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Li X, Owen LA, Taylor KD, Ostmo S, Chen YDI, Coyner AS, Sonmez K, Hartnett ME, Guo X, Ipp E, Roll K, Genter P, Chan RVP, DeAngelis MM, Chiang MF, Campbell JP, Rotter JI. Genome-wide association identifies novel ROP risk loci in a multiethnic cohort. Commun Biol 2024; 7:107. [PMID: 38233474 PMCID: PMC10794688 DOI: 10.1038/s42003-023-05743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
We conducted a genome-wide association study (GWAS) in a multiethnic cohort of 920 at-risk infants for retinopathy of prematurity (ROP), a major cause of childhood blindness, identifying 1 locus at genome-wide significance level (p < 5×10-8) and 9 with significance of p < 5×10-6 for ROP ≥ stage 3. The most significant locus, rs2058019, reached genome-wide significance within the full multiethnic cohort (p = 4.96×10-9); Hispanic and European Ancestry infants driving the association. The lead single nucleotide polymorphism (SNP) falls in an intronic region within the Glioma-associated oncogene family zinc finger 3 (GLI3) gene. Relevance for GLI3 and other top-associated genes to human ocular disease was substantiated through in-silico extension analyses, genetic risk score analysis and expression profiling in human donor eye tissues. Thus, we identify a novel locus at GLI3 with relevance to retinal biology, supporting genetic susceptibilities for ROP risk with possible variability by race and ethnicity.
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Affiliation(s)
- Xiaohui Li
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Leah A Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
- Department of Ophthalmology, University at Buffalo the State University of New York, Buffalo, NY, USA.
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susan Ostmo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aaron S Coyner
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kemal Sonmez
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Eli Ipp
- Division of Endocrinology and Metabolism, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn Roll
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Pauline Genter
- Division of Endocrinology and Metabolism, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Margaret M DeAngelis
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology, University at Buffalo the State University of New York, Buffalo, NY, USA
- Department of Biochemistry; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, NY, USA
- Department of Neuroscience; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, NY, USA
- Department of Genetics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, NY, USA
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - J Peter Campbell
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA.
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Hu X, Zhang J, Zhang M, Chen X, Han S, Zhu J. Incidence and Risk Factors for Retinopathy of Prematurity in a Tertiary Hospital in China. Clin Ophthalmol 2023; 17:3189-3194. [PMID: 37904850 PMCID: PMC10613405 DOI: 10.2147/opth.s434173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Purpose To investigate the incidence and risk factors for the retinopathy of prematurity (ROP) in the neonatal intensive care unit (NICU) of Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, China. Methods This retrospective case-control study included 611 preterm infants with birth weight (BW)<1500 grams admitted to the Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University between January 2019 and December 2022. The incidence and risk factors for any stage and severe ROP were analyzed. Results Within 611 infants, 245(40.1%) developed ROP; 160(26.2%) infants were stage 1, 54(8.8%) were stage 2, and 31(5.1%) were stage 3, no stage 4 and 5. Among them, 22(3.6%) infants needed treatment. Multivariate analysis showed a higher gestational age (GA) was protective, whereas twin birth and moderate-to-severe BPD increased the hazard of any stage ROP; higher BW and male gender were significant risk factors for severe ROP. Conclusion Compared to other tertiary hospitals, the incidence of any stage ROP in our NICU was higher, but the rate of ROP needed treatment was lower. A higher GA was protective, whereas twin birth and moderate-to-severe BPD increased the hazard of any stage ROP; higher BW was protective, whereas male gender were risk factors for the development of severe ROP.
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Affiliation(s)
- Xiaoshan Hu
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Jun Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Min Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Xiaohui Chen
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Shuping Han
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Jingai Zhu
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
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Di Pietro M, Decembrino N, Afflitto MG, Malerba E, Avitabile T, Franco LM, Longo A, Betta P. Risk factors in the development of retinopathy of prematurity: A 10-year retrospective study. Early Hum Dev 2023; 185:105844. [PMID: 37672895 DOI: 10.1016/j.earlhumdev.2023.105844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate Retinopathy of Prematurity (ROP) rate and risk factors in a large cohort of preterm newborns. METHODS Single center retrospective study. All preterm inborn hospitalized at the Neonatal Intensive Care Unit of the Policlinico of Catania from January 1, 2009 till December 31, 2018, were included. ROP stage and location, treatments required, maternal and infant risk factors were evaluated. RESULTS Medical records of 898 preterms were retrospectively examined (mean gestational age 32.9 ± 2.3 weeks). Of them 149 (16.6 %) developed bilateral ROP (92 stage 1, 44 stage 2 and 13 stage 3); 66 (7.3 %) received bilateral laser treatment. Six eyes of three patients affected by zone I ROP 1, with plus persistence 15 days after an optimal laser treatment, also received intravitreal ranibizumab injection. Risk factors for ROP development were gestational age (GA) (p < 0.001), birthweight (p < 0.001), assisted ventilation duration (p < 0.001), multiple birth (p = 0.003), erythropoietin (EPO) administration (p = 0.005) and persistence of tunica vasculosa lentis. The decision-tree analysis showed gestational age as the most significant predictive factor (P < 0.001); secondary predictive factors were EPO administration (p = 0.001) in newborns 29-31 weeks GA and birthweight lower than 2090 g (p < 0.001) in 32-34 weeks GA; in this latter group patent ductus arteriosus (PDA) was a tertiary predictive factor (p = 0.043). CONCLUSIONS In our study ROP incidence was 16,6 %; 7.3 % of the patients required laser treatment. Besides well-known factors, such as GA and birthweight, other factors like duration of assisted ventilation, EPO, multiple births, PDA, tunica vasculosa lentis persistence should be considered to tailor ophthalmic evaluation and follow-up.
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Affiliation(s)
- Massimo Di Pietro
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Nunzia Decembrino
- Integrated Activity Department for the Protection of Mother and Child Health, Neonatal Intensive Care Unit, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Miriam Gallo Afflitto
- Multizonal Ophtalmology Unit, Hospital of Trento and Rovereto, corso Verona, 4, 38068 Rovereto, Italy.
| | - Emilio Malerba
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy
| | - Teresio Avitabile
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Livio Marco Franco
- Ophtalmology Unit, Great Metropolitan Hospital of Reggio Calabria, via G. Melacrino 21, 891244 Reggio Calabria, Italy
| | - Antonio Longo
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Pasqua Betta
- Integrated Activity Department for the Protection of Mother and Child Health, Neonatal Intensive Care Unit, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy
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Wang J, Ying GS, Yu Y, Tomlinson L, Binenbaum G. Racial Differences in Retinopathy of Prematurity. Ophthalmic Epidemiol 2023; 30:523-531. [PMID: 36647265 PMCID: PMC10349899 DOI: 10.1080/09286586.2023.2168014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE To delineate racial differences in the incidence and time course of ROP in a large cohort of premature infants. METHODS The secondary analysis of data from the two Postnatal Growth and ROP Studies (G-ROP-1 and G-ROP-2) that were collected in 41 hospitals in North America from 2006 to 2017. According to self-reported maternal race, premature infants were classified into 3 groups: White (N = 5580), Black (N = 3252), and Asian (N = 353). Incidence, severity, and time course of ROP; plus disease; and postnatal weight gain rate were compared among racial groups. RESULTS Black infants had significantly smaller BW (mean 1035 vs. 1131 vs.1144 grams, P < .001) and lower GA (28.2 vs. 28.6, vs. 29.1 weeks, P < .001) than White and Asian infants. However, Black infants had lower incidences of severe ROP (11.1% vs. 12.4% vs. 11.9%), ROP (42.1% vs. 43.2% vs. 30.6%), and plus disease (3.6% vs. 6.3%, vs. 5.9%) than White and Asian infants (BW and GA adjusted risk ratio for Black vs. White 0.69 for severe ROP, 0.83 for ROP, 0.44 for plus disease, all P < .0001). Mean daily-weight-gain on days of life 11-20 and 21-30 were similar across groups (P > .05), but lower in Black and Asian infants on days 31-40 (P < .001). There were no differences in the timing of severe ROP and ROP across racial groups. CONCLUSIONS Despite relatively lower GA, BW, and daily-weight-gain, Black preterm infants had lower incidences of ROP and plus disease than White preterm infants. The mechanisms for these differences require further investigation.
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Affiliation(s)
- Jingyun Wang
- State University of New York College of Optometry, New York, NY
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
| | - Yinxi Yu
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
| | - Lauren Tomlinson
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Gil Binenbaum
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA
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Arora P, Mahapatra M, Arora K. Retinopathy of Prematurity: Incidence and Risk Factor Analysis in Small for Gestational Age Neonates Compared to Appropriate for Gestational Age. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1266-S1269. [PMID: 37694017 PMCID: PMC10485521 DOI: 10.4103/jpbs.jpbs_130_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To analyze the incidence of retinopathy of prematurity (ROP) among preterm neonates who were born small for gestational age (SGA) and appropriate for gestational age (AGA). Materials and Methods A prospective cohort study among preterm neonates born <34 weeks of gestational age (GA) and <2000 grams birth weight (BW) was conducted. The neonates were divided into AGA and SGA group. Incidence of ROP and risk factors was compared among the groups. Result 290 neonates were screened [AGA: 240 (82.8%); SGA: 50 (17.2%)]. The mean birth-weight and gestational age were 1510.7 ± 390.64 grams and 31.4 ± 4.8 weeks, respectively. The incidence of ROP in AGA and SGA was 30.2% and 33%, respectively (P = 0.58), whereas the incidence of type 1 ROP in AGA and SGA was 14% and 19% (P = 0.41). Male sex, anemia, oxygen administration, surfactant administration, sepsis, and PIH were independent significant risk factors for ROP on multivariate analysis. Conclusion This study showed that both AGA and SGA premature infants have similar incidence of ROP. SGA is not an independent risk factor for ROP.
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Affiliation(s)
- Priyanka Arora
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Madhushmita Mahapatra
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kamaldeep Arora
- Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Yehiam SZ, Simkin SK, Al-Taie R, Wong M, Battin M, Dai S. Incomplete peripheral retinal vascularisation in retinopathy of prematurity: is it the consequence of changing oxygen saturation? Front Pediatr 2023; 11:1203068. [PMID: 37416821 PMCID: PMC10320580 DOI: 10.3389/fped.2023.1203068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
Background We wish to determine the prevalence and risk factors of incomplete peripheral avascular retina (IPAR) in children screened for retinopathy of prematurity (ROP) and its association with oxygen saturation (SpO2) targets. Methods A retrospective review of retinal images of premature infants born and screened for ROP in Auckland Region, New Zealand, between January 2013 and December 2017 was conducted. Images were reviewed to determine if avascular retina was present at their final ROP screening. The prevalence of peripheral avascular retina was compared among infants born prior to (Group 1) and after (Group 2) 2015 when the SpO2 target was increased. Infants with any concurrent ocular pathology or who had received ROP treatment were excluded. Results In total, 62 (12.8%) of the total of 486 infants (247 in Group 1; 239 in Group 2) were found to have IPAR at their last ROP screening. Group 1 had more statistically significant infants with IPAR compared to Group 2 (39/247 infants and 23/239 infants respectively; p = 0.043). Conclusions Incomplete peripheral retinal vascularisation occurred at a prevalence of 12.8% in infants at risk of ROP. Higher SpO2 targets did not increase the prevalence of incomplete peripheral retinal vascularisation. Low gestational age and low birth weight are likely risk factors for the development of avascular retina. Further research into the risk factors associated with incomplete peripheral retinal vascularisation and the associated long-term outcomes is needed.
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Affiliation(s)
- Sigal Zmujack Yehiam
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Samantha K. Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rasha Al-Taie
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Neonatal Intensive Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Maisie Wong
- Neonatal Intensive Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Malcolm Battin
- Neonatal Intensive Care, Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Shuan Dai
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children’s Health Queensland Hospital and Health Service, Queensland Children’s Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Mosilli R, Aljabri MK, Alsaeedi AK, Zamzami O, Alhothali OS, Almatrafi M. A Multicenter Cross-Sectional Study of the Awareness and Screening for Retinopathy of Prematurity Among NICU Pediatricians in Makkah and Jeddah, Saudi Arabia. Cureus 2023; 15:e36176. [PMID: 37065330 PMCID: PMC10103819 DOI: 10.7759/cureus.36176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose This study aims to evaluate neonatal intensive care unit (NICU) pediatricians' knowledge about retinopathy of prematurity (ROP) in the major tertiary centers in Makkah and Jeddah, Saudi Arabia. Methods This cross-sectional study uses a self-administered electronic questionnaire completed by NICU pediatricians at the main hospitals of Makkah and Jeddah cities. Based on the participants' correctly selected responses to the validated questionnaire, a scoring system was used in the data analysis to show their level of ROP knowledge. Results Seventy-seven responses were analyzed. The male gender was 49.4%. The majority were recruited from the ministry of health hospitals (63.6%). A small proportion (28.6%) correctly identified who performs the examination. Around three-quarters of the participants have correctly stated that ROP therapy is a very good option to prevent blindness (72.7%). The treatment should generally begin within 72 hours after diagnosis of sight-threatening ROP (79.2%). The requirements for ROP screening were unknown to more than half of our participants (53.2%). With the lowest score of 4.0 and a maximum score of 17.0, the median knowledge score was 13.0 (IQR = 11.0 to 14.0). Based on pediatricians' clinical qualifications, knowledge scores varied significantly. Residents had a significantly lower knowledge score than specialists and consultants (median = 7.0, IQR = 6.0 to 9.0, p = 0.001). Additionally, pediatricians with less experience (<5 years) performed significantly lower on the knowledge score (median = 10.0, IQR = 6.2 to 12.8) than those with more experience (median = 13.0, IQR = 11.0 to 15.0) for participants with 5-10 years of experience, and (median = 13.0, IQR = 11.0 to 14.0) for participants with >10 years of experience). Conclusion Our study showed that NICU pediatricians understood ROP risk factors and treatment options. Nevertheless, they needed to understand the ROP screening inclusion criteria and when the screening could be stopped. Residents scored substantially lower in knowledge overall. Accordingly, we emphasized the need for NICU pediatricians to increase their level of awareness by having regular educational sessions and standardizing one guideline to be strictly followed.
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Systemic Cytokines in Retinopathy of Prematurity. J Pers Med 2023; 13:jpm13020291. [PMID: 36836525 PMCID: PMC9966226 DOI: 10.3390/jpm13020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved in ROP pathogenesis. The two-phase (vaso-obliteration followed by vasoproliferation) theory outlines the evaluation of cytokines in a time-dependent manner. Levels of cytokines may even differ between the blood and the vitreous. Data from animal models of oxygen-induced retinopathy are also valuable. Although conventional cryotherapy and laser photocoagulation are well established and anti-vascular endothelial growth factor agents are available, less destructive novel therapeutics that can precisely target the signaling pathways are required. Linking the cytokines involved in ROP to other maternal and neonatal diseases and conditions provides insights into the management of ROP. Suppressing disordered retinal angiogenesis via the modulation of hypoxia-inducible factor, supplementation of insulin-like growth factor (IGF)-1/IGF-binding protein 3 complex, erythropoietin, and its derivatives, polyunsaturated fatty acids, and inhibition of secretogranin III have attracted the attention of researchers. Recently, gut microbiota modulation, non-coding RNAs, and gene therapies have shown promise in regulating ROP. These emerging therapeutics can be used to treat preterm infants with ROP.
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Ittarat M, Chansaengpetch S, Chansangpetch S. Incidence and Risk Factors for Retinopathy of Prematurity at a Rural Tertiary Hospital in Thailand. J Ophthalmic Vis Res 2023; 18:81-87. [PMID: 36937197 PMCID: PMC10020780 DOI: 10.18502/jovr.v18i1.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/01/2022] [Indexed: 02/24/2023] Open
Abstract
Purpose To estimate the incidence and identify the factors affecting retinopathy of prematurity (ROP) in a rural tertiary hospital in Thailand. Methods This retrospective chart review included all infants screened for ROP. The study included all infants with gestational age (GA) ≤ 30 weeks or birth weight (BW) ≤ 1,500 gr or selected larger infants with an unstable clinical course. Retinal findings were classified according to the revised International Classification of ROP. Data were analyzed using univariate and multivariable logistic regression analyses. Results Of the 113 screened infants, the incidences of any ROP and ROP requiring intervention were 17.7% and 8.8%, respectively. In univariate analysis, lower GA, lighter BW, total days of supplemental oxygen, days of continuous positive airway pressure (CPAP), presence of apnea, and intraventricular hemorrhage (IVH) were associated with the development of any ROP. In the stepwise multivariable logistic regression analysis, lighter BW, male gender, and bronchopulmonary dysplasia (BPD) were significant risk factors for the development of any ROP. Lower GA and being either a twin or triplet were significant risk factors for ROP requiring intervention. However, no antenatal condition was identified as a risk factor for ROP. Conclusion The incidence of ROP in rural tertiary hospitals was relatively high as compared with previously published data from urban tertiary hospitals. Lighter BW, male gender, and BPD were significantly associated with the development of ROP in a local context. Epidemiological studies are necessary to prevent ophthalmic morbidities.
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Affiliation(s)
- Mantapond Ittarat
- Surin Hospital and School of Ophthalmology, Suranaree University of Technology, Surin, Thailand
| | | | - Sunee Chansangpetch
- Center of Excellence in Glaucoma, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Angert R, Jones-Bamman C, Moon JY, Mian U. Elective intubation for laser retinopexy treatment of severe ROP is not associated with increased morbidity or length of stay. J Neonatal Perinatal Med 2022; 16:67-74. [PMID: 36530093 DOI: 10.3233/npm-210788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND: Laser retinopexy is the current standard treatment for babies with type I retinopathy of prematurity (ROP). No guidelines exist for respiratory management during this procedure. Although neonatologists prefer to avoid intubation to prevent delays in extubation, feeding and discharge, ophthalmologists often request intubation, because sedation alone may lead to respiratory collapse. Little evidence is available regarding which treatment provides the most benefit to vulnerable infants. OBJECTIVE: This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy. METHODS: A retrospective chart review was performed to analyze data from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge. RESULTS: The main outcomes were analyzed in four groups: never intubated (n = 27), emergently intubated (n = 7), already intubated (n = 8) and electively intubated (n = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups. CONCLUSIONS: No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation.
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Affiliation(s)
- R. Angert
- Division of Neonatology, Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - C. Jones-Bamman
- Department of Pediatrics, Children’s Hospital of Colorado, Aurora, CO, USA
| | - J.-Y. Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - U.K. Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
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Hawn VS, Muhtadi R, Suman P, Latuga MS, Quinn G, Mian U. Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy of prematurity. J AAPOS 2022; 26:307.e1-307.e5. [PMID: 36404441 DOI: 10.1016/j.jaapos.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks. METHODS This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis. RESULTS Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP. CONCLUSIONS Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.
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Affiliation(s)
- Vivian S Hawn
- Albert Einstein College of Medicine, Bronx, New York
| | - Rakin Muhtadi
- Albert Einstein College of Medicine, Bronx, New York
| | - Pamela Suman
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Mariam S Latuga
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Graham Quinn
- Division of Ophthalmology, Children's Hospital of Pennsylvania, Philadelphia
| | - Umar Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.
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12
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Tawfik GM, Shahein EA, Dabour SA, Hassanein D, Elshewy AM. Comparison of intravitreal injection of ranibizumab versus bevacizumab for treatment of type 1 and aggressive retinopathy of prematurity in rural Egypt. A randomized clinical trial. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
ObjectiveThe objective of this study is to evaluate the efficacy of intravitreal ranibizumab (IVR) monotherapy compared with intravitreal bevacizumab (IVB) monotherapy for treatment of type 1 and aggressive retinopathy of prematurity (ROP) in rural Egypt.Methods36 eyes of 18 infants with bilateral aggressive or type 1 ROP were recruited between September 2020 and September 2022. Mean follow-up duration was 16.53 months. IVB was injected in the right eye and IVR in the left eye, rescue injection of the same initial anti-vascular endothelial growth factor (VEGF) in case of ROP reactivation. Outcome measures included regression achieved either by single injection or multiple injections or additional laser therapy at 55 weeks’ postmenstrual age (PMA), recurrence of ROP, total retinal vascularisation time and complications.ResultsInitial regression of ROP within 1 week occurred in 11/18 eyes (61.1%) in bevacizumab group and 15/18 eyes (83.3%) in ranibizumab group (p=0.137). Primary outcome measure was achieved in 14/18 eyes (77.8%) and 16/18 eyes (88.9%) in bevacizumab and ranibizumab groups, respectively (p=0.658). Late reactivation requiring retreatment with anti-VEGF was encountered in 4/18 eyes (22.2%) and 1/18 eyes (5.6%) in bevacizumab and ranibizumab groups, respectively (p=0.338). Peripheral laser therapy on the avascular retina was done in 3/18 eyes (16.7%) in each group at mean of 55.67 weeks' PMA.ConclusionBevacizumab and ranibizumab proved to be effective regarding regression of acute ROP and continuing peripheral retinal vascularisation. Higher proportion of reactivation with bevacizumab, however, clinically non-significant. Laser therapy can be postponed to reduce its complications.Trial registration numberNCT05033106.
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13
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Karvonen KL, Goronga F, McKenzie-Sampson S, Rogers EE. Racial disparities in the development of comorbid conditions after preterm birth: A narrative review. Semin Perinatol 2022; 46:151657. [PMID: 36153273 DOI: 10.1016/j.semperi.2022.151657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Faith Goronga
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
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14
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Retinopathy of prematurity: contribution of inflammatory and genetic factors. Mol Cell Biochem 2022; 477:1739-1763. [PMID: 35262882 DOI: 10.1007/s11010-022-04394-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disorder that represents an important cause of childhood visual impairment and blindness. Although oxidative stress has long been implicated in ROP etiology, other prenatal and perinatal factors are also involved. This review focuses on current research involving inflammation and genetic factors in the pathogenesis of ROP. Increasing evidence suggests that perinatal inflammation or infection contributes to ROP pathogenesis. Cytokines and chemokines with a fundamental role in inflammatory responses and that significantly contributing to angiogenesis are analyzed. Microglia cells, the retinal-resident macrophages, are crucial for retinal homeostasis, however, under sustained pathological stimuli release exaggerated amounts of inflammatory mediators and can promote pathological neovascularization. Current modulation of angiogenic cytokines, such as treatment with antibodies to vascular endothelial growth factor (anti-VEGF), has shown efficacy in the treatment of ocular neovascularization; however, some patients are refractory to anti-VEGF agents, suggesting that other angiogenic or anti-angiogenic cytokines need to be identified. Much evidence suggests that genetic factors contribute to the phenotypic variability of ROP. Several studies have implicated the involvement of candidate genes from different signaling pathways in the development of ROP. However, a genetic component with a major impact on ROP has not yet been discovered. Most studies have limitations and did not replicate results. Future research involving bioinformatics, genomics, and proteomics may contribute to finding more genes associated with ROP and may allow discovering better solutions in the management and treatment of ROP.
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15
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Filippi L, Cammalleri M, Amato R, Ciantelli M, Pini A, Bagnoli P, Dal Monte M. Decoupling Oxygen Tension From Retinal Vascularization as a New Perspective for Management of Retinopathy of Prematurity. New Opportunities From β-adrenoceptors. Front Pharmacol 2022; 13:835771. [PMID: 35126166 PMCID: PMC8814365 DOI: 10.3389/fphar.2022.835771] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022] Open
Abstract
Retinopathy of prematurity (ROP) is an evolutive and potentially blinding eye disease that affects preterm newborns. Unfortunately, until now no conservative therapy of active ROP with proven efficacy is available. Although ROP is a multifactorial disease, premature exposition to oxygen concentrations higher than those intrauterine, represents the initial pathogenetic trigger. The increase of oxygenation in a retina still incompletely vascularized promotes the downregulation of proangiogenic factors and finally the interruption of vascularization (ischemic phase). However, the increasing metabolic requirement of the ischemic retina induces, over the following weeks, a progressive hypoxia that specularly increases the levels of proangiogenic factors finally leading to proliferative retinopathy (proliferative phase). Considering non-modifiable the coupling between oxygen levels and vascularization, so far, neonatologists and ophthalmologists have “played defense”, meticulously searching the minimum necessary concentration of oxygen for individual newborns, refining their diagnostic ability, adopting a careful monitoring policy, ready to decisively intervene only in a very advanced stage of disease progression. However, recent advances have demonstrated the possibility to pharmacologically modulate the relationship between oxygen and vascularization, opening thus the perspective for new therapeutic or preventive opportunities. The perspective of a shift from a defensive towards an attack strategy is now at hand.
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Affiliation(s)
- Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Luca Filippi,
| | | | - Rosario Amato
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Bagnoli
- Department of Biology, University of Pisa, Pisa, Italy
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16
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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17
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Bahmani T, Karimi A, Rezaei N, Daliri S. Retinopathy prematurity: a systematic review and meta-analysis study based on neonatal and maternal risk factors. J Matern Fetal Neonatal Med 2021; 35:8032-8050. [PMID: 34256661 DOI: 10.1080/14767058.2021.1940938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Retinopathy of prematurity is the abnormal development of retinal arteries in preterm neonates less than 32 weeks and weighing 1500 g, and less, which can lead to visual impairment during life and blindness. This study aims to investigate the relationship between some clinical characteristics of neonates and mothers with Retinopathy of prematurity in the world via a systematic review and meta-analysis. MATERIALS AND METHODS The present study is a systematic review and meta-analysis on the relationship between maternal and neonatal clinical variables with Retinopathy of prematurity in the world from the beginning of 2000 to the end of 2020. Accordingly, all English articles published on the topic were searched in scientific databases of Web of Science, PubMed, Google Scholar, Science Direct, and Scopus. The articles were searched independently by two researchers. Statistical analysis of data was performed using fixed and random effects model statistical tests in the meta-analysis, Cochran, meta-regression, I2 index, Funnel plot, and Begg's by STATA software program, version 14. RESULT A total of 191 studies with a sample size of 140,921 persons were including in the meta-analysis. Accordingly, Preterm delivery ≤28 weeks (OR:6.3, 95% CI:4.9-8.1), Birth Weight ≤1000 g (OR:5.8, 95% CI:4.8-6.8), Birth Weight ≤1500 g (OR:4.8, 95% CI:3.8-6.1), PROM (OR:1.2, 95% CI:1.0-1.4), induced fertility (OR:1.9, 95% CI:1.1-3.0) and Chorioamnionitis (OR:1.5, 95% CI:1.0-2.2) There was a statistically significant association with retinopathy. CONCLUSION Based on the results of the present meta-analysis, the risk of retinopathy of prematurity in neonates born at 28 weeks and less, LBW (weight 1500 g and less), neonatal hypotension, chorioamnionitis, and induced fertility increases.
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Affiliation(s)
- Tahereh Bahmani
- School Medicine, Ilam University of Medical Science, Ilam, Iran
| | - Arezoo Karimi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nazanin Rezaei
- Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
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18
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Gohari M, Bahrami R, Dastgheib SA, Lookzadeh MH, Noorishadkam M, Mirjalili SR, Zare-Shehneh M, Neamatzadeh H. An Updated and Comprehensive Meta-Analysis of Association between VEGA -634G > C, -460T > C, +405G > C and +936C > T Polymorphisms and Retinopathy of Prematurity Risk. Fetal Pediatr Pathol 2021; 40:233-249. [PMID: 31846376 DOI: 10.1080/15513815.2019.1703227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Previous studies have suggested an association between VEGF-A polymorphisms and retinopathy of prematurity (ROP) risk. But the conclusions are still controversial. The aim of this meta-analysis was to evaluate the association between the VEGF-A polymorphisms and susceptibility of ROP. Methods: We searched PubMed, Scopus, WanFang and CNKI databases for all eligible case-control studies published before September 30, 2019. Results: A total of 27 case-control studies with 5,748 ROP cases and 6,146 controls were selected. The results suggested that there was an association between VEGF-A -460T > C polymorphism and increased risk of ROP under the allele model (C vs. T: OR= 0.879, 95% CI 0.776-0.994, p = 0.040). However, VEGF-A -634G > C, +405G > C and +936C > T polymorphisms were not significantly associated with risk of ROP. The subgroup analysis demonstrated that VEGF-A +405G > C polymorphism was associated with ROP risk in Caucasians. Conclusions: This meta-analysis indicates that VEGF-A -460T > C polymorphism may contribute to the susceptibility for ROP.
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Affiliation(s)
- Mohsen Gohari
- Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Bahrami
- Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Hosein Lookzadeh
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Noorishadkam
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Reza Mirjalili
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Zare-Shehneh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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19
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Kumawat D, Sachan A, Shah P, Chawla R, Chandra P. Aggressive posterior retinopathy of prematurity: a review on current understanding. Eye (Lond) 2021; 35:1140-1158. [PMID: 33514899 PMCID: PMC8115681 DOI: 10.1038/s41433-021-01392-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023] Open
Abstract
A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.
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Affiliation(s)
- Devesh Kumawat
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anusha Sachan
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Shah
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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20
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Identification of candidate genes and pathways in retinopathy of prematurity by whole exome sequencing of preterm infants enriched in phenotypic extremes. Sci Rep 2021; 11:4966. [PMID: 33654115 PMCID: PMC7925531 DOI: 10.1038/s41598-021-83552-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease affecting premature infants. In addition to prematurity itself and oxygen treatment, genetic factors have been suggested to predispose to ROP. We aimed to identify potentially pathogenic genes and biological pathways associated with ROP by analyzing variants from whole exome sequencing (WES) data of premature infants. As part of a multicenter ROP cohort study, 100 non-Hispanic Caucasian preterm infants enriched in phenotypic extremes were subjected to WES. Gene-based testing was done on coding nonsynonymous variants. Genes showing enrichment of qualifying variants in severe ROP compared to mild or no ROP from gene-based tests with adjustment for gestational age and birth weight were selected for gene set enrichment analysis (GSEA). Mean BW of included infants with pre-plus, type-1 or type 2 ROP including aggressive posterior ROP (n = 58) and mild or no ROP (n = 42) were 744 g and 995 g, respectively. No single genes reached genome-wide significance that could account for a severe phenotype. GSEA identified two significantly associated pathways (smooth endoplasmic reticulum and vitamin C metabolism) after correction for multiple tests. WES of premature infants revealed potential pathways that may be important in the pathogenesis of ROP and in further genetic studies.
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21
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Inflammation-associated gene polymorphisms and clinical variables in the incidence and progression of retinopathy of prematurity. Cent Eur J Immunol 2021; 45:283-293. [PMID: 33437180 PMCID: PMC7790002 DOI: 10.5114/ceji.2020.94789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction A growing body of evidence shows that genetics plays a vital role in the development and progression of retinopathy of prematurity (ROP). Perinatal inflammation is also considered an important risk factor of ROP. Therefore, understanding the interplay of genetics and susceptibility to inflammation might shed light on the pathogenesis of ROP and make its screening and treatment more effective in preventing visual impairment in premature infants. Material and methods This study investigated the correlation of inflammation-associated gene polymorphisms: IL-1β +3953 C>T, IL-1RN VNTR 86 bp, IL-6 -174 G>C, IL-6 -596 G>A, and TNF-α -308 G>A as well as demographic and clinical characteristics of ROP in preterm infants (n = 90). Results Our results demonstrate that IL-1RN rs2234663 1/1 genotype prevails in infants with ROP that regresses without intervention, when compared to those requiring laser photocoagulation/anti-VEGF injection (p = 0.031). Genotype 2/2 of IL-1RN occurs more frequently in children with severe ROP (28.6%) than in the group in which ROP regressed spontaneously (4.0%). The analysis revealed also differences between the genotypes of IL-1RN in ROP patients with intrauterine infection and in patients who had ROP without intrauterine infection; however, this was not statistically significant. Other studied polymorphisms were not associated with ROP development or its progression. Conclusions These results suggest that different genotypes of IL-1RN might have an impact on the course of ROP. Genotype 2/2 of IL-1RN gene may predispose to ROP progression.
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22
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Olson SL, Chuluunbat T, Cole ED, Jonas KE, Bayalag M, Chuluunkhuu C, Valikodath NG, Cherwek DH, Congdon N, MacKeen LD, Hallak J, Yap V, Ostmo S, Wu WC, Campbell JP, Chiang MF, Chan RVP. Development of Screening Criteria for Retinopathy of Prematurity in Ulaanbaatar, Mongolia, Using a Web-based Data Management System. J Pediatr Ophthalmol Strabismus 2020; 57:333-339. [PMID: 32956484 PMCID: PMC7880618 DOI: 10.3928/01913913-20200804-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia. METHODS 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). RESULTS 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). CONCLUSIONS 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.].
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23
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Singh JK, Wymore EM, Wagner BD, Thevarajah TS, Jung JL, Kinsella JP, Palestine AG, Lynch AM. Relationship between severe bronchopulmonary dysplasia and severe retinopathy of prematurity in premature newborns. J AAPOS 2019; 23:209.e1-209.e4. [PMID: 31132481 DOI: 10.1016/j.jaapos.2019.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are two adverse sequelae of preterm birth associated with abnormal vascular development. The purpose of this study was to characterize the relationship between these two outcomes at a single institution. METHODS The medical records of infants screened for ROP at the University of Colorado Hospital between January 2012 and December 2017 were reviewed retrospectively. ROP was classified according to Early Treatment Retinopathy of Prematurity (ET-ROP) criteria; BPD, according to the 2010 Criteria from the National Institute for Child Health and Human Development. We examined the relationship between moderate-severe BPD and the development of severe ROP (type 1 or 2) using univariate analysis and multivariable logistic regression with the odds ratio as a measure of association. Covariates included gestational age and birth weight at delivery. RESULTS A total of 625 cases were reviewed. Of these, 64 infants (10%) developed severe ROP and 176 (28%) infants developed moderate-severe BPD. We found a significant relationship between these two outcomes following adjustments for gestational age, birth weight, and multiparity (OR = 3.2; 95% CI, 1.6-6.5 [P < 0.01]). CONCLUSIONS In our cohort of preterm infants, we found a significant relationship between moderate-severe BPD with severe ROP. We hypothesize that these two neonatal outcomes have links with a common pathogenesis.
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Affiliation(s)
- Jasleen K Singh
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora.
| | - Erica M Wymore
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Tamara S Thevarajah
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Jennifer L Jung
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - John P Kinsella
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora
| | - Alan G Palestine
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Anne M Lynch
- Departments of Ophthalmology, University of Colorado School of Medicine, Aurora
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Zarei M, Bazvand F, Ebrahimiadib N, Roohipoor R, Karkhaneh R, Farahani Dastjani A, Imani Fouladi M, Riazi Esfahani M, Khodabande A, Davoudi S, Ghasemi H, S Modjtahedi B. Prevalence and Risk Factors of Retinopathy of Prematurity in Iran. J Ophthalmic Vis Res 2019; 14:291-298. [PMID: 31660108 PMCID: PMC6815327 DOI: 10.18502/jovr.v14i3.4785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/05/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants. Methods A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age ≤ 28 weeks), extremely low-birth-weight (≤ 1000 g), and multiple-gestation (MG) infants. Results The prevalence of ROP was 27.28% (n = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion (P < 0.0001, P < 0.0001, and P = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP (P < 0.0001) were observed in EP and ELBW infants. Birth weight (P = 0.088), history of transfusion (P = 0.066), and intubation (P = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age (P = 0.037) and history of transfusion (P = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight (P = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis. Conclusion ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.
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Affiliation(s)
- Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsar Farahani Dastjani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani Fouladi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Davoudi
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Hamed Ghasemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wang X, Tang K, Chen L, Cheng S, Xu H. Association between sepsis and retinopathy of prematurity: a systematic review and meta-analysis. BMJ Open 2019; 9:e025440. [PMID: 31129577 PMCID: PMC6537987 DOI: 10.1136/bmjopen-2018-025440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/19/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To explore the association between sepsis and retinopathy of prematurity (ROP) in premature infants. DESIGN A systematic review and meta-analysis. DATA SOURCES We performed a systematic search of PubMed, the Cochrane Library and Embase from 1 January, 2000, to 1 January, 2018, with no language restrictions and reported the relationship between sepsis and ROP. ELIGIBILITY CRITERIA Original observational studies, including cohort studies and case-control studies. DATA EXTRACTION AND SYNTHESIS Two reviewers independently completed the study selection and data extraction. The OR and corresponding 95% CI were used to measure the risk of sepsis in patients with ROP. The heterogeneity between studies was evaluated using Cochran's Q test and the I2 statistic. The Newcastle-Ottawa Scale was adopted to evaluate the quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the quality of the evidence. RESULTS Sixteen studies with a total sample size of 12 466 premature infants and 2494 cases of ROP were included in this meta-analysis. Adjusted analysis showed that sepsis was closely related to any stage of ROP (OR = 1.57, 95% CI 1.31 to 1.89) and severe stage of ROP (OR = 2.33, 95% CI 1.21 to 4.51) in premature infants, with 56.3% and 81.8% heterogeneity, respectively. Subgroup analyses showed that heterogeneity was obvious in prospective cohort studies (I2 = 62.1%, p<0.001). In a sensitivity analysis, we found that removing any single study did not significantly change the overall effect value. The quality of the evidence was rated as low for both any stage of ROP and severe stage of ROP. CONCLUSIONS Sepsis increases the risk of ROP in preterm infants. However, considering that all included studies are observational and causality can rarely be established, additional evidence is needed to substantiate this finding and provide advice for practice.
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Affiliation(s)
- Xiaofen Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Kun Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Department of Research, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Chen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Sixiang Cheng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Chan H, Cougnard-Grégoire A, Korobelnik JF, Delyfer MN, Touboul D, Coste V, Sarlangue J, Dutheil C, Paya C. Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period. J Fr Ophtalmol 2018; 41:926-932. [PMID: 30442486 DOI: 10.1016/j.jfo.2018.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/17/2018] [Accepted: 02/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. METHODS A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. RESULTS ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. CONCLUSION In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed.
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Affiliation(s)
- H Chan
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - A Cougnard-Grégoire
- Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - J F Korobelnik
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France; Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - M N Delyfer
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France; Inserm (institut national de la santé et de la recherche médicale), U897-épidemiologie-biostatistique, Bordeaux, France
| | - D Touboul
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - J Sarlangue
- Service de néonatologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Dutheil
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux 2, 146, rue Léo-Saignat, 33000 Bordeaux, France
| | - C Paya
- Service d'ophtalmologie, centre hospitalier universitaire (CHU de Bordeaux), place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Swan R, Kim SJ, Campbell JP, Paul Chan RV, Sonmez K, Taylor KD, Li X, Chen YDI, Rotter JI, Simmons C, Chiang MF. The genetics of retinopathy of prematurity: a model for neovascular retinal disease. Ophthalmol Retina 2018; 2:949-962. [PMID: 30250936 PMCID: PMC6150458 DOI: 10.1016/j.oret.2018.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
TOPIC Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease in premature infants, and is a major cause of childhood blindness worldwide. In addition to known clinical risk factors such as low birth weight and gestational age, there is a growing body of evidence supporting a genetic basis for ROP. CLINICAL RELEVANCE While comorbidities and environmental factors have been identified as contributing to ROP outcomes in premature infants, most notably gestational age and oxygen, some infants progress to severe disease despite absence of these clinical risk factors. The contribution of genetic factors may explain these differences and allow better detection and treatment of infants at risk for severe ROP. METHODS To comprehensively review genetic factors that potentially contribute to the development and severity of ROP, we conducted a literature search focusing on the genetic basis for ROP. Terms related to other heritable retinal vascular diseases like "familial exudative vitreoretinopathy", as well as to genes implicated in animal models of ROP, were also used to capture research in diseases with similar pathogenesis to ROP in humans with known genetic components. RESULTS Contributions across several genetic domains are described including vascular endothelial growth factor, the Wnt signaling pathway, insulin-like growth factor 1, inflammatory mediators, and brain-derived neurotrophic factor. CONCLUSIONS Most candidate gene studies of ROP have limitations such as inability to replicate results, conflicting results from various studies, small sample size, and differences in clinical characterization. Additional difficulty arises in separating the contribution of genetic factors like Wnt signaling to ROP and prematurity. Although studies have implicated involvement of multiple signaling pathways in ROP, the genetics of ROP have not been clearly elucidated. Next-generation sequencing and genome-wide association studies have potential to expand future understanding of underlying genetic risk factors and pathophysiology of ROP.
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Affiliation(s)
- Ryan Swan
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL
- Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Kemal Sonmez
- Center for Spoken Language Understanding, Oregon Health & Science University, Portland, OR
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Xiaohui Li
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Charles Simmons
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael F. Chiang
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR
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Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018; 63:618-637. [PMID: 29679617 DOI: 10.1016/j.survophthal.2018.04.002] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/09/2023]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Alexander D Port
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Ryan Swan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA; Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA.
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Onyango O, Sitati S, Amolo L, Murila F, Wariua S, Nyamu G, Lango M, Patel A. Retinopathy of prematurity in Kenya: prevalence and risk factors in a hospital with advanced neonatal care. Pan Afr Med J 2018; 29:152. [PMID: 30050616 PMCID: PMC6057580 DOI: 10.11604/pamj.2018.29.152.14046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Increased survival of preterm babies in sub-saharan Africa has held to an increasing prevalence of Retinopathy of prematurity (ROP). This study was done to determine the ROP prevalence in a hospital with advanced neonatal care in urban Kenya. Methods A hospital-based retrospective review of the records of premature infants screened for ROP between January 2010 and December 2015. Records of all premature infants screened for ROP in the neonatal unit and outpatient eye clinic were extracted. Information on Birth weights, Gestational age, Maternal risk factors (mode of delivery, pre-eclampsia/eclampsia) and Neonatal risk factors (neonatal sepsis, days on oxygen, blood transfusion) was recorded in a questionnaire then analysed. Results 103 infants were included in the study. Mean gestational age was 29.9 ± 2.2 weeks and the mean birth weight was 1280.1 ± 333.0 grams. Forty-three infants were diagnosed with ROP, a prevalence of 41.7%. Majority of these had Stage 1 or 2 ROP in Zone II, which spontaneously regressed with follow up. Nine infants were diagnosed with vision-threatening ROP (any Zone I disease or Stage 2/3 disease in Zone II with plus disease), a prevalence of 20.9%. All of these underwent laser treatment in the neonatal unit. The most significant risk factor was low gestational age. Other risk factors identified were: low birth weight and blood transfusions. Conclusion ROP prevalence in sub-saharan Africa will match those in middle-income and high income countries in neonatal units with advanced care and low mortality.
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Affiliation(s)
- Oscar Onyango
- Nairobi Hospital, Department of Ophthalmology, Nairobi, Kenya
| | - Sarah Sitati
- Sabatia Eye Hospital, Department of Pediatric Ophthalmology, Wodanga, Kenya
| | - Lucia Amolo
- Nairobi Hospital, Department of Neonatology, Nairobi, Kenya
| | | | - Susan Wariua
- Nairobi Hospital, Department of Neonatology, Nairobi, Kenya
| | - Gacheri Nyamu
- Nairobi Hospital, Department of Neonatology, Nairobi, Kenya
| | - Moses Lango
- Nairobi Hospital, Department of Neonatology, Nairobi, Kenya
| | - Atul Patel
- Nairobi Hospital, Department of Neonatology, Nairobi, Kenya
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Late-onset Circulatory Collapse and Continuous Positive Airway Pressure are Useful Predictors of Treatment-requiring Retinopathy of Prematurity: A 9-year Retrospective Analysis. Sci Rep 2017. [PMID: 28634380 PMCID: PMC5478650 DOI: 10.1038/s41598-017-04269-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Visual loss caused by retinopathy of prematurity (ROP) will be prevented if treatment-requiring ROP (TR-ROP) can be predicted. In this retrospective study including 418 infants with ≤32 weeks of gestational age (GA) and/or ≤1500 grams of birthweight, we attempted to identify useful predictors. We also examined the efficiency of significant predictors compared with existing predictive models, ROPScore and CHOP model. Multivariable logistic regression analyses supported the following factors were useful for predicting TR-ROP from all infants and infants with any ROP: GA (odds ratio [OR], 0.47 and 0.48), history of late-onset circulatory collapse (LCC) (OR, 2.76 and 2.44) and use of continuous positive airway pressure (CPAP) at 35 weeks of postmenstrual age (OR, 3.78 and 4.50). The comparison of areas under receiver operating characteristic curves indicated the combination of LCC, CPAP and ROPScore was better than ROPScore to predict TR-ROP from all infants and infants with any ROP (P = 0.007 and 0.02) and the combination of LCC, CPAP and CHOP model was also better than CHOP model to predict TR-ROP from all infants and infants with any ROP (P = 0.01 and 0.02). Our results suggested infants with a history of LCC and a long CPAP support have a high incidence of TR-ROP.
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Timkovic J, Pokryvkova M, Janurova K, Barinova D, Polackova R, Masek P. Evaluation of the WinROP system for identifying retinopathy of prematurity in Czech preterm infants. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:111-116. [DOI: 10.5507/bp.2016.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
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Ahn YJ, Hong KE, Yum HR, Lee JH, Kim KS, Youn YA, Park SH. Characteristic clinical features associated with aggressive posterior retinopathy of prematurity. Eye (Lond) 2017; 31:924-930. [PMID: 28234354 DOI: 10.1038/eye.2017.18] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
PurposeTo identify the risk factors for, and clinical features and treatment outcomes of aggressive posterior retinopathy of prematurity (APROP) in Korean infants.MethodsAmong 770 premature infants who underwent screening, 105 infants (198 eyes, 13.63%) received treatment for ROP. A total of 24 infants (48 eyes, 3.12%) developed APROP while 81 infants (150 eyes, 10.52%) developed non-APROP treatment-requiring type. The medical records of ROP-treated infants were reviewed retrospectively. The associated systemic and maternal risk factors were analyzed and anatomical outcomes were compared according to the severity of ROP and treatment modalities.ResultsThe mean gestational age and birth weight at birth in the APROP group were significantly lower than those in the non-APROP group (P=0.019, P<0.001, respectively). Infants who were born small for their GA developed APROP more frequently than non-APROP patients (P<0.001). Chorioamnionitis-positive infants also showed higher incidence rate of APROP (APROP vs non-APROP; P<0.001 and zone I APROP vs posterior zone II APROP; P=0.036, respectively). Infants with APROP required heavier laser treatment with a higher retreatment rate compared to infants with non-APROP. Favorable anatomical outcomes were achieved in 95.3% from treatment-requiring non-APROP group, 85.7% from zone I APROP and 84.6% from posterior zone II APROP group.ConclusionIntrauterine growth restriction and chorioamnionitis were associated with development of APROP. These findings suggest that perinatal maternal environment inhibiting normal retinal vascular growth in utero may contribute to increasing the risk of APROP in premature infants.
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Affiliation(s)
- Y J Ahn
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K E Hong
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H R Yum
- Department of Ophthalmology, Konyang University Hospital, Daejeon, South Korea
| | - J H Lee
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K S Kim
- Apgujeong St Mary's Eye Center, Seoul, South Korea
| | - Y A Youn
- Department of Pediatrics, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S H Park
- Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Aydin H, Gunay M, Celik G, Gunay BO, Aydin UT, Karaman A. Evaluation of Factor V Leiden, Prothrombin G20210A, MTHFR C677T and MTHFR A1298C gene polymorphisms in retinopathy of prematurity in a Turkish cohort. Ophthalmic Genet 2016; 37:415-418. [PMID: 27018927 DOI: 10.3109/13816810.2015.1126611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To assess Factor V Leiden (FVL) (rs6025), Prothrombin G20210A (rs1799963), MTHFR C677T (rs1801133), and MTHFR A1298C (rs1801131) gene mutations as risk factors in the development of retinopathy of prematurity (ROP). MATERIALS AND METHODS A total of 105 children were included in this cross-sectional study. Patients were divided into two groups. The study group consisted of 55 infants with a history of ROP and the control group comprised 50 healthy infants with term birth. All subjects were screened for the presence of certain mutations (FVL, Prothrombin G20210A, MTHFR C677T and MTHFR A1298C) by Real-Time PCR at 1 year of age. RESULTS The mean gestational age (GA) and birth weight (BW) of the study group were, 28.65 ± 2.85 weeks and 1171 ± 385.74 g, respectively. There were no significant differences of genotype and allele frequency of Prothrombin G20210A, MTHFR A1298C and MTHFR C677T between the study and control groups (p > 0.05). Eight children (14.5 %) had heterozygous and one child (1.8%) had homozygous FVL mutation in the study group. One child (2%) in the control group had heterozygous FVL mutation. There was statistically significant differences of FVL allele and genotype frequencies between the groups (p < 0.05). CONCLUSIONS The prevalence of FVL polymorphism (16.3 %) was higher in ROP patients than control subjects in this Turkish cohort. We suggest a possible association of FVL mutation with ROP at the end of the study.
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Affiliation(s)
- Hatip Aydin
- a Center of Genetics Diagnosis, Zeynep Kamil Maternity and Children's Disease Training and Research Hospital , Istanbul , Turkey
| | - Murat Gunay
- b Department of Ophthalmology, ROP Screening , Treatment and Training Center, Zeynep Kamil Maternity and Children's Disease Training and Research Hospital , Istanbul , Turkey
| | - Gokhan Celik
- b Department of Ophthalmology, ROP Screening , Treatment and Training Center, Zeynep Kamil Maternity and Children's Disease Training and Research Hospital , Istanbul , Turkey
| | - Betul Onal Gunay
- c Department of Ophthalmology , Umraniye Training and Research Hospital , Istanbul , Turkey
| | - Umeyye Taka Aydin
- d Department of Ophthalmology, Tuzla State Hospital , Istanbul , Turkey
| | - Ali Karaman
- a Center of Genetics Diagnosis, Zeynep Kamil Maternity and Children's Disease Training and Research Hospital , Istanbul , Turkey
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Abstract
PURPOSE Compared with the general population, patients with hydrocephalus are more likely to have strabismus. This study was undertaken to examine characteristics and outcomes of children with esotropia and ventricular-peritoneal shunt placement due to hydrocephalus. METHODS This is a retrospective chart review of all pediatric patients with esotropia and a history of ventricular-peritoneal shunt placement seen by our pediatric ophthalmology service between January 2000 and December 2010. RESULTS Sixteen patients between the age of 3 months and 5.6 years met study criteria. Nine were premature and all but one of the patients had developmental delay. Although all patients had a ventricular-peritoneal shunt, the diagnosis leading to shunt placement was intraventricular hemorrhage or congenital hydrocephalus in 75% of the patients. In all but 3 patients the hydrocephalus was diagnosed before the esotropia. Ten children had congenital esotropia and 6 had acquired esotropia. Eleven of the 16 children required glasses: 5 had a myopic prescription and 6 had a hyperopic prescription. Treatment of the esotropia resulted in 9 patients (56%) with successful ocular alignment (<10 prism diopters) on their last visit: 7 underwent strabismus surgery and 2 were treated with glasses only. Of the 9 patients who had strabismus surgery, 6 had congenital esotropia and 3 had acquired esotropia. Among patients who underwent strabismus surgery, 78% had successful ocular alignment at their last visit. CONCLUSIONS While acquired accommodative esotropia is more common in the general population, children with ventricular-peritoneal shunts may be more likely to have congenital esotropia. Although developmental delay is very frequent, successful ocular alignment may be possible in this patient population.
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Affiliation(s)
- Caroline N DeBenedictis
- a Department of Ophthalmology , North Shore - Long Island Jewish Health System , Great Neck , NY , USA
| | - Steven E Rubin
- a Department of Ophthalmology , North Shore - Long Island Jewish Health System , Great Neck , NY , USA
| | - Sylvia R Kodsi
- a Department of Ophthalmology , North Shore - Long Island Jewish Health System , Great Neck , NY , USA
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35
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Dailey WA, Gryc W, Garg PG, Drenser KA. Frizzled-4 Variations Associated with Retinopathy and Intrauterine Growth Retardation: A Potential Marker for Prematurity and Retinopathy. Ophthalmology 2015; 122:1917-23. [PMID: 26119001 DOI: 10.1016/j.ophtha.2015.05.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To present the association between mutations affecting the Wnt-signaling receptor protein (FZD4), inherited vitreoretinopathies, and retinopathy of prematurity (ROP). DESIGN Retrospective analysis of prospective samples at a tertiary referral center. PARTICIPANTS Patients referred to our practice for management of a variety of pediatric vitreoretinopathies were offered participation in an ophthalmic biobank (421 participants with vitreoretinopathies were included in this study). Full-term healthy infants (n = 98) were recruited to the study as controls. METHODS Patients with various vitreoretinopathies were prospectively enrolled in an ophthalmic biobank, approved by the Human Investigation Committee at William Beaumont Hospital. Retrospective genetic analysis of the FZD4 gene was performed (Sanger sequencing). Participants with a diagnosis of familial exudative vitreoretinopathy (FEVR), Norrie disease, Coats' disease, bilateral persistent fetal vasculature, and ROP were reviewed for the presence of a FZD4 variant. Data retrieval included status of retinopathy (including staging when possible), gestational age (GA), birth weight (BW) (when available), and family and birth histories. MAIN OUTCOME MEASURES The association of FZD4 variants with the presence of vitreoretinopathy. RESULTS The sequence variation p.[P33S(;)P168S] is the most prevalent FZD4 variant and is statistically significant for ROP and FEVR (P = 4.6E-04 and P = 2.4E-03, respectively) compared with full-term newborns (P = 1.7E-01). In addition, infants expressing the sequence variation tended to have significantly lower BWs for respective GA (P = 0.04). This suggests that the FZD4 p.[P33S(;)P168S] variant may be a risk factor for retinopathy and restricted intrauterine growth. CONCLUSIONS Testing for FZD4 gene mutations is useful in patients with suspected FEVR and ROP. The relatively high prevalence of the p.[P33S(;)P168S] variant in ROP and intrauterine growth restriction suggests that it also may be a marker for increased risk of developing ROP and preterm birth.
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Affiliation(s)
- Wendy A Dailey
- Research Institute, William Beaumont Hospital, Royal Oak, Michigan
| | - Wojciech Gryc
- Eye Research Institute, Oakland University, Rochester, Michigan
| | - Pooja G Garg
- Research Institute, William Beaumont Hospital, Royal Oak, Michigan
| | - Kimberly A Drenser
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.
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