Retinopathy Of Prematurity Type Research Articles

Validation of postnatal growth and retinopathy of prematurity (G-ROP) screening guidelines in a tertiary care hospital of Pakistan: A report from low-middle income country.

Retinopathy of Prematurity (ROP) significantly contributes to childhood blindness globally, with a disproportionately high burden in low- and middle-income countries (LMICs) due to improved neonatal care alongside inadequate ROP screening and treatment facilities. This study aims to validate the performance of Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria in a cohort of premature infants presenting at a tertiary care setting in Pakistan. This cross-sectional study utilized retrospective chart review of neonates admitted to the neonatal intensive care unit (NICU) at The Aga Khan University Hospital, Pakistan from January 2018 to February 2022. The complete G-ROP criteria were applied as prediction tool for infants with type 1 ROP, type 2 ROP, and no ROP outcomes. Out of the 166 cases, 125 cases were included in the final analysis, and remaining cases were excluded due to incomplete data. ROP of any stage developed in 83 infants (66.4%), of whom 55 (44%) developed type 1 ROP, 28 (22.4%) developed type 2 ROP, and 19 (15.2%) were treated for ROP. The median BW was 1060 gm (IQR = 910 to 1240 gm) and the median gestational age was 29 wk (IQR = 27 to 30 wk). The G-ROP criteria demonstrated a sensitivity of 98.18% (95% CI: 90.28-99.95%) for triggering an alarm for type 1 ROP. The G-ROP criteria achieved 100% sensitivity (95% CI: 87.66 to 100%) for type 2 ROP. The overall sensitivity of G-ROP criteria to trigger an alarm for any type of ROP was 98.8% (95% CI: 93.47 to 99.97%). Thus, the G-ROP screening model is highly sensitive in detecting at-risk infants for ROP in a Pakistani tertiary care setting, supporting its use in LMICs where standard screening criteria may not suffice.

Clinical and Growth Correlates of Retinopathy of Prematurity in Preterm Infants with Surgical Necrotizing Enterocolitis and Intestinal Perforation.

This study aimed to identify the clinical and growth parameters associated with retinopathy of prematurity (ROP) in infants with necrotizing enterocolitis (NEC) and spontaneous ileal perforation (SIP). We conducted a retrospective cohort study that compared clinical data before and after NEC/SIP onset in neonates, categorizing by any ROP and severe ROP (type 1/2) status. The analysis included 109 infants with surgical NEC/SIP. Sixty infants (60/109, 55%) were diagnosed with any ROP, 32/109 (29.3%) infants (22% type 1 and 7.3% type 2) with severe ROP. On univariate analysis, those with severe ROP (32/109, 39.5%) were of lower median gestational age (GA, 23.8 weeks [23.4, 24.6] vs. 27.3 [26.3, 29.0], p < 0.001), lower median birth weight (625 g [512, 710] vs. 935 [700, 1,180], p < 0.001) and experienced higher exposure to clinical chorioamnionitis (22.6 vs. 2.13%, p < 0.006), and later median onset of ROP diagnosis (63.0 days [47.0, 77.2] vs. 29.0 [19.0, 41.0], p < 0.001), received Penrose drain placement more commonly (19 [59.4%] vs. 16 [34.0%], p = 0.04), retained less residual small bowel (70.0 cm [63.1, 90.8] vs. 90.8 [72.0, 101], p = 0.007) following surgery, were exposed to higher FiO2 7 days after birth (p = 0.001), received ventilation longer and exposed to higher FiO2 at 2 weeks (p < 0.05) following NEC and developed acute kidney injury (AKI) more often (25 [86.2%] vs. 20 [46.5%], p = 0.002) than those without ROP. Those with severe ROP had lower length, weight for length, and head circumference z scores. In an adjusted Firth's logistic regression, GA (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: [0.35, 0.76]) and diagnosis at later age (aOR = 1.08, 95% CI: [1.03, 1.13]) was shown to be significantly associated with any ROP. Infants who develop severe ROP following surgical NEC/SIP are likely to be younger, smaller, have been exposed to more O2, develop AKI, and grow poorly compared with those did not develop severe ROP. · Thirty percent of infants with NEC/SIP had severe ROP.. · Those with severe ROP had poor growth parameters before and after NEC/SIP.. · Risk factors based ROP prevention strategies are needed to have improved ophthalmic outcomes..

Analysis of trends in retinopathy of prematurity over 5 years in a tertiary neonatal intensive care unit.

The aim of the study was to look at the incidence and trend of retinopathy of prematurity (ROP) between 2017 and 2021 in a tertiary neonatal intensive care unit (NICU) in Australia and to compare potential modifiable risk factors of ROP between preterm infants who required treatment for ROP and who did not need treatment. This retrospective study used the data of newborn infants who were <31 weeks gestational age (GA) or birth weight (BW) of <1250 g born between 2017 and 2021 at a tertiary NICU in Australia (n = 261). Univariate analysis using t test for continuous data, Fischer exact test for categorical data and multiple logistic regression analysis were undertaken to identify any significant differences between two groups. A total number of 261 infants were studied. 55.9% of infants developed any type of ROP (146 infants out of 261 infants), type 1 ROP was 5.4% (14 out of 261) and aggressive ROP (AROP) was 3% (8 out of 261). Out of 146 infants who were diagnosed with ROP, 22 (15%) of them required treatment. Mean GA for those who underwent ROP treatment was 25.6 (±1.47) weeks and for those who did not require treatment was 27.6 (±1.95) weeks. The mean BWs for those who needed treatment was 764 (±189.32) g and for those who did not need treatment was 1039 (±306.06) g. The mean duration of invasive ventilation for infants with ROP requiring treatment and those who did not require treatment were 23.95 (±22.41) days and 9.89 (±17.2) days. The total duration of oxygen requirement was 235.54 (±160.5) days and 121.11 (±117.34) days for those who needed treatment and those who did not need treatment respectively. Among infants who required treatment for ROP, 68.18% required blood transfusion whereas among those who did not need treatment, 24.19% required blood transfusion. Lower GA, lower BW, longer duration of invasive ventilation, longer total duration of oxygen requirement and blood transfusion in first 2 weeks of life were significant in preterm infants who required treatment for ROP compared with those who did not.

Современные подходы к оказанию высокотехнологичной офтальмологической помощи детям с ретинопатией недоношенных в Калужском филиале МНТК «Микрохирургия глаза»

Purpose. To present modern approaches to providing high-tech ophthalmic care to children with retinopathy of prematurity (ROP) in Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. Methods. For the 2003–2022 period screening for detection of active ROP was carried out in 16 000 premature infants. Various stages of the disease were identified in 4129 premature infants (24.9 %). Premature infants with various stages and forms of active ROP have been subjected to multimodal diagnostics of changes in the vascular system of the eye since 2016. Early laser treatment by pattern laser coagulation of the retina using hexagonal patterns was carried out in 226 children (286 eyes) in 2016–2021. Transpupillary laser coagulation of the retina using navigatied laser system was performed in 16 premature babies (26 eyes) in 2021–2023. Primary vitrectomy for severe stage 3 active ROP with the development of extraretinal retinovitreal neovascularization involving the posterior hyaloid membrane was performed in 9 premature infants (12 eyes) in 2021–2023. Results. Based on a comprehensive analysis of the results of multimodal diagnostics, informative prognostic signs of the type of active ROP were established, according to the data of fluorescein angiography of the fundus, spectral optical coherence tomography in the angio mode, and color duplex scanning. These signs provide an accurate definition of the type of course of the disease – a decisive factor in the choice of tactics for managing patients. The developed technologies of pattern hexagonal and navigatied laser coagulation of the retina provide maximal percentage of disease regression. These technologies create the most favorable conditions for further development of visual functions. Primary vitrectomy in all cases made it possible to achieve stable regression of the pathological process. Conclusion. Modern approaches to the provision of high-tech ophthalmic care for children with ROP, implemented in Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution, provide high efficiency in the treatment of active ROP with a minimal risk of late complications in the cicatricial period of the disease. Key words: retinopathy of prematurity; multimodal diagnostics; navigated laser coagulation of the retina; primary vitrectomy.

Retinopathy of prematurity among infants admitted to two neonatal intensive care units in Ethiopia

ObjectiveThis study was conducted to determine the prevalence and risk factors for retinopathy of prematurity (ROP) in two neonatal intensive care units (NICUs) in Addis Ababa, Ethiopia.Methods and analysisA prospective...

Опыт использования моно и комбинированного лечения ретинопатии недоношенных с применением лазерной коагуляции сетчатки и введения ингибиторов сосудистого эндотелиального фактора роста

Retinopathy of prematurity (ROP) is one of the main causes of blindness and visual impairment in young children. Laser coagulation of the avascular retina is a generally recognized method of treating active progressive ROP. The efficiency of laser coagulation depends on the type of ROP. Combined treatment is used when one of the types of monotherapy is ineffective. Purpose. To evaluate the effectiveness of mono and combined treatment of ROP using laser coagulation and introduction of vascular endothelial growth factor inhibitors. Material and methods. In the period 2020–2022, 403 babies born prematurely were under observation. The diagnosis of ROP was made to 170 (42 %) children. 47 (27 %) patients needed treatment. Mono laser coagulation was performed in 32 (68 %) patients, and 9 (19.1 %) were administered introduction of vascular endothelial growth factor inhibitors. Conclusions. Combined treatment was carried out on 6 (12.7 %). In all cases of PH treatment, a positive result was achieved with the preservation of vision. If we consider the PH of the scar phase of the 3rd degree as an unfavorable outcome, then success is achieved only in 95.6 % of cases. Combined treatment proved to be justified and effective – in our observation in 6.4 % of cases. The results of our study confirm the expediency of monitoring children after the introduction of vascular endothelial growth factor inhibitors until they reach the postconceptual age of 70–80 weeks. Keywords: retinopathy of prematurity, laser photocoagulation of the retina, inhibitors of vascular endothelial growth factor, combined treatment, monotherapy

Predictive Model for the Type of Active Retinopathy of Prematurity Based on Data from Angiological Studies

The purpose — to develop a prognostic model of the type of active retinopathy of prematurity (ROP) based on informative prognostic parameters of optical coherence tomography of the retina in angio-mode (OCT-A) and color duplex scanning (CDS) for a reliable choice of patient management tactics.Patients and methods. 30 premature infants (30 eyes) with favorable and unfavorable types of 1–3 stages of active ROP were performed with optical coherence tomography of the retina in angio-mode. Children were born at a gestational age of 25–34 weeks. The birth weight of children was 680–2030 g. 55 premature infants (55 eyes) with active ROP were performed with CDS in modes of color Doppler mapping and pulsed Doppler sonography. Children were born at a gestational age of 25–32 weeks. The birth weight of children was 680–1760 g. ROC analysis was used to estimate the prognostic information content of the quantitative indicators of OCT-A and CDS in relation to the type of active ROP. The discriminant analysis was used to estimate the contribution of the studied quantitative indicators to the intergroup differences in the type of active ROP. A regression model was built to obtain a prediction of a favorable or unfavorable type of disease. The assessment of the acceptability of the model as a whole was carried out according to the index of determination and the level of significance of the resulting model (p &lt; 0.05).Results. The most informative prognostic indicators of the type of active ROP were determined, according to OCT in angio-mode: the area of the foveal avascular zone — and, according to CDS: maximum systolic and end diastolic blood flow velocity in the ophthalmic artery, maximum systolic blood flow velocity in the posterior short ciliary arteries, minimum velocity blood flow in the central retinal vein. On the basis of informative indicators, a reliable prognostic model of the type of active ROP was built, which has two independent variables: the area of the foveal avascular zone and the end diastolic blood flow velocity in the ophthalmic artery. The dependent variable can take values close to 0, which determine the favorable type of the disease, or close to 1, which determines the unfavorable type of the disease.Conclusion. The introduction of the obtained model into clinical practice will allow to objectively determine the unfavorable course of the pathological process at the earliest stages, as well as to carry out early treatment of active ROP.

Outcomes of near confluent laser versus combined less dense laser and bevacizumab treatment of prethreshold ROP Type 1 Zone 2: a randomized controlled trial

BackgroundTo evaluate the results of near confluent laser therapy versus combined less dense laser and intra vitreal bevacizumab in treatment of infants with type 1 retinopathy of prematurity (ROP) in zone II.MethodsThis is a prospective double-blinded randomized clinical trial study. Infants with Type 1 ROP in Zone 2 were randomized into case and control groups. Conventional laser therapy was executed for control group and combination of IVB and laser treatment was employed for the case group.ResultsEighty-six eyes from 43 infants were analyzed in this trial. The first group included 42 eyes from 21 infants receiving a combination of laser ablation and IVB. The second group contained 44 eyes from 22 infants who received only conventional laser therapy. The combined IVB and laser ablation group demonstrated the neovascularization regression (20 out of 21 infants) one week after the procedure. In the conventional laser therapy group, this regression was found in (12 out of 22 infants) within one week after laser therapy (P = 0.001). Plus disease regression was observed in 20 (20/21) of combined treatment group and 7 infants (7/22) of conventional laser treatment group after one week.ConclusionCombined less dense laser and bevacizumab treatment resulted in more rapid regression in comparison with the conventional laser treatment.Trial registrationIRCT20201120049450N1, 27/12/2021.

Патология центральной нервной системы у детей с ретинопатией недоношенных

Purpose. To evaluate neurosonographic symptoms of preterm infants as a risk criterion for the development of retinopathy of prematurity. Material and Methods. 579 premature babies with risk of retinopathy of prematurity (ROP) (weight up to 2000 g, gestational age 34–35 weeks) were prospectively examined. Ophthalmic monitoring, neurosonographic examination was carried out. The data were statistically processed, the classical Pearson χ² criterion was calculated. Differences were considered significant at p&lt;0.05. Results. ROP developed in 172 cases (29.7%), 57 of them (33%) had a severe type of the disease (ROP type I). In 83 children neurosonographic symptoms of the head of the caudate nucleus ischemia were revealed. Intraventricular hemorrhage of the third stage was formed in 106 children (18.3%); periventricular leukomalacia was detected in 103 cases (17.7%). The incidence of structural hypoxic lesions of the central nervous system was higher in children with ROP. Severe form of ROP, which required surgical intervention, in 54.3% of cases developed in patient with intraventricular hemorrhages of the 3rd stage and in 50.8% of cases in patients with periventricular leukomalacia. There was a significant difference in the incidence of intraventricular hemorrhages of the 3rd stage (df=1; χ²=41.58, p&lt;0.0001) and periventricular leukomalacia (df=1; χ²=41.49, p&lt;0.0001) in children with ROP and without it. There was a significant difference in the incidence of intraventricular hemorrhages of the 3rd stage (df=1; χ² =51.09; p&lt;0.0001) and periventricular leukomalacia (df=1; χ² =25.31; p&lt;0.0001) in children with ROP I and II types. Significant differences in the prevalnece of neurosonographic signs of head ischemia of the caudate nucleus in the first month of life in the group with ROP and the group without ROP were revealed (df=1; χ² =84.14; p&lt;0.0001). Ischemia of caudate nucleus heads was more often detected in children with severe ROP than in children with ROP with spontaneous regression (df=1; χ² =7.79; p=0.053). Specificity (77.4%), accuracy (76.7%), predictive value of the positive result (34.9%) of the diagnostic criterion «Ischemia of caudate nucleus» is higher than similar indices for intraventricular hemorrhage of the third stage and periventricular leukomalacia, p&lt;0.001. The sensitivity of intraventricular hemorrhage of the third stage as a diagnostic criterion differs insignificantly (p=0.04). Conclusion. Neurosonographic symptoms are an early prognostic criterion for the development and severe course of retinopathy of prematurity. Key words: premature infants; retinopathy of prematurity; ophthalmological monitoring; neurosonography; intraventricular hemorrhage; periventricular leukomalacia; ischemia of the head of the caudate nucleus

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.

Factors associated with refractive outcome in children treated with bevacizumab for retinopathy of prematurity: the importance of retinal vascularization.

To evaluate the factors that may be associated with refractive outcome in eyes treated with intravitreal bevacizumab (IVB) injection for retinopathy of prematurity (ROP). Retrospective case series. Refractive outcomes of 181 infants who were treated with primary IVB for Type I ROP or aggressive ROP, were retrospectively evaluated. According to the pretreatment retinal vascularization, eyes were classified into zone I, zone I-zone II, and zone II groups. The first year, third year, and final refractive error were analyzed. Univariate logistic regression test was performed to evaluate the effect of factors on the development of ≥ 1 diopter (D) myopia. At the final examination, the mean age was 22.9 ± 10.9months. The zone II group was more hyperopic than the zone I-zone II and zone I zone groups (P = 0.001). Of the 331 eyes, 17 eyes (5.1%) had high myopia, 50 eyes (15.1%) had low myopia, and 83 eyes (25.1%) had emmetropia. During follow-up, 110 (33.2%) eyes underwent laser treatment. Gestational age, birth weight, neonatal intensive care unit type, the presence of additional laser treatment, number of injections, the type of ROP, and the dose of IVB were not associated with the development of ≥ 1 D myopia. The pretreatment and prelaser retinal zones were associated with the development of ≥ 1 D myopia. The most important factors affecting the refractive outcome in infants who underwent primary IVB treatment was the extent of pretreatment and prelaser retinal vascularization.

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.

Результаты лазерного лечения детей с ретинопатией недоношенных в Кузбассе за 10 лет

Objective.To evaluate results of laser treatment of children with first type of retinopathy of prematurity. Material and methods. A retrospective analysis of the case histories of 311 children (operations were carried out in Kuzbass) with retinopathy of prematurity type 1 was carried out. Results. Of the 311 children, laser treatment was performed once in 250 (80.39 %), the rest (19.61 %) required repeated laser intervention. Retinal detachment developed in 26 children (8.26%) with posterior aggressive retinopathy of prematurity. Сonclusion. Surgical treatment of 311 children with an average birth weight of 916.06 g over 10 years and an average gestational age of 26.65 weeks was effective (induced regression was achieved) in 86.81 % of cases. Keywords: retinopathy of prematurity, laser treatment, retinal detachment.

Vision-related Quality of Life in Malaysian Children with Threshold and Prethreshold Retinopathy of Prematurity.

PurposeThe prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and prethreshold ROP on VRQoL in Malaysian children.MethodsMulticenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than 7 years old with previous ROP diagnosis were recruited. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent or guardian completed the Children’s Visual Function Questionnaire (CVFQ) for the assessment of child’s general health, general vision, competence, personality, family impact, and treatment difficulty.ResultsEight were categorized with threshold ROP, 16 with high-risk prethreshold ROP, and 26 with low-risk prethreshold ROP. Fifty age-matched controls were also included. Mean visual acuity in logarithm of the minimum angle of resolution was 0.46 in the threshold, 0.08 in high-risk prethreshold, and 0.01 in low-risk prethreshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to prethreshold ROP. Mean total CVFQ score was significantly lower in the ROP group (p < 0.001) compared to the control group. Mean score and all mean subscale scores were significantly lower in the threshold subgroup compared to high-risk and low-risk prethreshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye, family income, and VRQoL (p < 0.05).ConclusionsROP was associated with lower VRQoL in children born prematurely in Malaysia. The threshold ROP group is the most affected. General vision and health domains are their main difficulties encountered. Gestational age, visual acuity of the better eye, and family income affects the VRQoL.

Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity

To characterize visual outcomes in children screened for retinopathy of prematurity (ROP). Retrospective, interventional case series. Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older. A total of 175 infants (350 eyes) were included for analysis (mean gestational age=28.2 weeks and birth weight=1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR]=0.6-0.86, P < .0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P=.79), strabismus (P=.98), and myopia (P=.93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P=.041). Infants receiving laser therapy were more likely to have severe myopia (aOR=1.02-1.3, P=.023), amblyopia (aOR=1.12-1.61, P=.002), and optic atrophy (aOR=1.01-1.32, P=.045) than infants not treated. These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.

Automatic diagnosis for aggressive posterior retinopathy of prematurity via deep attentive convolutional neural network

Retinopathy of Prematurity (ROP) is one of the most common childhood blindness in premature infants, and Aggressive Posterior Retinopathy of Prematurity (AP-ROP) is a special type of ROP, which will rapidly evolve into the fifth stage of ROP, even blindness if not detecting and treating in time. However, the incidence of AP-ROP is low and the symptoms are rare, which can easily cause misdiagnosis. Early diagnosis of AP-ROP using computer-assisted methods can help clinician make decision accurately. This paper proposes an automated AP-ROP diagnosis system, which divides a complex task into two tasks. Specifically, the two independent networks are utilized to automatically diagnose AP-ROP in an end-to-end way. Network 1 is responsible for identifying whether there is ROP in fundus images, and Network 2 is devised to divide ROP fundus images into AP-ROP and Regular ROP. A channel attention module is added to the two networks to improve the feature representation. In addition, a bilinear pooling module is leveraged to obtain complementary information between layers. The transfer learning mechanism is used to transfer the parameters of Network 1 to Network 2 to improve the classification performance of Network 2. The network is trained with 6867 fundus images that are collected from 2012 to 2018, in which 1709 fundus images are used as a validation set to assist training the network model, and the system performance is evaluated with another 3654 images. The accuracy, recall and specificity of Network 1 to identify the presence of ROP are 98.88%, 98.42% and 99.28%, respectively. The accuracy, sensitivity and specificity for diagnosing AP-ROP using Network 2 are 93.09%, 87.70% and 95.40%, respectively. After combining Network 1 and Network 2, the joint diagnosis accuracy of the test set is 95.81%, which is significantly better than using single three-class networks (95.16% for ResNet50 and 94.53% for ResNet101). We use a further 100 fundus images in 2019 for clinical evaluation of the automated AP-ROP diagnosis system. In the clinical environment, the diagnosis accuracy of the system is 100%, which is better than 90.00%, 85.00%, and 70.00% from the three ophthalmologists, respectively. Our system in this study achieves good performance, and the combined method is better than the three-classification method. Through the final performance evaluation of the devised framework, our classification results are close to those of prevalence ophthalmologists, which indicate that our method can effectively assist ophthalmologists to implement the diagnosis of AP-ROP.

Evaluating Contrast Sensitivity in Asian Indian Pre-Term Infants With and Without Retinopathy of Prematurity.

PurposeThe purpose of this study was to evaluate the contrast threshold in Asian Indian preterm infants with and without retinopathy of prematurity (ROP) using Newborn Contrast Cards measured during the first ROP screening and to correlate with final outcome and visual acuity at 3 months of corrected age.MethodsPreterm infants born ≤ 2000 grams birth weight (BW) and/or ≤ 34 weeks gestational age (GA) undergoing ROP screening were enrolled prospectively. Visual acuity was recorded using Teller Acuity Cards. Contrast threshold was measured with Newborn Contrast Cards at first screening visit and at the end of ROP screening at 40 weeks of postmenstrual age or older.ResultsOf the 173 study infants, 134 (77.5%) did not have any stage of ROP. Of the remaining 39 (22.5%), 34 (87%) had type 2 ROP and 5 (13%) had type 1 ROP requiring treatment. The mean contrast threshold at the first visit of the no ROP type 1 and type 2 groups was 0.36 ± 0.07, 0.65 ± 0.19, and 0.46 ± 0.09, respectively (P < 0.001). Contrast threshold had a significant correlation with BW (R = −0.291, P = < 0.001) and gestational age (R = −0.47, P = < 0.001). The contrast threshold at the first visit correlated with visual acuity measured at 3 months of corrected age in logMAR (R = 0.36, P = 0.01). Other than BW and GA, no other systemic risk factors correlated with contrast threshold measured at the first screening visit.ConclusionsNewborn Contrast Cards are a viable tool to test contrast threshold in preterm infants. The association between contrast threshold and ROP, and its correlation with visual acuity, suggest that contrast threshold measurement may help predict the clinical vision outcome among prematurely born infants.Translational RelevanceContrast threshold measurement may prove to be a useful tool in the estimation of visual potential in preterm infants.

Venous blood flow in ocular vessels of patients with active retinopathy of prematurity

To study the characteristics of venous circulation in the eyes with retinopathy of prematurity (ROP) observed in examination of blood flow in the central retinal vein and superior orbital vein in patients with different forms, stages and state of the disease. Color duplex scanning of the central retinal vein and superior orbital vein was performed using color Doppler imaging and pulsed Doppler sonography in 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) with no signs of ROP. All babies included in the study were born at 25-32 weeks of gestation, their birth weight was 680-1760 g. A characteristic feature of hemodynamic parameters in the central retinal vein at stages 1-3 of active ROP was a decrease in both the maximum and minimum blood flow velocities (Vmax and Vmin), indicating a serious disorder of ocular hemodynamics in this category of patients. An increase in Vmax in the central retinal vein was recorded for patients with aggressive posterior ROP, which occurs in response to venous stasis that is common in this form of the disease. The performed statistical assessment of the prognostic significance of hemodynamic parameters of the central retinal vein in relation to the type of active ROP revealed a high information content of Vmin, which is promising for early detection of unfavorable course of the disease helping to ensure timely treatment. The blood flow in the superior orbital vein showed distinctive absence of any correlations with the course of the disease, disallowing any immediate conclusions on the informativeness and predictive value of its parameters. The revealed features of venous blood flow in patients with active ROP help expand the understanding of vascular changes in this pathology, and can also be applied in clinical practice to improve the accuracy of predicting the course of the disease.

New opportunities in management of patients with retinopathy prematurity (literature review and analysis of own data)

Insufficient effectiveness of laser coagulation of the avascular retinal areas in retinopathy of prematurity (ROP) plus-disease in zone I and aggressive posterior retinopathy of prematurity (APROP) requires new treatment approaches, based on the regulation of retinal angiogenesis and anti-VEGF drugs use. The BEAT-RAP study, which was the first major randomized study of anti-VEGF therapy in ROP, revealed a higher effectiveness of bevacizumab compared to retinal laser coagulation in stage 3 plus-disease of zone I. A prospective randomized trial, RAINBOW, demonstrated the effectiveness of ranibizumab in plus-disease stages 1, 2 and 3 in zone I and stage 3 in zone II and in APROP, so that the drug may be recommended for use in children with ROP. The demonstrated high effect of anti-VEGF therapy in ROP is consistent with our own data. Anti-VEGF therapy opens up new possibilities in the treatment of a particular class of ROP forms. The advantages of anti-VEGF therapy include higher clinical effectiveness of treatment of ROP type I with localization in the posterior pole (I and posterior II zone), absence of "blockage" of the peripheral retina, lower frequency of myopia development and degree, relative fastness of the procedure, the acceptability for patients whose fundus is difficult to visualize, and somatically burdened patients who are contraindicated for prolonged anesthesia used for retinal laser coagulation. When using anti-VEGF drugs in the post-threshold stages of the disease, one should take account of an increased risk of proliferation progression and retinal detachment development. Premature infants with retinopathy regression after anti-VEGF therapy require a longer duration of regular and frequent follow-up (up to 70 weeks of postmenstrual age) due to the risk of relapse and extraretinal proliferation in future.

Development of Screening Criteria for Retinopathy of Prematurity in Ulaanbaatar, Mongolia, Using a Web-based Data Management System.

To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia. This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP). As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05). Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [J Pediatr Ophthalmol Strabismus. 2020;57(5):333-339.].