Vision-threatening Retinopathy Of Prematurity Research Articles

RELATIONSHIP OF GESTATION AGE AND WEIGHT IN PREMATURE BIRTH WITH RETINOPATHY OF PREMATURITY IN A TERTIER HOSPITAL

Abstract
 Introduction & Objectives : Retinopathy of Prematurity (ROP) is the leading cause of preventable blindness in these children and significantly impacts vision. It is estimated that from about 15 million infants born prematurely worldwide, around 53,000 infants are found to have vision-threatening ROP, and 20,000 infants experience severe visual impairment. This study is to determine the relationship between gestational age and body weight in preterm birth with retinopathy of prematurity.
 Methods : Medical records data with a diagnosis of retinopathy of prematurity were found in 385 infants treated at Dr. Soetomo Hospital from January 2016-December 2020. From 385 premature infants, 45 premature infants were found with ROP. The relevant data is then entered into the recording sheet and Microsoft Excel software and processed using SPSS 22.0 software.
 Results : Premature infants with ROP who were found 385 infants with 45 infants were found with ROP. Premature infants with ROP in the gestational age group >32 weeks were 10 infants (22.2%). Of 45 premature infants, 23 premature infants with birth weights less than 1500 grams. AP ROP there is also 1 infant in the weight category
 Conclusion : There is a relationship between gestational age at premature birth and retinopathy of prematurity. Meanwhile, birth weight was not associated with retinopathy of prematurity. In infants with a gestational age of more than 32 weeks, it is still necessary for ROP because there is still a possibility of ROP.

Inflammatory and Angiogenic Mediators in Amniotic Fluid Are Associated With the Development of Retinopathy of Prematurity in Preterm Infants.

PurposeTo investigate whether elevated levels of inflammatory/angiogenic and growth mediators in amniotic fluid (AF) and the presence of intra-amniotic infection are associated with the occurrence and progression of retinopathy of prematurity (ROP) in preterm infants.MethodsThis retrospective cohort study included 175 premature singleton infants who were born between 23+0 and 32+0 weeks. AF obtained via amniocentesis was cultured, and endoglin, endostatin, insulin-like growth factor-binding protein (IGFBP)-2, IGFBP-3, IGFBP-4, IL-6, IL-8, matrix metalloproteinase-8, matrix metalloproteinase-9, and vascular endothelial growth factor receptor-1 levels were assayed by ELISA. The primary outcome measures included the occurrence of any stage ROP, severe ROP (stage ≥3), and vision-threatening type 1 ROP requiring treatment.ResultsMultiple logistic regression analyses revealed that there are significant associations between elevated AF endoglin levels and ROP occurrence; between elevated AF endoglin, endostatin, and IGFBP-2 levels and severe ROP; and between high AF endoglin, IL-6, and IL-8 levels and vision-threatening ROP requiring treatment, after adjusting for potential postnatal confounders. Using stepwise regression analyses, antenatal prediction models based on these AF biomarkers and prenatal factors were developed for the ROP outcomes, which had good discriminatory power (area under the curves, 0.731–0.863). However, we found that intra-amniotic infection is not associated with ROP occurrence and progression.ConclusionsElevated levels of inflammatory (IL-6 and IL-8) and angiogenic (endoglin and IGFBP-2) mediators in the AF, but not the presence of intra-amniotic infection, are independently associated with the occurrence and progression of ROP in preterm infants. These findings suggest that the pathophysiologic events that predispose preterm neonates to ROP may begin before delivery.

Refractive Status in Children with Laser-Treated Retinopathy of Prematurity: Our Experience in Bulgaria.

BACKGROUND:With the establishment of laser photocoagulation as a standard treatment modality for prethreshold retinopathy of prematurity (ROP), a dramatic reduction of cases with ROP blindness and severe visual impairment have been reported. In the same time, high refractive errors, a common complication in ROP cases and especially in ROP treated infants, have become the main cause of visual and often severe visual impairment.AIM:The purpose of our study was to analyse the long-term refractive status in children at 3.5 years after laser-treatment for type 1 prethreshold ROP.PATIENTS AND METHODS:A retrospective, one centre study of refractive status of 18 children with laser-treated type 1 prethreshold ROP was conducted. The refraction after cycloplegia with 1% cyclopentolate was measured at a mean age of 3.56 years (SD ± 0.34). Hyperopia was subdivided into two groups – low hyperopia (SE < +5.0 D) and high hyperopia (SE ≥ +5.0 D). Myopia was classified as myopia (SE ≥ –0.25D) and high myopia (SE ≥ -5.0 D). Astigmatism was divided into low astigmatism (plus CD ≥ +1.0 D) and high astigmatism (plus CD ≥ +2.0 D).RESULTS:Thirty-three eyes of 18 children were recruited in the study. Three eyes were excluded because of unfavourable anatomical results. The mean gestational age at birth was 27.3 weeks (24-31 weeks, SD ± 1.78), and the mean birth weight – 928.9 g (550-1500 g, SD ± 252.8). The mean spherical equivalent for the whole group was -1.82 D and ranged from -9.00 D to +4.50 D (SD ± 3.48). Hyperopia was observed in 12 (36.4%) eyes. Myopic refraction had 21 (63.6%) eyes. Astigmatism was detected in 18 (54.5%) eyes. Anisometropia had 3 (16.7%) children. Six children (33.4%) had strabismus (4 esotropia; 2 exotropia).CONCLUSION:High per cent of treated infants for vision-threatening ROP have visual significant refractive errors and strabismus that can cause serious visual impairment if not treated properly and on time.

Assessment of WINROP algorithm as screening tool for preterm infants in Manitoba to detect retinopathy of prematurity.

Developing less invasive methods for early detection of retinopathy of prematurity (ROP) is vital to minimizing blindness in premature infants. Lofqvist and colleagues developed a computer-based ROP risk algorithm (WINROP) (https://winrop.com), which detects downtrends in postnatal weight gain that correlate with the development of sight-threatening ROP. The aim of this study is to investigate the sensitivity and specificity of the WINROP algorithm to detect vision-threatening ROP. This is a retrospective chart review study between January 2008 and December 2013. This study was conducted in the neonatal intensive care unit in Children's Hospital at Health Sciences Centre, Winnipeg, Manitoba, Canada. The study included preterm infants, less than 32 weeks' gestation, who were admitted to the hospital during the study period. The included 215 infants were eligible for ROP screening and had sufficient data to be entered into the WINROP algorithm. Infants were screened by a paediatric ophthalmologist for retinopathy of prematurity. The body weight of infants was measured weekly and entered into the WINROP algorithm; the sensitivity and the specificity of the WINROP algorithm were assessed. The mean gestational age was 28.6 ± 1.8 weeks. The mean body weight was 1244 ± 294 g. The sensitivity of the WINROP algorithm to detect vision-threatening retinopathy of prematurity in our cohort was 90% (P=0.021) with a specificity of 60% (P=0.002). The WINROP algorithm lacks sufficient sensitivity to be used clinically in our population. The algorithm needs to be reassessed in contemporary populations.

Retinopathy of prematurity in Korean infants with birthweight greater than 1500 g

ObjectiveTo determine the incidence and clinical features of, and risk factors for, retinopathy of prematurity (ROP) in Korean infants with birthweight (BW) >1500 g.MethodsA total of 201 consecutive infants with...

Low birth weight is a risk factor for severe retinopathy of prematurity depending on gestational age.

ObjectiveTo evaluate the impact of low birth weight as a risk factor for retinopathy of prematurity (ROP) that will require treatment in correlation with gestational age at birth (GA).Study designIn total, 2941 infants born <32 weeks GA were eligible from five cohorts of preterm infants previously collected for analysis in WINROP (Weight IGF-I Neonatal ROP) from the following locations: Sweden (EXPRESS) (n = 426), North America (n = 1772), Boston (n = 338), Lund (n = 52), and Gothenburg (n = 353). Data regarding GA at birth, birth weight (BW), gender, and need for ROP treatment were retrieved. Birth weight standard deviation scores (BWSDS) were calculated with Swedish as well as Canadian reference models. Small for gestational age (SGA) was defined as BWSDS less than −2.0 SDS using the Swedish reference and as BW below the 10th percentile using the Canadian reference charts.ResultsUnivariate analysis showed that low GA (p<0.001), low BW (p<0.001), male gender (p<0.05), low BWSDSCanada (p<0.001), and SGACanada (p<0.01) were risk factors for ROP that will require treatment. In multivariable logistic regression analysis, low GA (p<0.0001), male gender (p<0.01 and p<0.05), and an interaction term of BWSDS*GA group (p<0.001), regardless of reference chart, were risk factors. Low BWSDS was less important as a risk factor in infants born at GA <26 weeks compared with infants born at GA ≥26 weeks calculated with both reference charts (BWSDSSweden, OR = 0.80 vs 0.56; and BWSDSCanada, OR = 0.72 vs 0.41).ConclusionsLow BWSDS as a risk factor for vision-threatening ROP is dependent on the infant's degree of immaturity. In more mature infants (GA ≥26 weeks), low BWSDS becomes a major risk factor for developing ROP that will require treatment. These results persist even when calculating BW deficit with different well-established approaches.

The rate of change in retinal vessel width and tortuosity in eyes at risk for retinopathy of prematurity

To describe the rate of change in retinal vessel width and tortuosity in eyes that develop treatment-requiring, or type 1, retinopathy of prematurity (ROP) versus eyes that do not develop type 1 ROP. Posterior poles of eyes of 41 infants at risk for ROP were imaged longitudinally with a 30° fundus camera. Retinal vessel width and tortuosity were measured with computer-assisted image analysis. The rate of change per day in width and tortuosity up to the development of most severe ROP was calculated from linear regression and eyes with (n = 10) and without type 1 ROP (n = 31) were compared. Eyes that developed type 1 ROP had a greater rate of change in width for venules and 3 widest vessels (P < 0.0001), and a greater rate of change in tortuosity for arterioles and 3 most tortuous vessels (P < 0.0001) than eyes that did not develop type 1 ROP. These vessel parameters discriminate the 2 groups well (area under the ROC curve, 0.79-0.90). A combination of venular width and arteriolar tortuosity had the best discriminative ability (area under the ROC curve, 0.96). In this pilot study, eyes that eventually developed type 1 ROP demonstrated a faster increase in width and tortuosity of retinal vessels compared with those that did not. Further study of the kinetics of retinal vascular change in a larger sample may allow for the earlier identification of vision-threatening ROP.

Antivascular endothelial growth factor for retinopathy of prematurity

This review will discuss a potentially more effective treatment for retinopathy of prematurity (ROP) with fewer acute and long-term complications. Avastin (bevacizumab) therapy is a promising anti-vascular endothelial growth factor (anti-VEGF) administered directly into the vitreous. Recent reports detail the use of Avastin alone, and in combination with light amplification by stimulated emission of radiation (LASER) therapy and vitrectomy, for ROP stages 3, 4, and 5. Currently, one clinical trial is studying Avastin alone for acute vision-threatening ROP stage 3 in zone I and posterior zone II without LASER therapy. Another clinical trial is investigating Avastin following LASER therapy for recurrent ROP stages 4 and 5. Treatment for ROP has evolved from later, more destructive (cryotherapy) to earlier, less destructive (LASER therapy) peripheral retinal ablation. If evidence-based data supports early findings, the use of Avastin may be recommended without the need for ablative LASER therapy and before retinal detachment develops. Avastin will be especially useful for ROP stage 3 cases with hemorrhage decreasing retinal visualization, rigid pupils, intravitreal neovascularization with early or developing (minimal) fibrous membranes, or aggressive posterior retinopathy of prematurity (AP-ROP). These cases all continue to have poor outcomes with LASER therapy.

Retinopathy of Prematurity: Practical Clinical Approach

After completing this article, readers should be able to: 1. Describe the forms that should be used to record all retinopathy of prematurity (ROP) screening examinations. 2. Characterize the roles of ophthalmologists and neonatologists in developing local screening policies. 3. Delineate which preterm infants require screening for ROP and when the first screening examination should occur. 4. Describe the procedure for laser therapy to treat ROP and postsurgical follow-up. The neonatologist and neonatal intensive care unit (NICU) staff have a serious responsibility to minimize vision loss from retinopathy of prematurity (ROP). It requires a team effort throughout the hospitalization to reduce the incidence and severity of ROP and particularly conscientious tracking of patients during the phase of active disease to detect and treat the few cases that become severe enough to threaten retinal detachment. It is particularly frustrating in this most visual of diseases that the pathology occurs inside the eye where the threat is not visible and at the particular time when the infants are recovering from so many other insults and are nearly ready for home! Among infants of similar gestations, those who have the more unstable hospital course have the higher risk of serious ROP. It is important to remember that interventions that prolong pregnancy and reduce intraventricular hemorrhage, pneumothorax, serious sepsis, and chronic lung disease all reduce the risk of vision-threatening ROP. To date it is impossible to prevent all morbidities, but each year brings increased knowledge about how to reduce their incidence and hopefully the incidence of severe ROP. An effective ROP screening program requires the cooperative efforts of the neonatal team, screening ophthalmologists, and discharge coordinators. Unlike many screening programs in which the “screening test” is inexpensive, the time and effort of ophthalmologists is considerable in this program, and rarely are their consulting fees paid. Participating in ROP …

Prognostic significance of vascular dilation and tortuosity insufficient for plus disease in retinopathy of prematurity

Background: Plus disease, one of the most important prognostic indicators in retinopathy of prematurity (ROP), is designated as present or absent. A grading system based on comparison with standard, high-quality color photographs may be useful to more accurately describe the spectrum of vascular dilation and tortuosity preceding plus disease, but it is of practical value only if it has prognostic significance. We hypothesized that grading of “pre-plus” vascular changes can identify eyes at risk for progression to vision-threatening ROP. Methods: Video clips of posterior pole images captured at the examination closest to 33 weeks' postconceptional age of 32 infants screened during an 18-month period were randomized. Two masked examiners viewed and graded the images in comparison with standard photographs representative of 5 distinct grades of retinal vascular dilation and tortuosity. A case-control design was used to compare the incidence of progression to stage 3 ROP, development of plus disease, and requirement of laser treatment between infants with normal posterior poles and those judged to have early dilation and tortuosity insufficient for plus disease. Results: Of the 8 patients with mild vascular dilation and tortuosity insufficient for plus disease, 5 (63%) eventually required laser treatment, 4 (50%) later developed stage 3 ROP, and 5 (63%) progressed to plus disease. Of the 24 patients with normal posterior poles, none required laser treatment, 2 (8%) developed stage 3 ROP, and none progressed to plus disease. The group with mild vascular dilation and tortuosity had a significantly higher incidence of progression to laser treatment (P =.0003), stage 3 ROP (P =.027), and plus disease (P =.0003). Conclusions: Early vascular dilation and tortuosity judged insufficient for plus disease have prognostic significance in the early course of ROP. A grading system that uses standard, high-quality color photographs representing the spectrum of “pre-plus” vascular changes has potential utility in both the clinical and research settings. (J AAPOS 2000;4:224–9)

Retinopathy of Prematurity

Retinopathy of prematurity (ROP) remains a nonpreventable disorder associated with extreme prematurity. Recent advances in establishing the International Classification of ROP have facilitated both clinical care and research, highlighted by the demonstration of the effectiveness of cryoablative therapy for vision-threatening ROP. For those individuals who have ROP, early and life-long ophthalmic follow-up is critical. This is true for those with any residual retinal scars that we now know can lead to later vision loss as well as those who require services for the visually impaired.