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Lin WC, Jordan BK, Scottoline B, Ostmo SR, Coyner AS, Singh P, Kalpathy-Cramer J, Erdogmus D, Chan RP, Chiang MF, Campbell JP. Oxygenation Fluctuations Associated with Severe Retinopathy of Prematurity: Insights from a Multimodal Deep Learning Approach. OPHTHALMOLOGY SCIENCE 2024; 4:100417. [PMID: 38059124 PMCID: PMC10696464 DOI: 10.1016/j.xops.2023.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/27/2023] [Accepted: 10/18/2023] [Indexed: 12/08/2023]
Abstract
Purpose Retinopathy of prematurity (ROP) is one of the leading causes of blindness in children. Although the role of oxygen in the pathophysiology of ROP is well established, a precise understanding of the dynamic relationship between oxygen exposure ROP incidence and severity is lacking. The purpose of this study was to evaluate the correlation between time-dependent oxygen variables and the onset of ROP. Design Retrospective cohort study. Participants Two hundred thirty infants who were born at a single academic center and met the inclusion criteria were included. Infants are mainly born between January 2011 and October 2022. Methods Patient data were extracted from electronic health records (EHRs), with sufficient time-dependent oxygen data. Clinical outcomes for ROP were recorded as none/mild or moderate/severe (defined as type II or worse). Mixed-effects linear models were used to compare the 2 groups in terms of dynamic oxygen variables, such as daily average and the coefficient of variation (COV) fraction of inspired oxygen (FiO2). Support vector machine (SVM) and long-short-term memory (LSTM)-based multimodal models were trained with fivefold cross-validation to predict which infants would develop moderate/severe ROP. Gestational age (GA), birth weight, and time-dependent oxygen variables were used to develop predictive models. Main Outcome Measures Model cross-validation performance was evaluated by computing the mean area under the receiver operating characteristic (AUROC) curve, precision, recall, and F1 score. Results We found that both daily average and COV of FiO2 were associated with more severe ROP (adjusted P < 0.001). With fivefold cross-validation, the multimodal LSTM models had higher performance than the best static models (SVM using GA and 3 average FiO2 features) and SVM models trained on GA alone (mean AUROC = 0.89 ± 0.04 vs. 0.86 ± 0.05 vs. 0.83 ± 0.04). Conclusions The development of severe ROP might not only be influenced by oxygen exposure but also by its fluctuation, which provides direction for future study of pathophysiological factors associated with severe ROP development. Additionally, we demonstrated that multimodal neural networks can be a method to extract useful information from time-series data, which may be a valuable methodology for the investigation of other diseases using EHR data. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Wei-Chun Lin
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Brian K. Jordan
- Department of Neonatology, Oregon Health and Science University, Portland, Oregon
| | - Brian Scottoline
- Department of Neonatology, Oregon Health and Science University, Portland, Oregon
| | - Susan R. Ostmo
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Aaron S. Coyner
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Praveer Singh
- Department of Ophthalmology, University of Colorado (CU) School of Medicine, Denver, Colorado
| | | | - Deniz Erdogmus
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - J. Peter Campbell
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
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Boo NY, Ang EL, Ang EBK. Retinopathy of Prematurity in Very Low Birthweight Neonates of Gestation Less Than 32 weeks in Malaysia. Indian J Pediatr 2024:10.1007/s12098-023-04997-9. [PMID: 38200381 DOI: 10.1007/s12098-023-04997-9] [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: 08/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To determine the screening rates and incidence of retinopathy of prematurity (ROP), and risk factors associated with ROP in very low birthweight (VLBW, <1500 g) neonates of gestation <32 wk admitted to neonatal intensive care units (NICUs) in a middle-income country. METHODS It was a retrospective cohort study of prospectively submitted data by 44 Malaysian NICUs participating in the Malaysian National Neonatal Registry. All VLBW neonates of gestation <32 wk born in 2015-2020 and survived to discharge were included. RESULTS Of 11768 survivors, 90.5% (n = 10436) had ROP screening; 16.1% (1685/10436) had ROP. ROP was significantly more common in neonates <28 wk gestation (extremely preterm, EPT) than ≥28 wk gestation (37.7% vs. 9.7%; p <0.001), and more common in those with birthweight <1000 g (extremely low birthweight, ELBW) than ≥1000 g (32.9% vs. 9.1%; p <0.001). Multiple logistic regression analysis showed that the significant independent factors associated with increased risk of ROP were ELBW, EPT, Indian ethnic group, vaginal delivery, mechanical ventilation >5 d, high frequency ventilation, total parenteral nutrition, late-onset sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Receiving oxygen therapy at birth was associated with significantly lower risk of ROP. CONCLUSIONS The incidence and severity of ROP increased with decreasing gestation and birthweight. Prolonged duration of oxygen therapy, infection, invasive respiratory support, and conditions commonly causing fluctuations of oxygenation were significant factors associated with increased risk of ROP. Receiving oxygen at birth did not increase risk.
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Affiliation(s)
- Nem Yun Boo
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Jalan Sungai Long, Bandar Sungai Long, Kajang, 43000 Selangor, Malaysia.
| | - Ee Lee Ang
- Department of Pediatrics, Tengku Ampuan Rahimah Hospital, Ministry of Health of Malaysia, Klang, Selangor, Malaysia
| | - Eric Boon-Kuang Ang
- Department of Pediatrics, Sultanah Bahiyah Hospital, Ministry of Health, Alor Setar, Kedah, Malaysia
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Gillespie TC, Kim ES, Grogan T, Tsui I, Chu A, Calkins KL. Decreased Levels of Erythrocyte Membrane Arachidonic and Docosahexaenoic Acids Are Associated With Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2022; 63:23. [PMID: 36383353 PMCID: PMC9680586 DOI: 10.1167/iovs.63.12.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Retinopathy of prematurity (ROP) can lead to blindness. Arachidonic acid (ARA) and docosahexaenoic acid (DHA) regulate retinal inflammation and angiogenesis. The aim of this study was to investigate red blood cell membrane (RBCM) ARA and DHA in preterm infants. Methods This prospective observational study divided infants into groups by ROP severity and RBCM ARA and DHA means and terciles. Results Although the mean ± SD RBCM ARA was different between groups (no ROP, 17.9% ± 0.7%, vs. type 2 ROP, 17.4% ± 0.8%, vs. type 1 ROP, 16.7% ± 1.0%; P < 0.001), the mean RBCM DHA was similar (P = 0.161). Infants with type 1 ROP were more likely to be in the lowest ARA and DHA terciles than in the highest (ARA, 44% vs. 5.6%; DHA, 22% vs. 5.6%). ARA and DHA declined over the first month of life in all ROP groups. At week 1, ARA was lower in the type 1 and type 2 ROP groups compared with the no-ROP group (18% ± 2% and 19% ± 3% vs. 21% ± 2%, respectively; P < 0.05 for all). At week 2, DHA and ARA were lower in the type I ROP group compared with the no-ROP group (3% ± 1% vs. 4% ± 1%, P = 0.03 and 16% ± 1% vs. 19% ± 1%, respectively; P < 0.01). A RBCM ARA% ≥ 17 was associated with a 45% reduction in any ROP. As the estimated 4-week ARA% mean increased by 1%, the odds of ROP decreased by 70% (odds ratio = 0.30; 95% confidence interval, 0.1-0.7). Conclusions Infants with severe ROP have lower ARA and DHA levels than infants without ROP. ARA and DHA may act synergistically to protect against ROP.
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Affiliation(s)
- Tessa C. Gillespie
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Esther S. Kim
- Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California, Los Angeles, and UCLA Mattel Children's Hospital, Los Angeles, California, United States
| | - Tristan Grogan
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Irena Tsui
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, and UCLA Mattel Children's Hospital, Los Angeles, California, United States
| | - Alison Chu
- Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California, Los Angeles, and UCLA Mattel Children's Hospital, Los Angeles, California, United States
| | - Kara L. Calkins
- Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California, Los Angeles, and UCLA Mattel Children's Hospital, Los Angeles, California, United States
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Boskabadi H, Saravi A, Zakerihamidi M. Comparison of Retinopathy of Prematurity Incidence in Preterm Infants of Mothers with Preeclampsia and Infants of Healthy Mothers. J Obstet Gynaecol India 2022; 72:409-413. [PMID: 36458063 PMCID: PMC9568630 DOI: 10.1007/s13224-022-01660-9] [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: 08/21/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Preeclampsia is one of the four leading causes for pregnancy complications, maternal-fetal and neonatal mortality. This study was aimed at comparing the incidence of retinopathy of prematurity in neonates of mothers with preeclampsia and neonates of healthy mothers. Methods This cross-sectional study was performed among 213 mothers, including 49 healthy mothers and 164 mothers with preeclampsia whose neonates were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran, during 2016-2021. The participants were chosen using the convenience sampling method. The data collection tool was a researcher-made checklist including items on laboratory evaluation, maternal and neonatal characteristics, and eye examination. The data were analyzed using t-test and Chi-square. Results In the two groups, gestational age (P = 0.112), first-minute Apgar score (P = 0.209), and fifth-minute Apgar score (P = 0.949) were not significantly different. There was a significant difference between the two groups in terms of maternal age (P = 0.0001), type of delivery (P = 0.0001), premature rupture of membranes (P = 0.003), and eye condition (P = 0.033). Conclusion The results of our study show that preeclampsia affects the prognosis of infants, and in neonates with preeclamptic mothers, the rate of premature rupture of the membranes, cesarean delivery, and retinopathy of prematurity were higher.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Saravi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon, Iran
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Yucel OE, Eraydin B, Niyaz L, Terzi O. Incidence and risk factors for retinopathy of prematurity in premature, extremely low birth weight and extremely low gestational age infants. BMC Ophthalmol 2022; 22:367. [PMID: 36096834 PMCID: PMC9469514 DOI: 10.1186/s12886-022-02591-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. METHODS The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. RESULTS Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. CONCLUSIONS ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.
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Affiliation(s)
- Ozlem Eski Yucel
- Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine, 55139, Atakum, Samsun, Turkey.
| | - Bilge Eraydin
- Department of Ophthalmology, Bafra State Hospital, Samsun, Turkey
| | - Leyla Niyaz
- Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine, 55139, Atakum, Samsun, Turkey
| | - Ozlem Terzi
- Department of Public Health, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Yu CW, Popovic MM, Dhoot AS, Arjmand P, Muni RH, Tehrani NN, Mireskandari K, Kertes PJ. Demographic Risk Factors of Retinopathy of Prematurity: A Systematic Review of Population-Based Studies. Neonatology 2022; 119:151-163. [PMID: 35124682 DOI: 10.1159/000519635] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Current national guidelines use gestational age (GA) and birth weight (BW) as their basis for retinopathy of prematurity (ROP) screening. The strength of association of these and other demographic risk factors is inconsistent across studies. This review aims to evaluate the strength of association of documented risk factors for ROP in large sample, population-based studies. METHODS MEDLINE, EMBASE, and Cochrane Library were searched from January 2010 to May 2020. Original studies reporting the risk of ROP in a region and demographic risk factors were included. RESULTS Eighteen studies comprising 342,005 infants were included. The overall risk of ROP in preterm infants was 18.8%. For every week decrease in GA, there was a median adjusted odds ratio (aOR) of 1.4 times (range 1.2-1.9) of developing ROP. For every 100-g decrease in BW, the median aOR was 1.8 times (range 1.2-2.7). Higher risk was found in infants with neonatal sepsis and bronchopulmonary dysplasia. The risk of any, severe, and treatment-requiring ROP was highest for 23 weeks GA, which was 66.5, 40.3, and 39.4%, respectively. Regions with higher neonatal mortality rates had the highest mean GA of infants with ROP. CONCLUSION For every week decrease in GA and every 100-g decrease in BW, there was a median of 1.4 times and 1.8 times the odds of developing ROP, respectively. Further research is required to clarify the role of additional risk factors.
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Affiliation(s)
- Caberry W Yu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Parnian Arjmand
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nasrin N Tehrani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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7
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Ge G, Zhang Y, Zhang M. Pregnancy-induced hypertension and retinopathy of prematurity: a meta-analysis. Acta Ophthalmol 2021; 99:e1263-e1273. [PMID: 33611839 DOI: 10.1111/aos.14827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Retinopathy of prematurity (ROP), one of the leading causes of childhood blindness, is a complex condition in which various antenatal and neonatal factors participate at different stages of the disease. This meta-analysis was conducted to investigate whether pregnancy-induced hypertension (PIH) was associated with ROP by summarizing all available evidence. METHODS PubMed, EMBASE, Web of Science, EBSCO and SCOPUS databases were searched for all relevant studies published from inception to April 2020. Studies investigating the association between PIH and ROP were included. RESULTS A total of 29 studies were finally included for the meta-analysis after study selection. The results showed there are both no significant association between PIH and the occurrence of ROP in case-control studies (OR 0.91, 95%CI 0.59 to 1.40, I2 = 81%, p = 0.67) and cohort studies (OR 1.32, 95%CI 0.89 to 1.98, I2 = 93%, p = 0.17). The conclusion was same between pre-eclampsia and ROP (OR 0.82, 95%CI: 0.50 to 1.35, I2 = 83%, p = 0.43 in case-control studies and OR 1.70, 95%CI: 0.82 to 3.50, I2 = 95%, p = 0.15 in cohort studies). CONCLUSION In summary, this meta-analysis did not reveal a consistent result, the conclusion remains inconclusive, and further studies will be needed to come to a conclusion for the effect of maternal PIH on ROP and foster a better understanding of the prevention of ROP.
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Affiliation(s)
- Ge Ge
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
| | - Yun Zhang
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
| | - Meixia Zhang
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
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Alsammahi A, Basheikh A. Retinopathy of Prematurity and Assisted Reproductive Technology: Is There an Association? Clin Ophthalmol 2021; 15:227-233. [PMID: 33519184 PMCID: PMC7837546 DOI: 10.2147/opth.s295248] [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: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to determine the incidence of retinopathy of prematurity (ROP) and to assess whether assisted reproductive technology (ART) is a risk factor for ROP independent of the generation of multiple births by determining the occurrence and severity of ROP and the need for treatment. We will also evaluate other risk factors associated with the development of ROP among preterm infants. Patients and Methods We conducted a retrospective chart review for all premature infants who were screened for ROP according to the screening guidelines of the American Academy of Ophthalmology and born at King Abdulaziz University Hospital from 2015 to 2019. In addition to ophthalmological results, data on gestational age (GA), birth weight (BW), type of pregnancy (singleton or multiple), type of conception (natural or ART), infantile factors, and maternal factors were recorded. Results A total of 229 preterm babies met our criteria. The mean GA at birth was 29.35 weeks. Notably, 175 neonates were conceived naturally and 54 were conceived by ART. Furthermore, 33 infants in the natural conception group were products of multiple pregnancies, as were 49 infants in the ART group. ROP was noted in 96 of 229 infants (41.92%). No significant difference was found in the occurrence of ROP between multiple neonates in the natural and ART groups. However, ART birth babies in general were significantly associated with the development of ROP (P=0.045). On multiple regression analysis, early GA, low BW, and extended oxygen therapy were the variables most significantly associated with ROP (P≤0.001). Conclusion In our sample, ART in multiple birth babies per se did not seem to be a risk factor for ROP. However, ART babies were more prone to develop ROP than natural conception birth babies, which seemed to be more severe.
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Affiliation(s)
- Alaa Alsammahi
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Basheikh
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Owen LA, Shirer K, Collazo SA, Szczotka K, Baker S, Wood B, Carroll L, Haaland B, Iwata T, Katikaneni LD, DeAngelis MM. The Serine Protease HTRA-1 Is a Biomarker for ROP and Mediates Retinal Neovascularization. Front Mol Neurosci 2020; 13:605918. [PMID: 33281553 PMCID: PMC7705345 DOI: 10.3389/fnmol.2020.605918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a blinding aberrancy of retinal vascular maturation in preterm infants. Despite delayed onset after preterm birth, representing a window for therapeutic intervention, we cannot prevent or cure ROP blindness. A natural form of ROP protection exists in the setting of early-onset maternal preeclampsia, though is not well characterized. As ischemia is a central feature in both ROP and preeclampsia, we hypothesized that angiogenesis mediators may underlie this protection. To test our hypothesis we analyzed peripheral blood expression of candidate proteins with suggested roles in preeclamptic and ROP pathophysiology and with a proposed angiogenesis function (HTRA-1, IGF-1, TGFβ-1, and VEGF-A). Analysis in a discovery cohort of 40 maternal-infant pairs found that elevated HTRA-1 (high-temperature requirement-A serine peptidase-1) was significantly associated with increased risk of ROP and the absence of preeclampsia, thus fitting a model of preeclampsia-mediated ROP protection. We validated these findings and further demonstrated a dose-response between systemic infant HTRA-1 expression and risk for ROP development in a larger and more diverse validation cohort consisting of preterm infants recruited from two institutions. Functional analysis in the oxygen-induced retinopathy (OIR) murine model of ROP supported our systemic human findings at the local tissue level, demonstrating that HtrA-1 expression is elevated in both the neurosensory retina and retinal pigment epithelium by RT-PCR in the ROP disease state. Finally, transgenic mice over-expressing HtrA-1 demonstrate greater ROP disease severity in this model. Thus, HTRA-1 may underlie ROP protection in preeclampsia and represent an avenue for disease prevention, which does not currently exist.
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Affiliation(s)
- Leah A Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Kinsey Shirer
- Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, United States
| | - Samuel A Collazo
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kathryn Szczotka
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Shawna Baker
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT, United States
| | - Blair Wood
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Lara Carroll
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Takeshi Iwata
- National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Lakshmi D Katikaneni
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, United States
| | - Margaret M DeAngelis
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States.,Department of Pharmacotherapy, The College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences State University of New York, Buffalo, NY, United States
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Carroll L, Owen LA. Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions. EXPLORATION OF MEDICINE 2020; 1:4-26. [PMID: 32342063 PMCID: PMC7185238 DOI: 10.37349/emed.2020.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a blinding morbidity of preterm infants, which represents a significant clinical problem, accounting for up to 40% of all childhood blindness. ROP displays a range of severity, though even mild disease may result in life-long visual impairment. This is complicated by the fact that our current treatments have significant ocular and potentially systemic effects. Therefore, disease prevention is desperately needed to mitigate the life-long deleterious effects of ROP for preterm infants. Although ROP demonstrates a delayed onset of retinal disease following preterm birth, representing a potential window for prevention, we have been unable to sufficiently alter the natural disease course and meaningfully prevent ROP. Prevention therapeutics requires knowledge of early ROP molecular changes and risk, occurring prior to clinical retinal disease. While we still have an incomplete understanding of these disease mechanisms, emerging data integrating contributions of maternal/placental pathobiology with ROP are poised to inform novel approaches to prevention. Herein, we review the molecular basis for current prevention strategies and the clinical outcomes of these interventions. We also discuss how insights into early ROP pathophysiology may be gained by a better understanding of maternal and placental factors playing a role in preterm birth.
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Affiliation(s)
- Lara Carroll
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
| | - Leah A. Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
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11
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Vural A, Yıldız Ekinci D. Comparison of Vascular Outgrowth Rate and Retinal Vascular Development Border after Intravitreal Injection of Aflibercept or Bevacizumab to Treat Retinopathy of Prematurity. Ophthalmologica 2019; 243:86-93. [PMID: 31593948 DOI: 10.1159/000503568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE It is aimed to evaluate vascular outgrowth rate (VOR) of retinal vessels and retinal vascular development border (RVDB) after intravitreal injections of aflibercept or bevacizumab (IVA or IVB) monotherapy, which have been used to treat retinopathy of prematurity. METHODS In this study, patients were followed by two sequential fluorescein angiography (FA) examinations (Ret-Cam III Imaging System Clarity Medical Systems, Pleasanton, CA, USA) after anti-VEGF monotherapy. RVDB was determined by the ratio between DB (the distance from the center of the disk to the RVDB) and DM (the distance from the center of the disk to the center of the macula). On the other hand, VOR was calculated by the following novel formula: VOR = (DB/DM on the second FA) - (DB/DM on the first FA)/time between two FA examinations. RESULTS Fifty-one eyes of 27 infants who received aflibercept were included as group 1; 38 eyes of 19 patients who received bevacizumab were included in group 2. There were no significant differences between these groups in terms of demographic variables, percentages of disease at zone 1 and posterior zone 2 (p = 0.260), as well as stage 2+ and stage 3+ disease (p = 1.0) at the time of anti-VEGF injections. VORs, which had been measured in between two sequential follow-up FAs, were estimated to be significantly higher in group 1, both in nasal (p = 0.042) and temporal sides (p = 0.033). However, DB/DM ratios were significantly higher in group 2 in the first FA (p = 0.001 at nasal and temporal sides) and the second FA examinations (p = 0.007 and p = 0.004 at nasal and temporal sides, respectively). CONCLUSION VOR was found to be significantly higher in patients who were treated with IVA monotherapy. Paradoxically, RVDB was farther in patients receiving IVB monotherapy despite a slower VOR in these patients.
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Affiliation(s)
- Aslı Vural
- Bakırköy Dr. Sadikonuk Training and Research Hospital Ophthalmology Clinics, Istanbul, Turkey,
| | - Dilbade Yıldız Ekinci
- Kanuni Sultan Suleyman Training and Research Hospital Ophthalmology Clinics, Istanbul, Turkey
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Ying GS, Bell EF, Donohue P, Tomlinson LA, Binenbaum G. Perinatal Risk Factors for the Retinopathy of Prematurity in Postnatal Growth and Rop Study. Ophthalmic Epidemiol 2019; 26:270-278. [PMID: 31012360 DOI: 10.1080/09286586.2019.1606259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
Objective: To evaluate perinatal risk factors for retinopathy of prematurity (ROP), in a large, broad-risk cohort of premature infants. Study design: Secondary analysis of data from the Postnatal Growth and ROP (G-ROP) Study, a retrospective cohort study of infants undergoing ROP examinations at 29 North American hospitals in 2006-2012. Results: Among 7483 infants, 3224 (43.1%) had any ROP and 931 (12.4%) had severe ROP (Type 1 or 2 ROP). In multivariable logistic regression analysis, significant risk factors for any ROP were lower birth weight (BW, odds ratio (OR) = 5.2, <501 g vs. >1250 g), younger gestational age (GA, OR = 32, <25 vs. >29 weeks), 1-min Apgar score <4 (OR = 1.2), race (OR = 1.6, White vs. Black), outborn (OR = 1.5), and delivery room intubation (OR = 1.3); and for severe ROP were lower BW (OR = 20, <501 g vs. >1250 g), younger GA (OR = 30, <25 vs. >29 weeks), male (OR = 1.5), Hispanic ethnicity (OR = 1.8), race (OR = 1.6, White vs. Black), outborn (OR = 1.6), and delivery room intubation (OR = 1.6). Together, these factors predicted well for any ROP (area under ROC curve (AUC) = 0.87) and severe ROP (AUC = 0.89), but BW and GA were the dominant factors for ROP (AUC = 0.86) and severe ROP (AUC = 0.88). Conclusions: Based on the largest report to date with detailed ROP data from infants meeting current screening guidelines, ROP risk is predominantly determined by the degree of prematurity at birth, with other perinatal factors contributing minimally.
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Affiliation(s)
- Gui-Shuang Ying
- a Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Edward F Bell
- b Department of Pediatrics , University of Iowa , Iowa City , Iowa , USA
| | - Pamela Donohue
- c Department of Pediatrics , Johns Hopkins University , Baltimore , Maryland , USA
| | - Lauren A Tomlinson
- d Division of Pediatric Ophthalmology , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Gil Binenbaum
- a Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
- d Division of Pediatric Ophthalmology , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
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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: 283] [Impact Index Per Article: 47.2] [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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Alshaikh B, Salman O, Soliman N, Ells A, Yusuf K. Pre-eclampsia and the risk of retinopathy of prematurity in preterm infants with birth weight <1500 g and/or <31 weeks' gestation. BMJ Open Ophthalmol 2017; 1:e000049. [PMID: 29354703 PMCID: PMC5721629 DOI: 10.1136/bmjophth-2016-000049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/31/2017] [Accepted: 03/09/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the relationship between pre-eclampsia and development of retinopathy of prematurity (ROP) in infants with birth weight of <1500 g and/or gestation <31 weeks. Methods A retrospective cohort study comprising infants born to mothers with pre-eclampsia between January 2007 and June 2010 at a single tertiary care centre. Their ROP outcome was compared with infants born to the next two normotensive mothers with a ±1 week gestational age difference. Pearson χ2 test was used for categorical variables and Mann-Whitney U test was used for continuous variables. Multivariable regression was used to estimate the OR of ROP with prenatal pre-eclampsia exposure and adjust for confounders. Results Of the 97 infants in the pre-eclampsia group, 27 (27%) developed ROP and of the 185 infants in the normotensive group, 50 (27%) developed ROP. On multivariable regression modelling, pre-eclampsia was not a risk factor for the development of ROP (OR 1.4, 95% CI 0.46 to 4.1). Gestational age, intrauterine growth restriction and blood transfusion were significant risk factors for the development of ROP. Conclusions In our cohort, pre-eclampsia was not a significant risk factor for the development of ROP. Intrauterine growth restricted infants of pre-eclamptic and normotensive mothers were at higher risk of ROP.
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Affiliation(s)
- Belal Alshaikh
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Omar Salman
- University of Toronto at Scarborough, Toronto, Canada
| | - Nancy Soliman
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Anna Ells
- Department of Ophthalmology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Kamran Yusuf
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Canada
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Screening Retinopathy of Prematurity in Extremely Low Birth Weight Infants in China and the Need for Earlier Screening Times. J Ophthalmol 2016; 2016:7065835. [PMID: 28116141 PMCID: PMC5223020 DOI: 10.1155/2016/7065835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/29/2016] [Accepted: 12/04/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To convey the need for a revised screening strategy for retinopathy of prematurity (ROP) for extremely low birth weight (ELBW) infants in China. Design. A retrospective longitudinal study. Methods. The medical charts of infants with a birth weight (BW) of less than 1 kg were reviewed. The infants were divided into three groups: group A, without ROP; group B, with ROP but not up to type 1 prethreshold or threshold ROP; group C, with type 1 prethreshold or threshold ROP. Data collected included gender, gestational age (GA), BW, postmenstrual age (PMA), age of onset of ROP, and age at which treatment was carried out, if required. Results. A total of 77 infants were involved. Fifty-six infants developed ROP at any stage and 38 infants developed type 1 prethreshold or threshold ROP. The mean BW and GA of infants in group A were significantly different compared with groups B and C. The mean PMA of onset of ROP in infants who developed mild ROP was 37 weeks compared with 34 weeks for infants who developed severe ROP. Conclusion. ELBW infants have a higher incidence of ROP in China which highlights the need for optimizing neonatal care for these infants. In ELBW infants, ROP tends to develop more severely when it occurs earlier. It is necessary for ELBW infants, especially for those with a BW less than 800 g or a GA less than 25 weeks, to be initially screened at an earlier time.
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Chan PYL, Tang SM, Au SCL, Rong SS, Lau HHW, Ko STC, Ng DSC, Chen LJ, Yam JCS. Association of Gestational Hypertensive Disorders with Retinopathy of prematurity: A Systematic Review and Meta-analysis. Sci Rep 2016; 6:30732. [PMID: 27491726 PMCID: PMC4974497 DOI: 10.1038/srep30732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
The role of gestational hypertensive disorders, which includes both pre-eclampsia and gestational hypertension, in the development of retinopathy of prematurity (ROP) has been controversial. Therefore, this systematic review and meta-analysis is to evaluate the association between gestational hypertensive disoders and ROP. Eligible studies published up to June 5, 2016 were identified from MEDLINE and EMBASE that evaluated the association between the two conditions. Totally 1142 published records were retrieved for screening, 925 of them eligible for detailed evaluation. Finally 19 studies involving 45281 infants with 5388 cases of ROP met our criteria for meta-analysis. Gestational hypertensive disorders were not associated with ROP (unadjusted OR: 0.89; P = 0.38; adjusted OR: 1.35; P = 0.18). Subgroup analyses also revealed no significant association between ROP with pre-eclampsia (unadjusted OR: 0.85; P = 0.29; adjusted OR:1.29; P = 0.28) or with gestational hypertension (unadjusted OR: 1.10; P = 0.39; adjusted OR: 1.25; P = 0.60) separately. Sensitivity analysis indicated our results were robust. We concluded no significant association between gestational hypertensive disorders and ROP. More large scale well-conducted prospective cohorts on the topic are needed.
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Affiliation(s)
- Priscilla Y L Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Shu-Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Sunny C L Au
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Shi-Song Rong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Henry H W Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jason C S Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy. Sci Rep 2016; 6:27082. [PMID: 27256987 PMCID: PMC4891718 DOI: 10.1038/srep27082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/09/2016] [Indexed: 11/08/2022] Open
Abstract
We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.
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Özen Tunay Z, Özdemir Ö, Ergintürk Acar D, Petriçli İS, Oğuz ŞS. Clinical features of infants treated for severe retinopathy of prematurity: 8-yearstudy from a large tertiary neonatal intensive care unit in Turkey. Turk J Med Sci 2016; 46:42-7. [PMID: 27511331 DOI: 10.3906/sag-1411-18] [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: 11/06/2014] [Accepted: 02/14/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to report the gestational age (GA) and birth weight (BW) distribution of premature babies who needed treatment for retinopathy of prematurity (ROP) and to assess the timing of the treatment. MATERIALS AND METHODS The records of 9008 infants who were screened for ROP were examined and 556 infants who underwent laser therapy for ROP were reviewed. Sex, GA, BW, postnatal age, and postmenstrual (PM) age at the time of laser therapy were recorded. The babies were classified as in-born (Group 1) and out-born infants (Group 2). RESULTS The mean GA was 27.3 weeks (range: 22-33 weeks) and the mean BW was 991.1 g (range: 520-2160 g). Of the treated infants, 7.0% were born later than 32 weeks and 8.3% were born over 1500 g. The mean postnatal age was 9.48 weeks (range: 5-22 weeks) and the mean PM age was 36.72 weeks (range: 29-48 weeks) at the time of treatment. Mean BWs and GAs were significantly higher and the mean postnatal age at the time of laser therapy was significantly earlier in Group 2. CONCLUSION Infants with severe ROP had a wider range of BWs and GAs compared to those from developed countries and earlier treatment was needed for out-born infants.
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Affiliation(s)
- Zühal Özen Tunay
- Department of Ophthalmology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Özdemir Özdemir
- Department of Ophthalmology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Damla Ergintürk Acar
- Department of Ophthalmology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - İkbal Seza Petriçli
- Department of Ophthalmology, Zübeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Şerife Suna Oğuz
- Department of Neonatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Yau GSK, Lee JWY, Tam VTY, Yip S, Cheng E, Liu CCL, Chu BCY, Wong IYH. Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study. Medicine (Baltimore) 2015; 94:e867. [PMID: 25950699 PMCID: PMC4602518 DOI: 10.1097/md.0000000000000867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022] Open
Abstract
To determine the incidence and risk factors of retinopathy of prematurity (ROP) among new-born Chinese infants of multiple gestations.A retrospective review of medical records was performed for all neonates of multiple gestations screened for ROP between January 2007 and December 2012 in 2 neonatal intensive care units in Hong Kong. Screening was offered to very low birth weight (VLBW; ≤1500 g) and/or preterm (gestation ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.A total of 153 Chinese infants of multiple gestations were included in the study. The mean gestational age (GA) was 30.8 ± 2.4 weeks and the mean birth weight (BW) was 1284.8 ± 267.4 g. The incidence of ROP and Type 1 ROP was 11.8% and 3.9%, respectively. On univariate analysis, younger GA, lighter birth weight, postnatal hypotension, inotropes use, bronchopulmonary disease, and intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP (all P ≤ 0.04). On multivariate analysis, younger GA, surfactant use, invasive mechanical ventilation, higher mean oxygen concentration, thrombocytopenia, intraventricular hemorrhage, total parental nutrition, and hypoglycemia were significant risk factors for ROP. For Type 1 ROP, there were no significant dependent risk factors.In preterm Chinese infants born from multiple gestations, prematurity, lighter weight, postnatal hypotension, inotropes use, bronchopulmonary dysplasia, and an intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP.
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Affiliation(s)
- Gordon S K Yau
- From the Department of Ophthalmology, Caritas Medical Centre, Hong Kong SAR (GSKY, JWYL, VTYT, BCYC); Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR (SY, CCLU); Centre of Health Behaviours Research, The Chinese University of Hong Kong, Hong Kong SAR (EC); Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, People's Republic of China (IYHW, JWYL)
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Yau GSK, Lee JWY, Tam VTY, Liu CCL, Wong IYH. Risk factors for retinopathy of prematurity in extremely preterm Chinese infants. Medicine (Baltimore) 2014; 93:e314. [PMID: 25526484 PMCID: PMC4603108 DOI: 10.1097/md.0000000000000314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 10/09/2014] [Accepted: 10/30/2014] [Indexed: 01/18/2023] Open
Abstract
To investigate the incidence and risk factors of retinopathy of prematurity (ROP) and Type 1 ROP in extremely preterm Chinese infants. A retrospective review of medical records was performed of all extremely preterm neonates (gestational age, GA≤28 weeks) screened for ROP from 2007 to 2012 at an ophthalmology centre in Hong Kong. Thirty-three maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. The mean gestational age (GA) was 26.4±1.3 weeks and the birth weight (BW) was 855.0±199.0 g. The incidence of ROP development was 60.7% and 16.2% for Type 1 ROP. On univariate analysis, 6 risk factors were identified for ROP development including: lighter BW; lower GA; postnatal hypotension; inotrope use; surfactant use; and invasive mechanical ventilation (all P≤0.01). On multivariate analysis, neonatal congenital heart disease and greater GA were protective factors for ROP development (P≤0.04). On the other hand, 4 risk factors were associated with Type 1 ROP development in univariate analysis, including: lower GA, lighter BW, multiple pregnancies, and invasive mechanical ventilation (all P≤0.02); while there was no significant risk factors on multivariate analysis. A lighter BW and lower GA were the only common independent risk factors for both ROP and Type 1 ROP while neonatal congenital heart disease and greater GA were the protective factors against ROP.
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Affiliation(s)
- Gordon S K Yau
- From the Department of Ophthalmology, Caritas Medical Centre (GSKY, JWYL, VTYT); Department of Ophthalmology, The University of Hong Kong (JWYL, IYHW); Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China (CCLL)
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Gunay M, Celik G, Ovali F, Yetik H, Aktas A, Gunay BO. One-year clinical outcome after laser treatment for retinopathy of prematurity at a tertiary center in Turkey. Int Ophthalmol 2014; 35:27-35. [PMID: 25381161 DOI: 10.1007/s10792-014-0014-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/02/2014] [Indexed: 11/28/2022]
Abstract
The purpose of the study is to evaluate the clinical outcome of laser photocoagulation (LPC) in the treatment of retinopathy of prematurity (ROP) at a referral hospital in Turkey. In this retrospective study, a chart review of infants who underwent LPC for ROP between June 2011 and June 2013 was done. Clinical and demographic characteristics, laser parameters, anatomic, and refractive outcomes were evaluated. Totally 113 infants (202 eyes) were enrolled in the study. Of the 202 eyes, 29 eyes had threshold ROP, 141 eyes had prethreshold ROP, and 32 eyes had aggressive posterior ROP (APROP) at initial interventions. The mean gestational age (GA) was 28.13 ± 1.99 weeks (range between 24 and 33 weeks), the mean birth weight (BW) was 1,147.77 ± 341.77 g (range between 530 and 2,000 g) and the mean postmenstrual age (PMA) at first laser treatment time was 35.79 ± 1.74 weeks (range between 33 and 39 weeks). The mean number of laser spots (NLS) applied for each eye was 1,358.05 ± 369.91. Eyes with APROP had higher number of NLS than eyes with threshold ROP and prethreshold ROP (P < 0.01). Anatomic outcome was favorable for 171 eyes (84.7 %) at the end of the 1-year follow-up. Refractive data were available for 56 infants (100 eyes). The mean refractive error was 0.00 ± 2.48D SE. The incidence of high myopia (>5D) and strabismus was 2 and 14.3 %, respectively. Laser photocoagulation is an effective therapy for ROP. Early and appropriate laser treatment improves the clinical outcome of the disease.
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Affiliation(s)
- Murat Gunay
- Department of Ophthalmology, ROP Screening, Treatment and Training Center, Zeynep Kamil Maternity and Children's Disease Education and Research Hospital, Burhanettin Üstünel Cad. No: 10, Üsküdar, 34668, Istanbul, Turkey.
| | - Gokhan Celik
- Department of Ophthalmology, ROP Screening, Treatment and Training Center, Zeynep Kamil Maternity and Children's Disease Education and Research Hospital, Burhanettin Üstünel Cad. No: 10, Üsküdar, 34668, Istanbul, Turkey
| | - Fahri Ovali
- Department of Neonatology, Zeynep Kamil Maternity and Children's Disease Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Yetik
- Department of Ophthalmology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alev Aktas
- Department of Pediatrics, Zeynep Kamil Maternity and Children's Disease Education and Research Hospital, Istanbul, Turkey
| | - Betul Onal Gunay
- Department of Ophthalmology, Umraniye Education and Research Hospital, Istanbul, Turkey
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