Retinopathy Of Prematurity Research Articles

SHORT-TERM REACTIVATION OF RETINOPATHY OF PREMATURITY AFTER PRIMARY RANIBIZUMAB TREATMENT.

Investigate risk factors for short-term reactivation of retinopathy of prematurity (ROP) after intravitreal ranibizumab (IVR) therapy and determine safety and efficacy of repeat injections. Retrospective chart review study of patients screened for ROP as inpatients between 2013 and 2023 who received IVR within the UCLA health care system. Primary outcomes were rates and timing of short-term ROP reactivation, defined as repeat worsening of ROP to stage 2 or 3 before 52 weeks postmenstrual age, as well as risk factors for reactivation. Other outcomes included adverse events and rates of reactivation after a second intravitreal injection. Eighty-two eyes of 43 patients received primary IVR 0.25 mg/0.025 cc for type 1 ROP. Thirteen patients (22 eyes) (30.2% of patients, 26.8% of eyes) developed short-term reactivation an average of 7.2 weeks ± 1.7 weeks after treatment. Increased reactivation risk was associated with zone I disease (odds ratio 6.23, 95% CI, 1.35-28.7, P = 0.019), lower postmenstrual age at first injection (odds ratio 1.64, 95% CI, 1.19-2.26; P = 0.003), and lower gestational age at birth (odds ratio 1.80, 95% CI, 1.04-3.13, P = 0.037). Of the 13 patients that received repeat injections, five required laser treatment for a second reactivation (11.6% of patients receiving IVR). No eyes developed retinal vascular occlusion, endophthalmitis, or cataract. Repeat injections may be required after primary IVR for aggressive ROP. Repeat IVR treatment for ROP is effective and poses few ophthalmic adverse events, although additional reactivation remains a risk.

Influence of Early Total Enteral Feeding in Preterm Infants with Respiratory Distress Syndrome

Plain Language SummaryThe objective of this secondary analysis of data from the randomized trial comparing less invasive surfactant therapy (LISA) with InSurE method of surfactant administration among preterm infants with respiratory distress syndrome (RDS) is to demonstrate the feasibility of ETEF in hemodynamically stable preterm neonates on respiratory support.In this randomized control trial comparing LISA versus InSurE among preterm infants with RDS between 26 and 34 weeks of gestation, 150 infants were enrolled with 117 being hemodynamically stable. In 33 patients, early total enteral feeding could not be started due to various reasons – 7 babies had absence/reversal of end-diastolic flow (A/REDF) on antenatal Doppler, 15 babies had shock and required inotropic support on day 1 of life, 8 babies had higher ventilatory settings at the time of admission, and in the 3 babies, the abdomen was not soft to start total enteral feeding. Full-volume enteral feeding without any parenteral supplementation was started on day 1 of life using the mother’s own milk (MoM) or donor human milk (≤32 weeks of GA) and MoM or preterm formula (33–34 weeks of GA). The data were analyzed to assess the proportion of babies developing feed intolerance and/or NEC and factors associated with failure of ETEF. Out of these 117 babies, 102 tolerated ETEF, and 15 had one or more episodes of FI requiring parenteral supplementation, but none developed NEC. There was a statistically significantly increased incidence of culture-positive sepsis as well as the requirement of antibiotic therapy for possible sepsis in babies with failure of ETEF. There was no difference in the morbidities noted such as intraventricular hemorrhage grade 2 or more, patent ductus arteriosus requiring medical or surgical management, retinopathy of prematurity requiring treatment, and NEC stage II or more. Our study suggests that hemodynamically stable preterm infants with RDS on respiratory support can be successfully fed with exclusive enteral feeds started immediately post-birth. ETEF results in early attainment of full feeding and reduces the incidence of sepsis and the duration of hospital stay without increasing the risk of NEC.

Relationship between Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants: A Systematic Review

Background: Retinopathy of prematurity (ROP) is the major cause of neonatal blindness and may account for up to 10% of juvenile blindness. This systematic review evaluates the relationship between hyperglycemia and ROP in VLBW infants. Methods: PRISMA guidelines were used to conduct a systematic review using an online database: Google Scholar, PubMed, and the Wiley Online Library. Original research studies examining the association between hyperglycemia and ROP were the inclusion criteria. Animal studies, a letter to the editor, a commentary report, a review, a meta-analysis not available in full text in English or Bahasa Indonesia, and data in the study insufficient for analysis were all excluded. Results: This systematic review includes nine studies, six cohorts and three case-control studies, involving a total of 1,566 infants. Six studies indicated that newborns in the ROP group had lower mean gestational age and birthweight than those in the non-ROP group. Five investigations found that the mean glucose level in the ROP group was greater than in the non-ROP group. Six studies found that the prevalence of glycemia was much higher than in the non-ROP group. Eight of the nine studies found a significant relationship between hyperglycemia in VLBW infants, and only one found no significant relationship between them. The highest odds ratio and relative risk of hyperglycemia causing ROP were 14.27 (5.16–39.50); p-value <0.001 and 28.062 (7.881–99.924); p-value <0.001, respectively. The overall range of values found across the studies was also considered. Conclusion: Hyperglycemia has a significant relationship with ROP and is also a risk factor for ROP in VLBW infants.

Interaction of high-tech perinatal and ophthalmological centers as the basis for favorable outcomes of retinopathy of prematurity

Interaction of high-tech perinatal and ophthalmological centers as the basis for favorable outcomes of retinopathy of prematurity

Tear fluid cytokine analysis: a non-invasive approach for assessing retinopathy of prematurity severity.

To determine whether there is a significant association between inflammatory cytokines in the tear fluid and the severity of Retinopathy of Prematurity (ROP). Retrospective cohort study. The cytokine levels in tear fluids were determined in 34 eyes with ROP and 18 eyes without ROP. There were 15 eyes with severe ROP requiring treatment and 19 eyes with mild ROP not requiring treatment. For severe ROP eyes, tear fluids were collected before treatment. Significantly higher levels of CCL2 and vascular endothelial growth factor (VEGF) were detected in eyes with severe ROP compared to eyes with mild ROP and no ROP. When assessed for cytokine levels that discriminate each disease group, CCL2 showed a significant odds ratio of 1.76 for severity change (/quintile, P = 0.032, after adjusting for birth weight). Correlation analysis showed that birth weight correlated with IL-1α levels, and decreased weight gain increased IFN-γ levels. We next determined tear fluid cytokines which discriminate severe ROP using receiver operating characteristics' analysis. We found that combination of higher CCL2 levels, higher VEGF levels, and lower IFN-γ levels in the tear fluid had a stronger predictive value for severe ROP (area under curve, 0.85). The levels of CCL2, VEGF, and IFN-γ in tear fluid may serve as useful biomarkers for assessing the severity of ROP.

Lower Hemoglobin Levels as a Risk Factor for the Development of Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is an important cause of visual morbidity among preterm infants. The objective of the study was to assess the relationship between the initial hematological parameters of the complete blood count (CBC) and ROP development in preterm neonates. This retrospective cohort study was conducted in a neonatal intensive care unit in Odisha. The hematological parameters of the CBC conducted within the first 48 hours of age, demographic characteristics, neonatal morbidities, and ROP screening findings of preterm neonates (gestational age <34 weeks) were analyzed. Independent risk factors associated with ROP development were identified in a multivariate logistic regression model. A total of 43 (29.1%) out of 148 neonates had any of the ROP stages (stage 1-26, 2-08, and 3-09). Birth weight (aOR 0.003; 95% CI 0.00, 0.11);hemoglobin (Hb) level (aOR 0.70; 95% CI 0.54, 0.90); presence of respiratory distress syndrome (RDS) (aOR 7.61; 95% CI 1.5, 36.39); and need for packed red blood cell (PRBC) transfusion (aOR 4.26; 95% CI 1.1, 16.44) were independently associated withROP development. The odds of ROP were higher among the neonates with initial Hb 10.5-15.4 g/dL (OR (95% CI) 3.7(1.5, 8.9), p=0.003) and for neonates with Hb 15.4-17.3 g/dL (OR (95% CI)2.5(1.01, 6.16), p=0.047) in comparison to neonates with initial Hb >17.3 g/dL. Preterm neonates with a lower level of Hb during the early postnatal days are at higher risk for ROP development and need to be prioritized for screening.

The Role of HIF-1α in Retinopathy of Prematurity: A Review of Current Literature.

Hypoxia-inducible factor (HIF) plays a crucial role in regulating oxygen sensing and adaptation at the cellular level, overseeing cellular oxygen homeostasis, erythrocyte production, angiogenesis, and mitochondrial metabolism. The hypoxia-sensitive HIF-1α subunit facilitates tissue adaptation to hypoxic conditions, including the stimulation of proangiogenic factors. Retinopathy of prematurity (ROP) is a proliferative vascular disease of the retina that poses a significant risk to prematurely born children. If untreated, ROP can lead to retinal detachment, severe visual impairment, and even blindness. The pathogenesis of ROP is not fully understood; however, reports suggest that premature birth leads to the exposure of immature ocular tissues to high levels of exogenous oxygen and hyperoxia, which increase the synthesis of reactive oxygen species and inhibit HIF expression. During the ischemic phase, HIF-1α expression is stimulated in the hypoxia-sensitive retina, causing an overproduction of proangiogenic factors and the development of pathological neovascularization. Given the significant role of HIF-1α in the development of ROP, considering it as a potential molecular target for therapeutic strategies appears justified. This review synthesizes information from the last six years (2018-2024) using databases such as PubMed, Google Scholar, and BASE, focusing on the role of HIF-1α in the pathogenesis of ROP and its potential as a target for new therapies.

Targeting survival without morbidity: Heart rate characteristics for oxygen supplementation optimization in neonatal care

The preterm newborn is susceptible to many diseases related to oxidative stress, and supplemental oxygen therapy and its interaction with inflammatory processes may be a contributing factor to their underlying pathophysiology. Supplemental oxygen therapy can lead to over-oxygenation, and can complicate ischemia–reperfusion processes, which in turn can promote oxidative stress pathways. We hypothesize that the optimal dose of supplemental oxygen therapy likely varies for each preterm infant based on their unique and developing physiology, and may be adjusted through the assessment autonomic nervous function and pulmonary resilience by measuring heart rate variability. We present preliminary findings demonstrating that among extremely preterm infants with low-to-moderate heart rate characteristics index (HRCi) scores (indicating healthy ANS function) during the first six postnatal days, exposure to a low target oxygen saturation range was associated with decreased risk of the composite outcome of death by 36 weeks postmenstrual age (PMA), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and/or retinopathy of prematurity (ROP). This suggests a novel therapeutic approach to supplemental oxygen delivery in the neonatal intensive care unit (NICU) wherein the HRCi can be leveraged to guide the prescription of individualized target oxygen saturation ranges that are responsive to each infant’s unique and dynamic physiology, minimizing the risks of morbidity and mortality.

Frequency and Problems Associated With Retinopathy of Prematurity (ROP) in A Tertiary Care Hospital

Background: Retinopathy of prematurity (ROP) is a retinal disease that principally affects preterm infants. It is recognized as the leading cause of preventable blindness and visual impairment in the pediatric population. An increase in survival of very young preterm infants due to the advances in neonatology has subjected them to the risk of developing ROP. Aims &amp; Objectives: To find out the frequency and problems associated with Retinopathy of Prematurity (ROP) in premature babies. Materials and Methods: This observational study was conducted at Dhaka Medical College and Hospital from July 2016-December 2016. A total of 73 preterm neonates with gestational age less than 35 weeks and weighing less than 2000 grams at birth, being born or admitted at Dhaka Medical College and Hospital were included in the study. After purposive sampling who had fulfilled the inclusion criteria and screened for ROP at 4 weeks after birth. The data analysis was done to find out the prevalence and problems associated with ROP of premature babies. Result: A total of 73 neonates were screened. The prevalence of ROP was found to be 54% (n=40); of which 35% were in stage 1 and 35% were in stage 2 and the majority were in zone 3 (50%). The prevalence of ROP between 28-30 weeks of gestation was 75% (n=12) and between 31-34 weeks was 49.12% (n=28). 50% (20) neonates with birth weights less than 1500 grams were found to develop ROP. The prevalence of post-natal problems that predispose to ROP was oxygen therapy, apnea, blood transfusion, and sepsis, and the P-value was significant. Out of ROP-positive cases, 16(40%) need laser photocoagulation. Conclusion: The prevalence of Retinopathy of Prematurity (ROP)in premature babies is high below 30 weeks of gestational age and birth weight less than 1500 gm. Problems significantly associated with ROP were oxygen therapy, apnea, blood transfusion, and sepsis. J Dhaka Med Coll. 2022; 31(2) : 237-242

Characteristics of retinal vascularization in reactivated retinopathy of prematurity requiring treatment and clinical outcome after reinjection of ranibizumab

This study aimed to determine whether the state of retinal vascularization after anti-vascular endothelial growth factor (anti-VEGF) injection can help predict the risk of reactivated retinopathy of prematurity (ROP) requiring treatment and whether repeated ranibizumab injection will be effective in such cases. We retrospectively reviewed 24 infants (43 eyes) who received ranibizumab monotherapy between January 2021 and December 2022. All eyes were classified as having non-retreated ROP or retreated ROP. The state of ROP at the time of treatment, the time required for resolution of plus disease, and the extent of vascularization at 4 and 8 weeks after treatment were analyzed. Extent of temporal retinal vascularization was measured with serial fundus images using disc-fovea distance (DF) unit and disc diameter (DD). Reactivated ROP requiring treatment occurred in six infants (25.0%) and ten eyes (23.3%) after ranibizumab treatment. The mean retreatment interval was 9.0 ± 3.3 weeks (range 4–16). In the retreated ROP group, the time required for the resolution of plus disease after primary injection was longer compared to the control group (13.3 days vs 5.2 days), with a mean ROP regression time of 3.4 weeks. All eyes in the retreated ROP showed retinal vascularization < 0.5 DF from the original site at 4 weeks after injection. In 90% of cases with retreated ROP, the extent of vascularization at 8 weeks after injection was within 1 DF from the original ROP site, and all cases showed reactivation in the posterior Zone II area. The extent of retinal neovascularization in the retreated group was an average of 0.7 DD (vs 1.7 DD) and 1.3 DD (vs 3.3 DD) at 4 and 8 weeks after injection, respectively. After ranibizumab retreatment, only one reactivated case with vitreous traction progressed to focal retinal detachment, while all other cases regressed with peripheral vascular development. The continuation of delayed retinal blood vessel development after ≥ 8 weeks may indicate a high likelihood of reactivated ROP requiring treatment. In the absence of vitreous traction, ranibizumab reinjection is likely to be effective in treating reactivated ROP requiring treatment.

Universal eye screening: perinatal risk factors and ocular abnormalities in 1795 newborns not meeting retinopathy of prematurity criteria.

This prospective cohort study aimed to investigate the ocular outcomes of universal eye screening in newborns and assess the relationship between different perinatal risk factors and various ocular abnormalities in infants who do not meet the criteria for retinopathy of prematurity (ROP) screening. An universal eye screening questionnaire was utilised to screen newborn babies who did not meet the ROP screening criteria within 72 h of birth at a public and private hospital between June 2016 and April 2018. The questionnaire covered demographic characteristics, neonatal history, and eye examination findings. A trained retina specialist conducted comprehensive anterior and posterior segment examinations utilising a binocular indirect ophthalmoscope. Out of the 1795 newborns screened, 55.2% were male, and 44.8% were female. The most prevalent ocular abnormality observed was retinal haemorrhage (RH), with a prevalence of 10.64% (95% CI: 9.25-12.16%). The prevalence of non-RH abnormality was 7.5% (95% CI: 6.34-8.84%). The retinal haemorrhages were associated with normal vaginal deliveries (OR: 9.91; 95% CI: 6.71-14.64, p-value < 0.001), while non-RH abnormalities were associated with pre-term babies (OR: 4.87; 95% CI: 3.03-7.83, p < 0.001), consanguinity (OR: 2.20; 95% CI: 1.28-3.8, p < 0.001), low birth weight (OR: 0.22; 95% CI: 0.14-0.34, p < 0.001) and systemic abnormalities (OR: 3.08; 95% CI: 1.94-4.91, p < 0.001). Sight-threatening ocular pathology in newborns may be linked to perinatal risk factors such as preterm birth, low birth weight, consanguinity, and systemic abnormalities. Accordingly, it may be prudent to consider specialized ocular screening protocols for neonates within this high-risk cohort in future prospective studies.

Written information about retinopathy of prematurity in Aotearoa New Zealand: identification, review and opportunities for improvement.

The aims of this research include adapting a patient information tool for whānau (extended family) Māori needs, identifying and reviewing written information provided for the retinopathy of prematurity eye examination (ROPEE) and identifying improvements to ROPEE written information. ROPEE patient information (printed leaflets, website, app) was obtained from all tertiary neonatal intensive care units in Aotearoa New Zealand (Aotearoa). Information was reviewed using an adapted "20 good-design principles" guide and given a star rating and Flesch-Kincaid readability score to identify acceptability and usability for patients. Seven ROPEE information materials were reviewed and varied in alignment with the adapted good-design principles tool. Based on the adapted good-design principles, opportunities were identified in many aspects of the written information for improvement, including words and language, tone and meaning, content and design. The Flesch-Kincaid grade level reading scores ranged from 12-22 years reading age. Written information also did not use te reo Māori (Aotearoa Indigenous language) or extensively use Māori imagery. Opportunities exist to improve ROPEE whānau information, including making content more readable, understandable and visually appealing. Optimising the clinical information on ROPEE nationally for Aotearoa will support whānau decision making, and aligning written information with Māori (Indigenous peoples of Aotearoa) is a priority.

Screening for Retinopathy of Prematurity in Neonatal Intensive Care Unit in Ain Shams University Hospital

Abstract Purpose to evaluate the Retinopathy of prematurity prevalence and screening outcome in a tertiary hospital in Cairo, Egypt. Also, to assess the risk factors for its development and to suggest modifications to the international guidelines for screening for Retinopathy of prematurity to fit the Egyptian population. Methods A prospective observational study was carried out in Neonatal Intensive Care Unit (NICU) in Ain Shams University Hospital. In this study 159 premature infants born in the period between 1 September 2018 to 1 September 2021 were screened for Retinopathy of Prematurity (ROP). Screening was based on the most inclusive criteria reported to date. All premature infants with gestational age (GA) of ≤ 34 weeks or birth weight (BW) of ≤ 2000 grams were included. Infants were also included if GA &amp;gt; 34 weeks or BW &amp;gt; 2000 grams, but multiple co-morbidities existed. The prevalence of retinopathy of prematurity and plus disease and their correlation with risk factors of interest were studied. Results The gestational age of the included infants ranged from 27 to 36 weeks, with a mean (SD) of 31.87 (± 1.81) weeks. Infants had birth weight ranging from 640 to 3900 grams, with a mean (SD) of 1784.71 (± 560.30) grams. The prevalence of ROP changes more than stage 0 in the screened infants was 25.8% (41 infants) with 7.3% of cases (11 infants) showing plus disease and 6.3% of cases (10 infants) showing severe changes that needed treatment. Of those, 2 cases (20%) fell outside the British Guideline’s criteria for Screening. there was a highly significant (p &amp;lt; 0.0001) correlation between appearance of Retinopathy of prematurity changes more than stage 0 and low gestational age, low birth weight of the screened infants, receiving mechanical ventilation, respiratory distress syndrome stage, presence of Necrotizing enterocolitis, Intraventricular haemorrhage and blood transfusion. On the other hand, no significant correlation was found between appearance of Retinopathy of prematurity changes more than stage 0 and gender (p = 0.911), presence of PDA (p = 0.187), or sepsis (p = 0.998). Conclusion Retinopathy of prematurity is a significant problem in the premature infants in Cairo, Egypt. Extremely premature infants with lower birth weight are more prone to develop this disease. However, cases with higher gestational age and birth weight than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe Retinopathy of prematurity changes that needed intervention, which implies the need to develop a screening guideline for the Egyptian population.

Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda

ABSTRACT Purpose With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo. Methods Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model. Results Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity. Conclusion The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

Efficacy of Indirect Laser Photocoagulation in Cases with Retinopathy of Prematurity Presenting with Late Stage 3 Turning into Stage 4A

Abstract Background Retinopathy of prematurity (ROP) is a preventable irreversible cause of blindness in children especially in developing countries. Early detection and management of type 1 ROP with intravitreal injection of Anti-VEGF or indirect laser photocoagulation is the cornerstone of preventing blindness from this disease. Screening programs for ROP are mandatory for picking cases early before retinal detachment develops. Standardized screening programs are still lacking in developing countries, like Egypt, so cases may present in later stages. Cases presenting too late with Stage 4 and 5 ROP are managed surgically with lens-sparing vitrectomy or lensectomy vitrectomy. A portion of the cases present at the transition from stage 3 into stage 4a ROP. Management of those cases with intravitreal anti-VEGF was reported to cause acute crunch and tractional retinal detachment. Management with laser photocoagulation has not been discussed before. Methods This is a retrospective interventional, non-comparative study. Review of records of ROP cases presenting after 4 weeks from delivery having stage 3 turning into stage 4a ROP for which indirect laser photocoagulation was done were collected in the period from January 2017 till May 2019. Gestational age, birth weight, postmenstrual age at first presentation, date of laser photocoagulation and number of sessions, fundus images showing initial regression and final regression and if any recurrences happened were recorded. Results Nine treatment naive eyes of five premature infants were included. Mean GA was 30.4+/- 1.5 wks (range, 28-32 wks; median, 31). Mean BW 1190+/- 174.6 gm (range, 900-1300; median = 1300). Mean PMA at presentation 42.5+/-5.7 wks (range, 38.5-52.5; median, 40.5). All 9 eyes presented with plus disease and highly elevated fibrovascular ridge with significant fibrous component in Zone II. 7 eyes (77.7%) had secondary retinoschisis, localized tractional retinal detachment. 2 eyes (22.2%) showed temporal dragging. All eyes received Indirect laser photocoagulation to the avascular retina (near confluent burns) one session for each eye. No skip areas were reported. 5 eyes (3 patients) were done under topical anesthesia and 4 (2 patients) under general anesthesia. All 9 eyes (100%) showed complete regression of ROP with release of traction, restoration of retinal anatomy at a mean of 3.7+/- 2.7 months (range, 2-8.5 months; median, 2.5 months). Conclusion Indirect laser photocoagulation is an effective treatment measure in premature infants presenting late with fibrovascular proliferation having high fibrous components and starting Stage 4a ROP in Zone II. Laser rather than IVI of Anti-VEGF may save those infants from crunch phenomenon and need for vitrectomy with final good anatomical and thus visual outcomes.

Special features of postoperative long-term follow-up patients with retinopathy of prematurity

Background: Retinopathy of prematurity (ROP), leading to a high percentage of visual disability, continues to be one of the most complex and unresolved problems of pediatric ophthalmology. Some patients, despite successful surgical treatment and regression of ROP, lose their vision by the age of 25–35 years from the long-term consequences of ROP. That is why patients after surgical treatment of ROP, including those with peripheral chorioretinal dystrophy, need lifelong clinical follow-up in order to on time diagnose reactive conditions in the long-term postoperative period, leading to a significant loss of visual function. Methods: This paper presents a special case of a patient with stage 4 ROP and her long-term clinical and functional outcome. Conclusions: As a result of regular dynamic monitoring of the patient, using modern highly informative research methods, we promptly detected the formation of an exudative component of the macular area, which made it possible to prevent retinal detachment and loss of vision. Strengths of this study: This study presented a clinical case of a patient with ROP and long-term patient follow-up. This shows the importance of long-term monitoring of patients after treatment and the importance of combining treatment methods.

Epithelial Membrane Protein 2 (EMP2) Blockade Attenuates Pathological Neovascularization in Murine Oxygen-Induced Retinopathy.

Retinopathy of prematurity (ROP) results from postnatal hyperoxia exposure in premature infants and is characterized by aberrant neovascularization of retinal blood vessels. Epithelial membrane protein-2 (EMP2) regulates hypoxia-inducible factor (HIF)-induced vascular endothelial growth factor (VEGF) production in the ARPE-19 cell line and genetic knock-out of Emp2 in a murine oxygen-induced retinopathy (OIR) model attenuates neovascularization. We hypothesize that EMP2 blockade via intravitreal injection protects against neovascularization. Ex vivo choroid sprouting assay was performed, comparing media and human IgG controls versus anti-EMP2 antibody (Ab) treatment. In vivo, eyes from wild-type (WT) mice exposed to hyperoxia from postnatal (P) days 7 to 12 were treated with P12 intravitreal injections of control IgG or anti-EMP2 Abs. Neovascularization was assessed at P17 by flat mount imaging. Local and systemic effects of anti-EMP2 Ab treatment were assessed. Choroid sprouts treated with 30µg/mL of anti-EMP2 Ab demonstrated a 48% reduction in vessel growth compared to control IgG-treated sprouts. Compared to IgG-treated controls, WT OIR mice treated with 4µg/g of intravitreal anti-EMP2 Ab demonstrated a 42% reduction in neovascularization. They demonstrated down-regulation of retinal gene expression in pathways related to vasculature development and up-regulation in genes related to fatty acid oxidation and tricarboxylic acid cycle respiratory electron transport, compared to controls. Anti-EMP2 Ab-treated OIR mice did not exhibit gross retinal histologic abnormalities, vision transduction abnormalities, or weight loss. Our results suggest that EMP2 blockade could be a local and specific treatment modality for retinal neovascularization in oxygen-induced retinopathies, without systemic adverse effects.

Comparison of Intravitreal Ranibizumab and Laser Photocoagulation in the Treatment of Type I Retinopathy of Prematurity in Malaysia: A One-Year Follow-Up Study.

This study aimed to evaluate the treatment efficacy, anatomical outcomes, and refractive outcomes of laser photocoagulation (LPC) and intravitreal ranibizumab (IVR) in the treatment of type I retinopathy of prematurity (ROP) at one-year follow-up. This is a retrospective study on the treatment of type I ROP and aggressive ROP (A-ROP) using LPC or IVR in three Malaysian hospitals providing pediatric ophthalmology services from January 2019 to December 2021. Information on gestational age, birth weight, ROP zone and stage, and underlying comorbidities was collected. Parameters for evaluating treatment efficacy include the time taken to achieve complete regression, the regression rate, and the reactivation rate. The anatomical and refractive outcomes were evaluated at one year of adjusted age. This study included 92 eyes from 46 infants. Of these, 42 eyes received LPC as the initial treatment, while 50 eyes underwent IVR. A higher percentage of infants with cardiovascular disease were treated with IVR (66.7%) compared to LPC (40%) (p<0.05). However, there were no significant differences in gestational age, birth weight, respiratory distress syndrome, sepsis, or intraventricular hemorrhage between the two treatment groups (p>0.05). Infants treated with LPC had a higher regression rate than those treated with IVR, but they were also significantly more myopic and had worse best-corrected visual acuity (BCVA). Conversely, infants treated with IVR experienced a significantly higher reactivation rate compared to those treated with LPC. Logistic regression analysis showed no significant associations between gestational age, birth weight, plus disease, zone 1 ROP, and the choice of initial treatment with the reactivation of ROP. Both LPC and IVR effectively treat type I ROP in infants, with IVR yielding superior anatomical and refractive outcomes and LPC offering a lower reactivation rate. Understanding individual patient characteristics is crucial for treatment selection.

Artificial intelligence in ophthalmology: the present and the future

The medical industry is undergoing an active digital transformation, including the creation of electronic databases, cloud security systems, mobile health monitoring devices, and telemedicine tools. Artificial intelligence (AI), one of the most important technological achievements of the last decade, is gradually gaining momentum in various areas of practical medicine. The cutting edge of AI, neural networks, offers promising approaches to the improvement of clinical examination quality. The review presents data of studies focusing on the use of AI tools in the diagnosis of the most common ophthalmic diseases: diabetic retinopathy, macular degeneration, retinopathy of prematurity, glaucoma, cataracts, and ophthalmic oncology. We discuss both the advantages of neural networks in the diagnosis and monitoring of eye diseases, and outline the difficulties of their implementation, including ethical and legal conflicts.

Knowledge, Attitudes and Practices of Health Workers and Caregivers Towards Retinopathy of Prematurity in Uganda: A Mixed‐Methods Study

ABSTRACTIntroductionRetinopathy of prematurity (ROP) is a significant global issue and a leading cause of preventable childhood blindness. Early screening and timely management of preterm babies at risk are crucial. To effectively implement this strategy, it is essential that caregivers and health workers are well‐informed about ROP. This study plays a vital role in assessing the knowledge, attitudes and practices of caregivers and healthcare workers towards ROP in Uganda, providing valuable insights into the current understanding and approach towards this condition.MethodWe conducted a sequential explanatory mixed‐methods study, involving 214 participants. This group included 12 paediatricians, 56 neonatal nurses and 146 caregivers, all of whom play crucial roles in the healthcare system. The study was conducted at two tertiary hospital neonatal clinics in Uganda. A researcher‐administered structured questionnaire was used to collect the data on the participants’ knowledge, attitudes and practices. Descriptive statistics were used to describe variables, while qualitative data were analysed using thematic content analysis.ResultsWe recruited 146 caregivers with a mean age of 29.4 (±standard deviation 6.5) years, 12 paediatricians with a median age of 37 years (IQR: 36–41) and 56 nurses with a median age of 35 years (30–42). The median working duration of health workers at the neonatal unit was 3 (IQR: 1.8–4.2) years. Thirty‐two (21.92%) caregivers and 28 (49.12%) health workers had good knowledge about ROP, whereas 9 nurses and 2 paediatricians did not know about ROP. Barriers to ROP screening included limited resources (equipment, time and skilled personnel) and limited parental involvement. Enhancing collaboration among medical care teams has the potential to improve ROP screening.ConclusionInsufficient knowledge about ROP among caregivers calls for increased efforts to educate and sensitise them about ROP and its risk factors.