatment groups. The visual acuity (VA) and spherical equivalent refraction were also compared between the two groups. Nine eyes with anti-VEGF therapy and 12 eyes with laser treatment were enrolled in the analysis. The total, upper, nasal upper, nasal, nasal lower, temporal lower, and temporal upper visual fields were significantly wider in the eyes with anti-VEGF therapy than in those with laser treatment (496 vs 416, P = .002; 53 vs 45, P = .008; 56 vs 43, P = .003; 58 vs 39, P < .001; 55 vs 44, P = .01; 72 vs 65, P = .01; and 62 vs 56, P = .03, respectively). The logarithm of the minimum angle of resolution VA tended to be better in the eyes with anti-VEGF therapy than in those with laser treatment (0.01 vs 0.15, P = .06). Eyes with anti-VEGF therapy had significantly lower myopia than those with laser treatment (spherical equivalent refraction: -0.72 vs -5.7, P = .001). Anti-VEGF therapy may provide a wider visual field, better VA, and less myopia compared with laser treatment.

Persistent Vascular Anomalies in Retinopathy of Prematurity Children: Ultrawide-field Fluorescein Angiography Findings until School Age.

To investigate vascular abnormalities, including persistent avascular retina (PAR), in a large cohort of patients with regressed or treated retinopathy of prematurity (ROP) through long-term follow-up until school age. Retrospective large cohort study. We included pediatric patients (< 18 years old) with a history of nontreated or treated ROP (treated with either photocoagulation or intravitreal injection [IVI]) and regularly followed up until2020. Upon enrollment, we categorized patients into 4 groups: prematurity, regressed ROP, and IVI and laser treatment ROP groups. All patients had undergone visual acuity examinations, OCT, and ultrawide-field fluorescein angiography. Percentage of eyes with PAR (greater than or equal to the area of 2 disc diameters from the ora serrata to vascular termini) and with vascular abnormalities in the peripheral and posterior retina. In total, we included 187 eyes of 95 patients. The prevalence of PAR was 0%, 33.33%, and 31.65% in eyes in the prematurity, regressed ROP, and IVI treatment groups, respectively (P<0.0001). There was no significant difference in the percentage of PAR eyes when comparing regressed ROP group (33.33%) with the IVI treatment group (31.65%). At least 1 type of vascular abnormality was noted until school age in all (100%) treated ROP eyes. Although multivariate analysis found a significant association between IVI treatment and PAR (odds ratio: 10.28, 95% confidence interval: 3.29-32.14) until the school age of 6 to 8 years old, there were no stage 3 eyes in the spontaneously regressed group, suggesting that stage 3 ROP in the IVI group could also drive the association. Approximately one-third of ROP eyes with spontaneous regression or IVI treatment still exhibit PAR when the child reaches school age. Several distinct vascular anomalies at the vascular-avascular juncture and within the vascularized retina can persist in these children. The clinical significance of these anomalies and the decision whether to treat them warrant further investigation to optimize their outcomes. The authors have no proprietary or commercial interest in any materials discussed in this article.

An Artificial Intelligence System for Screening and Recommending the Treatment Modalities for Retinopathy of Prematurity.

The purpose of this study was to develop an artificial intelligence (AI) system for the identification of disease status and recommending treatment modalities for retinopathy of prematurity (ROP). This retrospective cohort study included a total of 24,495 RetCam images from 1075 eyes of 651 preterm infants who received RetCam examination at the Shenzhen Eye Hospital in Shenzhen, China, from January 2003 to August 2021. Three tasks included ROP identification, severe ROP identification, and treatment modalities identification (retinal laser photocoagulation or intravitreal injections). The AI system was developed to identify the 3 tasks, especially the treatment modalities of ROP. The performance between the AI system and ophthalmologists was compared using extra 200 RetCam images. The AI system exhibited favorable performance in the 3 tasks, including ROP identification [area under the receiver operating characteristic curve (AUC), 0.9531], severe ROP identification (AUC, 0.9132), and treatment modalities identification with laser photocoagulation or intravitreal injections (AUC, 0.9360). The AI system achieved an accuracy of 0.8627, a sensitivity of 0.7059, and a specificity of 0.9412 for identifying the treatment modalities of ROP. External validation results confirmed the good performance of the AI system with an accuracy of 92.0% in all 3 tasks, which was better than 4 experienced ophthalmologists who scored 56%, 65%, 71%, and 76%, respectively. The described AI system achieved promising outcomes in the automated identification of ROP severity and treatment modalities. Using such algorithmic approaches as accessory tools in the clinic may improve ROP screening in the future.

Identification and validation of lactate metabolism-related genes in oxygen-induced retinopathy

Retinopathy of Prematurity (ROP) is a multifactorial disease characterized by abnormal retinal vascular growth in premature infants, which is one of the leading causes of childhood blindness. Lactic acid metabolism may play an imperative role in the development of ROP, but there are still few relevant studies. Our team use a dataset GSE158799 contained 284 genes in 3 P17_OIR mice and 3 P30_OIR mice to identify 41 potentially differentially expressed lactate metabolism-related genes (LMRGs) related to ROP. Then through bioinformatics analysis, we strive to reveal the interaction, the enriched pathways and the immune cell infiltration among these LMRGs, and predict their functions and internal mechanisms. These DEGs may regulate lactate metabolism, leading to the changes of metabolism and immunity, thereby inducing the development of ROP. Our results will expand our understanding of the intrinsic mechanism of ROP and may be helpful for the directions for treatment of ROP in the future.

A Meta-Analysis of Neurodevelopmental Outcomes following Intravitreal Bevacizumab for the Treatment of Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is the most common cause of preventable blindness in preterm infants. First-line treatments include intravitreal bevacizumab (IVB) or laser photocoagulation (LPC). Objectives: The aim of the study was to evaluate neurodevelopmental safety of IVB compared to LPC for ROP. Methods: MEDLINE, Embase, and Cochrane library were searched up to September 2022. Studies were included with at least 12-month follow-up of primary outcomes such as severe neurodevelopmental impairment (sNDI), cerebral palsy (CP), and hearing impairment (HI). Secondary outcomes were moderate-to-severe neurodevelopmental impairment (msNDI), Bayley Scores of Infant Development (BSID-III), and visual impairment. Results: 1,231 patients from 11 comparative studies were included. Quality of evidence was rated low for all outcomes. IVB was associated with a higher risk for sNDI (risk ratio [RR] = 1.25, 95% confidence interval [CI]: [1.01, 1.53], p = 0.04); and CP (RR = 1.40, CI: [1.08, 1.81], p = 0.01) compared to LPC. There was no significant difference between IVB and LPC for msNDI (RR = 1.15, CI: [0.98, 1.35], p = 0.08) and HI (RR = 1.43, CI: [0.86, 2.39], p = 0.17). BSID-III percentile scores were similar between IVB and LPC, with weighted mean differences of 1.51 [CI = −1.25, 4.27], 2.43 [CI = −1.36, 6.22], and 1.97 [CI = −1.06, 5.01] for cognitive, language, and motor domains, respectively (p > 0.05). Conclusion: To our knowledge, this is the largest meta-analysis on neurodevelopmental outcomes and the first to rigorously examine IVB monotherapy in ROP treatment. Compared to LPC, there was a marginally increased risk for sNDI and CP with IVB but little or no difference in the risk of msNDI and HI. Further randomized studies are needed to strengthen these findings.

Improved screening of retinopathy of prematurity (ROP): development of a target product profile (TPP) for resource-limited settings

BackgroundAs more preterm infants survive, complications of preterm birth, including retinopathy of prematurity (ROP), become more prevalent. ROP rates and blindness from ROP are higher in low-income and middle-income countries,...

Prognostic Value of Parenteral Nutrition Duration on Risk of Retinopathy of Prematurity

The prognostic impact of parenteral nutrition duration (PND) on retinopathy of prematurity (ROP) is not well studied. Safe prediction models can help optimize ROP screening by effectively discriminating high-risk from low-risk infants. To evaluate the prognostic value of PND on ROP; to update and validate the Digital ROP (DIGIROP) 2.0 birth into prescreen and screen prediction models to include all ROP-screened infants regardless of gestational age (GA) and incorporate PND; and to compare the DIGIROP model with the Weight, IGF-1, Neonatal, and ROP (WINROP) and Postnatal Growth and ROP (G-ROP) models. This retrospective study included 11 139 prematurely born infants from 2007 to 2020 from the Swedish National Registry for ROP. Extended Poisson and logistic models were applied. Data were analyzed from August 2022 to February 2023. Any ROP and ROP requiring treatment were studied in relation to PND. ROP treatment was the outcome in DIGIROP models. Sensitivity, specificity, area under the receiver operating characteristic curve, and adjusted OR (aOR) with 95% CI were the main measures. Internal and external validations were performed. Of 11 139 screened infants, 5071 (45.5%) were girls, and the mean (SD) gestational age was 28.5 (2.4) weeks. ROP developed in 3179 infants (29%), treatment was given in 599 (5%), 7228 (65%) had PND less than 14 days, 2308 (21%) had PND for 14 days or more, and 1603 (14%) had unknown PND. PND was significantly correlated with ROP severity (Spearman r = 0.45; P < .001). Infants with 14 days or more of PND vs less than 14 days had faster progression from any ROP to ROP treatment (adjusted mean difference, -0.9 weeks; 95% CI, -1.5 to -0.3; P = .004). Infants with PND for 14 days or more vs less than 14 days had higher odds of any ROP (aOR, 1.84; 95% CI, 1.62-2.10; P < .001) and of severe ROP requiring treatment (aOR, 2.20; 95% CI, 1.73-2.80; P < .001). Among all 11 139 infants, the DIGIROP 2.0 models had 100% sensitivity (95% CI, 99.4-100). The specificity was 46.6% (95% CI, 45.6-47.5) for the prescreen model and 76.9% (95% CI, 76.1-77.7) for the screen model. G-ROP as well as the DIGIROP 2.0 prescreen and screen models showed 100% sensitivity on a validation subset (G-ROP: sensitivity, 100%; 95% CI, 93-100; DIGIROP prescreen: sensitivity, 100%; 95% CI, 93-100; DIGIROP screen: sensitivity, 100%; 95% CI, 93-100), whereas WINROP showed 89% sensitivity (95% CI, 77-96). Specificity for each prediction model was 29% (95% CI, 22-36) for G-ROP, 38% (95% CI, 32-46) for DIGIROP prescreen, 53% (95% CI, 46-60) for DIGIROP screen at 10 weeks, and 46% (95% CI, 39-53) for WINROP. Based on more than 11 000 ROP-screened infants born in Sweden, PND of 14 days or more corresponded to a significantly higher risk of having any ROP and receiving ROP treatment. These findings provide evidence to support consideration of using the updated DIGIROP 2.0 models instead of the WINROP or G-ROP models in the management of ROP.

Incomplete peripheral retinal vascularisation in retinopathy of prematurity: is it the consequence of changing oxygen saturation?

We wish to determine the prevalence and risk factors of incomplete peripheral avascular retina (IPAR) in children screened for retinopathy of prematurity (ROP) and its association with oxygen saturation (SpO2) targets. A retrospective review of retinal images of premature infants born and screened for ROP in Auckland Region, New Zealand, between January 2013 and December 2017 was conducted. Images were reviewed to determine if avascular retina was present at their final ROP screening. The prevalence of peripheral avascular retina was compared among infants born prior to (Group 1) and after (Group 2) 2015 when the SpO2 target was increased. Infants with any concurrent ocular pathology or who had received ROP treatment were excluded. In total, 62 (12.8%) of the total of 486 infants (247 in Group 1; 239 in Group 2) were found to have IPAR at their last ROP screening. Group 1 had more statistically significant infants with IPAR compared to Group 2 (39/247 infants and 23/239 infants respectively; p = 0.043). Incomplete peripheral retinal vascularisation occurred at a prevalence of 12.8% in infants at risk of ROP. Higher SpO2 targets did not increase the prevalence of incomplete peripheral retinal vascularisation. Low gestational age and low birth weight are likely risk factors for the development of avascular retina. Further research into the risk factors associated with incomplete peripheral retinal vascularisation and the associated long-term outcomes is needed.

Prevalence, risk factors and severity of retinopathy of prematurity in preterm infants in a tertiary care hospital in rural Karnataka

Retinopathy of prematurity (ROP) is a condition which is one of the major causes of preventable childhood blindness. ROP may develop in premature new-borns due to avascular or incompletely vascularized retina at birth which are prone to damage. The purpose of this study is to investigate the prevalence of retinopathy of prematurity (ROP), as well as its risk factors and severity, among newborns who were admitted to and screened at a tertiary care facility that serves a rural community.A cross-sectional study was conducted for a period of 1 year. All infants born prematurely who were admitted to the hospital and had a birth weight of less than or equal to 1500 g and/or less than 32 weeks of gestation were included in the study. Additionally, babies born between 1501-2500 grams and/or 33-35 weeks who were at a higher risk were also included. Under aseptic conditions all preterms were screened with RetCam in NICU of a tertiary hospital situated in rural area in Karnataka.224 preterm babies were screened for ROP. No ROP was noted in 185 babies (82.59%), 9 babies had stage 1 (4.02%), 21 babies stage 2 (9.38%), 9 babies had stage 3 ROP (4.02). No infant developed stage 4 and stage 5 ROP. Prevalence of ROP is 17.41% in our study. Low birth weight (LBW), Very low birth weight (VLBW), Respiratory Distress Syndrome and sepsis are found to be clinically significant in this study.In this study, the prevalence of ROP is 17.41%. LBW, VLBW, Respiratory Distress Syndrome and sepsis are found to significant risk factors. Early screening and timely appropriate treatment of ROP can prevent from causing childhood blindness.

Ophthalmological long-term sequelae of premature birth-Persisting into adulthood : Eye development and premature birth anamnesis

Premature birth and the postnatal occurrence of retinopathy of prematurity (ROP) are the main risk factors for reduced visual acuity and blindness in childhood and adolescence accompanied by numerous morphological ocular changes. It can be assumed that these alterations persist throughout life and could represent apotential risk factor for ocular diseases, although little is known to date about the long-term effects of prematurity on ocular function and morphology in adulthood. The aim of the present study is to review the literature on the long-term effects of prematurity and associated factors. Individuals born preterm exhibit reduced visual acuity, lower visual quality of life, and steeper corneal configuration in adulthood. Furthermore, individuals with advanced ROP and need for ROP treatment are at particularly high risk for myopic refractive error, the occurrence of strabismus, and increased lens opacities with thicker lenses. Low gestational age is associated with thinner peripapillary retinal nerve fiber layer thickness as well as thicker foveal retinal thickness and more frequent occurrence of foveal hypoplasia. In addition, data from the Gutenberg Health Study showed that low birth weight as asurrogate marker for prematurity and fetal growth restriction are associated with an increased prevalence of age-related macular degeneration as well as more frequently with diabetes and consequently diabetic retinopathy. Premature birth and associated factors lead to life-long functional and morphological ocular changes. There is evidence that this can lead to retinal diseases later in life and thus, there appear to be fetal origins for adult eye disease. This may have implications for ophthalmic controls and its intervals in adulthood.

Intraocular pressure effect of intravitreal conbercept injection for retinopathy of prematurity.

Purpose: Intravitreal injection of conbercept (IVC) is a novel anti-vascular endothelial growth factor (anti-VEGF) treatment for retinopathy of prematurity (ROP). This study aimed to assess the intraocular pressure (IOP) effect of IVC. Methods: All IVC surgeries were performed in the Department of Ophthalmology, Guangdong Women and Children Hospital, from January 2021 to May 2021. In this study, 30 eyes of 15 infants who received intravitreal injections of conbercept at a dose of 0.25mg/0.025mL were included. The IOP of all participants was measured prior to administering the injection and subsequently at 2min, 1h, 1day, and 1week thereafter. Results: We included 30 eyes (10 boys and 5 girls) with ROP. For the male group, the mean birth weight, mean gestational age at birth, and the mean time of postmenstrual age (PMA) at IVC treatment were 1,174.0 ± 446.0g, 28.4 ± 3.0weeks, and 37.1 ± 1.6weeks, respectively; for the female group, they were 1,108 ± 285.5g, 28.2 ± 2.5weeks, and 36.8 ± 2.1weeks, respectively. For the male group, the IOP at baseline, 2min, 1h, 1day, and 1week after IVC were 12.4 ± 1.5mmHg, 49.0 ± 3.1mmHg, 26.3 ± 2.5mmHg, 13.4 ± 2.2mmHg, and 11.6 ± 1.7mmHg, respectively; for the female group, they were 10.7 ± 2.0mmHg, 47.3 ± 3.2mmHg, 26.4 ± 3.2mmHg, 10.7 ± 1.8mmHg, and 10.2 ± 1.8mmHg, respectively. In both groups, the IOP immediately (2min) after the operation was significantly higher than that at any other time point (p < 0.01). IOP values returned to the preoperative baseline level on the first day after surgery, with no significant difference compared with that before injection (p > 0.05). IOP continued to be maintained at the preoperative baseline level on the first week after surgery, with no significant difference compared with that before surgery (p > 0.05). Conclusion: Infants with ROP who received IVC experienced a sharp increase in the IOP immediately after injection, which decreased to below 30mmHg after 1h and maintain that level for 1week or longer.

The effect of sex on retinopathy of prematurity severity among premature mixed-sex multiple gestation infants

This retrospective study of 68 premature infants examined whether there was a difference between male and female mixed-sex multiple gestation infants with regard to stage of retinopathy of prematurity (ROP) developed or need for ROP treatment. We found that among mixed-sex twin infants there was no statistically significant difference between sexes in most severe ROP stage developed or need for ROP treatment, but males were treated at an earlier postmenstrual age (PMA) than females, despite females having a lower mean birthweight and slower mean growth velocity compared to males.

Evaluation of Outcomes and Regression after Neovascularization Treatment for Non-type 1 Retinopathy of Prematurity

Introduction: To study the unfavorable outcomes and regression after neovascularization treatment for non-type 1 retinopathy of prematurity (ROP) in a tertiary care facility in Thailand. Methods: A retrospective study was done of all infants undergoing screening and treatment for ROP at a tertiary referral center between July 2018 and June 2021 with follow-up for 60 weeks postmenstrual ages (PMA). The outcomes measured were unfavorable outcomes, including macula involving posterior retinal folds, macula involving retinal detachment, retrolental cicatrix formation, or a mass obscuring the view of the posterior pole, and the regression of ROP after treatment. The infants received neovascularization treatment (stage 3 ROP) within 72 h of diagnosis. The study also compared the unfavorable outcomes and regression between neovascularization in type 1 ROP and non-type 1 ROP subgroups. Results: There were 58 eyes of 31 infants that received neovascularization treatment that were included in the study. Of these 58 eyes, 41 had non-type 1 ROP, and 17 had type 1 ROP. 92.68% of the eyes treated for non-type 1 ROP had stage 3 ROP in zone II with pre-plus disease and 74.47% of the eyes treated for type 1 ROP had stage 3 ROP in zone II with plus disease. The mean gestational age and birth weight of the enrolled infants were 28.48 ± 1.99 weeks and 1165.32 ± 394.57 g, respectively. Unfavorable outcomes after neovascularization treatment occurred in three eyes (17.65%) in the type 1 ROP group, but there were no unfavorable outcomes in the non-type 1 ROP group (p=0.022); these three eyes were treated with laser indirect ophthalmoscopy (LIO) combined with Intravitreal bevacizumab (IVB). The non-type 1 ROP treated with laser LIO alone group had 100% regression, whereas type 1 ROP treated with LIO or combined LIO and IVT bevacizumab group had 82.35% regression. Progression after treatment without regression occurred in five eyes (29.41%) with type 1 ROP, but no progression occurred in eyes with non-type 1 ROP (p=0.001). Conclusion: Neovascularization treatment in non-type 1 ROP is useful for preventing unfavorable outcomes and achieving the regression of neovascularization, especially for diseases less severe than type 1 ROP. Moreover, neovascularization treatment in non-type 1 ROP can reduce the progression of ROP disease.

Association between treatment for retinopathy of prematurity and blood monocyte counts.

To investigate blood monocyte counts as a risk factor for retinopathy of prematurity (ROP) treatment. Retrospective cohort study. Infants who underwent ROP screening at Shiga University of Medical Science Hospital between January, 2011 and July, 2021 were included in this study. Screening criteria were a gestational age (GA) < 32 weeks or birth weight (BW) < 1500g. The week with the largest difference in monocyte counts between the infants with and without type 1 ROP determined based on the effect size. Multivariate logistic regression analysis was applied to investigate whether the monocyte counts constituted an independent risk factor for type 1 ROP. The objective variable was type 1 ROP, and the explanatory variables were GA, BW, infants' infection, and Apgar score at 1min and monocyte counts in the week with the largest monocyte-counts difference between the with- and without type 1 ROP groups. In total, 231 infants met the inclusion criteria. The monocyte counts in the fourth week after birth (4w MONO) exhibited the largest difference between infants with and without type 1 ROP. The analysis was performed on 198 infants, excluding 33 infants without 4w MONO data. Thirty-one infants had type 1 ROP, whereas 167 infants did not. BW and 4w MONO were significantly associated with type 1 ROP (odds ratio: 0.52 and 3.9, P < .001 and 0.004, respectively). The 4w MONO was an independent risk factor for type 1 ROP and may be useful in follow-up of infants with ROP.

TRENDS OF RETINOPATHY OF PREMATURITY IN A TERTIARY CARE CENTRE IN URBAN INDIA

Introduction: Retinopathy of prematurity is the leading cause of preventable blindness in premature infants. Our study aims at nding the Incidence and severity of Retinopathy of prematurity (ROP) and its association with various risk factors like low gestational age, low birth weight, oxygen exposure, respiratory distress syndrome, sepsis, blood transfusion and intraventricular hemorrhage. This is a prospective observational study conducted in a tertiary ca Methods: re teaching hospital in Western Maharashtra. Patient data including systemic and ocular ndings were documented. Incidence and severity of ROP was calculated and the association of various risk factors with ROP was calculated using Chi-square test. Among the 266 babies i Results: ncluded in study, the Incidence of ROP was found to be 13.50% and Type I disease was found in 1.31%. The mean birth weight of neonates with ROP was 1230.2 ± 479.5 g and the mean gestational age was 30.27 ± 2.87 weeks. Development of ROP was signicantly associated with low gestational age (GA), low birth weight (BW) and Respiratory Distress Syndrome (RDS). Early screening of preterm babies is crucial Conclusion: for early diagnosis and treatment of ROP to prevent its sight threatening complications

Successful treatment for retinopathy of prematurity in a very preterm baby: a case report

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, including in Indonesia. ROP screening and intervention are essential to establish the diagnosis, stop disease progression, and prevent retinal detachment that causes blindness. ROP treatments such as vitrectomy and laser are beneficial. This case aims to report the anatomical and functional outcomes after surgery for ROP. Case description: A very preterm baby with 29 weeks of gestational age and birthweight of 1300 grams was referred to the pediatric ophthalmology clinic at Cipto Mangunkusumo Hospital for ROP screening. Retinal camera (RetCam®) examination revealed stage 3 ROP in the right eye (RE) and stage 4A ROP in the left eye (LE). The LE underwent a vitrectomy, while the RE underwent laser photocoagulation under general anesthesia. Upon examination under sedation (EUS) after surgery, the retina was examined using RetCam® and was found attached to the LE and regressed on the RE. The baby is able to fixate on and follow objects. However, the refraction examination showed myopia in both eyes. Glasses were prescribed due to the myopia outcome in this case. Conclusion: Vitrectomy for stage 4A ROP and laser photocoagulation for stage 3 ROP are effective in anatomical and functional outcomes in a very preterm baby.

Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study

ObjectiveTo quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).DesignThe EVERREST (Does vascular endothelial growth factor gene therapy safely improve outcome in...

10years of screening for retinopathy of prematurity (2009-2019) : Results analysis of two German level-1 neonatal intensive care units (NICUs) with university on-site screening and atelemedical approach in the non-university NICU

Retinopathy of prematurity (ROP) is one of the most common causes of childhood blindness in Germany and worldwide and adequate screening is essential. The telemedical approach with objective documentation of retinal findings opens up the possibility of reliably diagnosing all ROP stages independent of the examiner, if a team of ophthalmologists specialized in ROP evaluates the images. A 10-year comparison of ROP screening at two level‑1 neonatal intensive care units (NICU): university and on-site vs. non-university and telemedical. Retrospective analysis of screened premature infants by gestational age (GA), birth weight (BW), sex, multiple births, time of ROP occurrence, treatment needs and time as well as examination frequency. From 2009 to2019, we screened 1191 infants of whom 29had been screened before by an external clinic. The internal 1162 infants were screened on-site with 3713 retinal examinations. We diagnosed34% with ROP and treated 5.4% (3.7% in Giessen, 7.2% in Siegen). Mean GA was 28.9weeks (± 2.5 weeks); mean BW 1155 g (± 417.5 g). The number of ROP diagnoses increased by 227.3% in Giessen and by 111.1% in Siegen due to the increasing number of premature births in neonatal care. Comparative analysis confirmed nationally and internationally increasing ROP screening and children with acute ROP. Telemedical screening was equivalent to on-site screening and safe. Both screening methods identified infants requiring treatment on time. No child with GA > 29weeks required treatment, analogous to Swedish ROP registry results; however, in the German ROP registry some premature babies with GA ≥ 30weeks required treatment.

Comparison of post-treatment recurrence between ranibizumab injection and laser photocoagulation for type 1 retinopathy of prematurity

ObjectiveTo compare post-treatment recurrence between ranibizumab injection and laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP), and explore the associated risk factors.MethodsThe clinical data of ROP infants treated with LP or ranibizumab in a NICU of China from October 2007 to November 2021 were retrospectively analyzed and compared, such as general condition, degree of ROP, therapeutic effectiveness and post-treatment recurrence. The dependent variable was recurrence after ROP treatment. Univariate and regression analysis of risk factors was performed.ResultsOf the 298 ROP infants (556 eyes), 58% of the eyes were treated with LP and the other 42% with ranibizumab. There was no significant difference in gestational age at birth, birth weight, sex, delivery mode, prenatal corticosteroids, ROP diagnosed before admission or after admission, and the duration of oxygen therapy between the two groups. However, the ratio of type 1 ROP and aggressive retinopathy of prematurity (A-ROP) in ranibizumab group was higher than that in LP group. The number of treatments, recurrence rate and recurrence interval in ranibizumab group were higher than those in LP group. However, there was no difference in the recurrence rate between the two groups after stratified analysis by the lesion area and the presence or absence of A-ROP. There was no significant difference in the final lesion regression between the two groups. Regression analysis showed that plus disease and ROP located in zone I were independent risk factors for post-treatment recurrence.ConclusionThere is no significant difference in the recurrence rate of ROP between ranibizumab injection and LP, and recurrence is mainly related to the severity of ROP. In half of our patients treated with A-ROP recurrences occur.