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Sen P, Bhende P, Maitra P. Surgical outcomes in aggressive retinopathy of prematurity (AROP)-related retinal detachments. Indian J Ophthalmol 2023; 71:3454-3459. [PMID: 37870006 PMCID: PMC10752330 DOI: 10.4103/ijo.ijo_2999_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 06/07/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the disc toward the posterior lens surface progressing to Stage 5 disease without traversing the classical course that includes Stages 1 to 3. Since AROP behaves differently from type 1 ROP, this study was undertaken to evaluate the surgical outcome of AROP-related detachments. Methods Retrospective analysis of data from electronic medical records of babies diagnosed with AROP-related detachments who underwent micro-incision vitrectomy surgery (MIVS) was included. The demographic data, details of primary intervention (laser and/or intravitreal bevacizumab), and surgery were noted. In a subset of patients, surgical intervention was planned early at the onset of fibrovascular tissue. Results 43 eyes of 26 babies with median birth weight 1175 g and median gestational age of 29 weeks were analyzed. 42/43 eyes underwent primary intervention in form of laser and/or anti-VEGF injection before surgery. 41.8%, 25.5%, and 32.5% eyes progressed to stages 4A, 4B, and 5, respectively, requiring surgical intervention. 66% eyes underwent lensectomy and vitrectomy (LV), and 44% eyes underwent lens sparring vitrectomy (LSV). 58% eyes had attached macula. 44% eyes that had a relatively less vascular diseases had better anatomical outcome (P = 0.019). At final follow-up, 53.4% eyes followed or at least had light fixation, and 77.7% eyes undergoing LSV fixated and/or followed light compared to 33% for LV (P = 0.04). Conclusion Challenges in AROP include rapid progression to advanced stages of ROP requiring close monitoring and multiple interventions. Surgeries for AROP have a favorable anatomical and functional outcome in 58% and 53%, respectively. Eyes undergoing lens sparing vitrectomy had better visual outcomes.
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Affiliation(s)
- Parveen Sen
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Chennai, Tamil Nadu, India
| | - Pramod Bhende
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Chennai, Tamil Nadu, India
| | - Puja Maitra
- Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Chennai, Tamil Nadu, India
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Obata S, Yanagi T, Ohji M. Response to a letter to the editor related to Graefe's Arch Clin Exp Ophthalmol. 2023 April; 261(4):951-957. "Blood neutrophil-to-lymphocyte ratio as a risk factor in the treatment of retinopathy of prematurity". Graefes Arch Clin Exp Ophthalmol 2023; 261:2723-2724. [PMID: 37233826 DOI: 10.1007/s00417-023-06125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
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Prasad M, Ingolfsland EC, Christiansen SP. Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity. Life (Basel) 2023; 13:life13051075. [PMID: 37240719 DOI: 10.3390/life13051075] [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: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/28/2023] Open
Abstract
Severe ROP is characterized by the development of retinal fibrovascular proliferation that may progress to retinal detachment. The purpose of this report is to review five of the most common and well-studied perinatal and neonatal modifiable risk factors for the development of severe ROP. Hyperoxemia, hypoxia, and associated prolonged respiratory support are linked to the development of severe ROP. While there is a well-established association between clinical maternal chorioamnionitis and severe ROP, there is greater variability between histologic chorioamnionitis and severe ROP. Neonatal sepsis, including both bacterial and fungal subtypes, are independent predictors of severe ROP in preterm infants. Although there is limited evidence related to platelet transfusions, the risk of severe ROP increases with the number and volume of red blood cell transfusions. Poor postnatal weight gain within the first six weeks of life is also strongly tied to the development of severe ROP. We also discuss preventative strategies that may reduce the risk of severe ROP. Limited evidence-based studies exist regarding the protective effects of caffeine, human milk, and vitamins A and E.
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Affiliation(s)
- Minali Prasad
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Ellen C Ingolfsland
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stephen P Christiansen
- Departments of Ophthalmology and Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Obata S, Matsumoto R, Kakinoki M, Sawada O, Sawada T, Saishin Y, Yanagi T, Maruo Y, Ohji M. Blood neutrophil-to-lymphocyte ratio as a risk factor in treatment for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2023; 261:951-957. [PMID: 36378339 DOI: 10.1007/s00417-022-05902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the blood neutrophil-to-lymphocyte ratio (NLR) as a risk factor for retinopathy of prematurity (ROP) development or treatment. METHODS Retrospective cohort study. Infants who underwent ROP screening at Shiga University of Medical Science Hospital and Omihachiman Community Medical Center between April 2010 and December 2021 were included in this study. Screening criteria were gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g. Multivariate logistic regression analysis was applied to investigate whether the NLR constituted an independent risk factor for ROP development or treatment. The objective variable was ROP development or treatment, and the explanatory variables were GA, BW, NLR, maternal infection or clinical chorioamnionitis and corticosteroid use by the mother. Maternal infection or clinical chorioamnionitis and corticosteroid use by the mother was included in the explanatory variables to adjust for factors affecting the NLR. RESULTS In total, 220 infants met the inclusion criteria, of whom 125 developed ROP, whereas 95 infants did not display ROP. GA was significantly associated with ROP development (odds ratio (OR): 0.41, p < 0.001); however, the NLR was not significantly associated with ROP development (OR: 1.0, p = 0.74). Thirty-eight infants received treatment for ROP, whereas 182 infants had no such treatment. BW and the NLR were significantly associated with ROP treatment (OR: 1.6 and 0.66, p < 0.001 and 0.003, respectively). CONCLUSION The NLR was not a risk factor for ROP development but was a risk factor for ROP treatment.
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Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
| | - Riko Matsumoto
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Tomoko Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
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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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Xie H, Liu Y, Lei H, Song T, Yue G, Du Y, Wang T, Zhang G, Lei B. Adversarial learning-based multi-level dense-transmission knowledge distillation for AP-ROP detection. Med Image Anal 2023; 84:102725. [PMID: 36527770 DOI: 10.1016/j.media.2022.102725] [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: 11/21/2021] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
The Aggressive Posterior Retinopathy of Prematurity (AP-ROP) is the major cause of blindness for premature infants. The automatic diagnosis method has become an important tool for detecting AP-ROP. However, most existing automatic diagnosis methods were with heavy complexity, which hinders the development of the detecting devices. Hence, a small network (student network) with a high imitation ability is exactly needed, which can mimic a large network (teacher network) with promising diagnostic performance. Also, if the student network is too small due to the increasing gap between teacher and student networks, the diagnostic performance will drop. To tackle the above issues, we propose a novel adversarial learning-based multi-level dense knowledge distillation method for detecting AP-ROP. Specifically, the pre-trained teacher network is utilized to train multiple intermediate-size networks (i.e., teacher-assistant networks) and one student network by dense transmission mode, where the knowledge from all upper-level networks is transmitted to the current lower-level network. To ensure that two adjacent networks can distill the abundant knowledge, the adversarial learning module is leveraged to enforce the lower-level network to generate the features that are similar to those of the upper-level network. Extensive experiments demonstrate that our proposed method can realize the effective knowledge distillation from the teacher to student networks. We achieve a promising knowledge distillation performance for our private dataset and a public dataset, which can provide a new insight for devising lightweight detecting systems of fundus diseases for practical use.
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Affiliation(s)
- Hai Xie
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yaling Liu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Haijun Lei
- Guangdong Province Key Laboratory of Popular High-performance Computers, School of Computer and Software Engineering, Shenzhen University, Shenzhen, China
| | - Tiancheng Song
- Shenzhen Silan Zhichuang Technology Co., Ltd., Shenzhen, China
| | - Guanghui Yue
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yueshanyi Du
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Tianfu Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Guoming Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China.
| | - Baiying Lei
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
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Athikarisamy SE, Lam GC, Cooper MN, Strunk T. Retinopathy of prematurity and placental histopathology findings: A retrospective cohort study. Front Pediatr 2023; 11:1099614. [PMID: 36911032 PMCID: PMC9996070 DOI: 10.3389/fped.2023.1099614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
Aim Retinopathy of prematurity (ROP) is a biphasic vaso-proliferative disease that has the potential to cause blindness. In addition to prematurity and hyperoxia, perinatal infection and inflammation have been reported to play a critical role in the pathogenesis of ROP. The aim of this study was to assess the association between placental inflammation and the severity of ROP. Methods A retrospective study of infants (<30 weeks of gestational age) born at the King Edward Memorial Hospital, a tertiary perinatal center in Western Australia. Results A total of 878 infants were included in this study (ROP stage 0-2 = 829; 3 or more = 49). The presence of maternal chorioamnionitis appeared to show signs of an association with reduced odds of severe ROP: mild chorioamnionitis OR=0.43 (95% CI: 0.17, 1.05) and severe chorioamnionitis OR=0.68 (95% CI: 0.29, 1.60). A strong association was observed for oxygen supplementation at 36 weeks (OR: 5.16; p < 0.001), exposure to postnatal steroids (OR: 6.65; p < 0.001), and receipt of platelet transfusion (OR: 8.21; p < 0.001). Conclusion Maternal chorioamnionitis or fetal chorioamnionitis was associated with reduced odds of severe ROP. A strong association was found in infants who needed oxygen supplementation at 36 weeks and those who required steroids or platelets in the postnatal period.
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Affiliation(s)
- Sam Ebenezer Athikarisamy
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia.,School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Geoffrey C Lam
- Department of Ophthalmology, Perth Children's Hospital, Perth, WA, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, WA, Australia
| | - Matthew N Cooper
- Wesfarmers' Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia.,School of Medicine, University of Western Australia, Crawley, WA, Australia.,Wesfarmers' Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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de las Rivas Ramírez N, Luque Aranda G, Rius Díaz F, Pérez Frías FJ, Sánchez Tamayo T. Risk factors associated with Retinopathy of Prematurity development and progression. Sci Rep 2022; 12:21977. [PMID: 36539470 PMCID: PMC9767907 DOI: 10.1038/s41598-022-26229-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Several studies propose that Retinopathy of Prematurity (ROP) is a multifactorial disorder implicating many prenatal and postnatal factors. The objective of our study was to determine the incidence and the risk factors that influenced ROP development and progression. We retrospectively compiled data of preterms with birth weight (BW) ≤ 1.500 g and/or gestational age (GA) < 32 weeks, or BW between 1.501 and 2.000 g and/or GA ≥ 32 weeks with oxygen supply > 72 h or unstable clinical course screened for ROP in Regional University Hospital of Málaga from 2015 to 2018. 202 infants (44.7%) developed ROP and 66 exhibited progression (32.7% of ROP infants). In the univariate analysis, many risk factors were associated with ROP. In the subsequent multivariate analysis, GA, oxygen therapy and weight at 28 days of life, mechanical ventilation duration, non-invasive ventilation, surfactant administration and late-onset sepsis were independently associated with the development. However, oxygen therapy duration, late-onset sepsis and weight at 28 days were associated with the progression. The ROP development and progression risk factors were different. Our results are important to facilitate screening, early diagnosis and ROP treatment while reducing unneeded examinations.
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Affiliation(s)
- Nieves de las Rivas Ramírez
- Department of Ophthalmology, Hospital de la Serranía, Ronda-San Pedro, Km 2, 29400 Ronda, Málaga Spain ,grid.10215.370000 0001 2298 7828School of Medicine, Málaga University (Facultad de Medicina, Universidad de Málaga), Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Guillermo Luque Aranda
- grid.411457.2Department of Ophthalmology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Francisca Rius Díaz
- grid.10215.370000 0001 2298 7828Department of Preventive Medicine and Public Health, Biostatistics, School of Medicine, Málaga University, 29071 Málaga, Spain
| | - Francisco Javier Pérez Frías
- grid.411457.2Department of Pediatrics, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain ,grid.10215.370000 0001 2298 7828Pediatrics Division, Málaga University, 29071 Málaga, Spain
| | - Tomás Sánchez Tamayo
- grid.411457.2Department of Pediatrics, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain ,grid.10215.370000 0001 2298 7828Pediatrics Division, Málaga University, 29071 Málaga, Spain
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RELATIONSHIP BETWEEN RETINOPATHY AND MEAN PLATELET VOLUME. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.894397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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: 13] [Impact Index Per Article: 6.5] [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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Czeszyk A, Hautz W, Jaworski M, Bulsiewicz D, Czech-Kowalska J. Morphology and Vessel Density of the Macula in Preterm Children Using Optical Coherence Tomography Angiography. J Clin Med 2022; 11:1337. [PMID: 35268428 PMCID: PMC8911277 DOI: 10.3390/jcm11051337] [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] [Received: 01/12/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case−control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12−12.77), while the age of the control group was 11.78 years (IQR: 8.81−13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.
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Affiliation(s)
- Agnieszka Czeszyk
- Department of Ophthalmology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Wojciech Hautz
- Department of Ophthalmology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Maciej Jaworski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Dorota Bulsiewicz
- Department of Neonatology and Neonatal Intensive Care, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (D.B.); (J.C.-K.)
| | - Justyna Czech-Kowalska
- Department of Neonatology and Neonatal Intensive Care, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (D.B.); (J.C.-K.)
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Berrocal AM, Fan KC, Al-Khersan H, Negron CI, Murray T. Retinopathy of Prematurity: Advances in the Screening and Treatment of Retinopathy of Prematurity Using a Single Center Approach. Am J Ophthalmol 2022; 233:189-215. [PMID: 34298009 PMCID: PMC8697761 DOI: 10.1016/j.ajo.2021.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To focus on the longitudinal evaluation of high-risk infants for the development of retinopathy of prematurity (ROP) at a single tertiary neonatal intensive care unit (NICU), and to evaluate evolving demographics of ROP and the transition of treatment-warranted disease. DESIGN Retrospective cohort study. METHODS A consecutive retrospective review was performed of all infants screened for ROP between 1990 and 2019 at the Jackson Memorial Hospital neonatal intensive care unit. All inborn infants meeting a birth criteria of <32 weeks' gestational age (GA) or a birthweight (BW) of 1500 g were included. Longitudinal demographic, diagnostic, and treatment data were reported. RESULTS Between January 1, 1990, and June 20, 2019, a total of 25,567 examinations were performed and 7436 patients were included. Longitudinal trends over 3 decades demonstrated a decreasing incidence of ROP (P < .05). Although the mean BW and GA increased over 3 decades, patients with ROP demonstrated lower BW and GA over time (P < .05). The prevalence of micro-premature infants (as defined by BW <750 g) continues to rise over time. Micro-preemies demonstrated increasing severity of zone and stage grading, plus disease, and propensity to require treatment (P < .05). The rate of progression of ROP to stage 4 and 5 disease has decreased over time, and there has been an associated increased adoption of intravitreal bevacizumab as primary and salvage therapy. CONCLUSIONS Understanding the evolution of ROP infants and treatment over time is critical in identifying high-risk infants and in reducing the incidence of severe-stage ROP. Micro-prematurity is one of the significant risk factors for treatment-warranted ROP that continues to increase as neonatal care improves. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Audina M Berrocal
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | - Kenneth C Fan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Catherin I Negron
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Timothy Murray
- Murray Oncology and Retina (T.M.), South Miami, Florida, USA
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Abd Rahman SNA, Mohd Khialdin S, Ishak S. Aggressive Retinopathy of Prematurity in a Larger and Less Preterm Infant: A Review of Possible Risk Factors. Cureus 2021; 13:e19267. [PMID: 34881124 PMCID: PMC8643494 DOI: 10.7759/cureus.19267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/05/2022] Open
Abstract
Aggressive retinopathy of prematurity (A-ROP), formerly known as aggressive posterior retinopathy of prematurity (APROP), occurs generally in extremely premature infants less than 28 weeks gestational age with extreme low birth weight of ≤1000g. We report a case of A-ROP occurring in a larger and less preterm infant. The possible risk factors that lead to the occurrence of A-ROP in this infant will be discussed. An infant born vaginally at 30 weeks gestational age weighing 1550g was diagnosed with A-ROP. Retinopathy of prematurity (ROP) screening was performed due to the presence of risk factors: prematurity, low birth weight, received supplemental oxygen, intraventricular hemorrhage and history of maternal chorioamnionitis. Following a single injection of intravitreal ranibizumab, significant regression of A-ROP was observed. A-ROP was unexpected in this infant and was believed to have developed as a result of receipt of supplemental oxygen, maternal chorioamnionitis, and Ureaplasma infection.
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Affiliation(s)
| | | | - Shareena Ishak
- Pediatrics, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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14
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Gangwe AB, Agrawal D, Gangrade AK, Parchand SM, Agrawal D, Azad RV. Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2171-2176. [PMID: 34304203 PMCID: PMC8482928 DOI: 10.4103/ijo.ijo_3016_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR). Methods: In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser. Results: 63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: –1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002). Conclusion: Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.
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Affiliation(s)
- Anil Babanrao Gangwe
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | | | | | | | - Deepanshu Agrawal
- Consultant Vitreo Retina Services, Vitreoretina Services, Raipur, Chhattisgarh, India
| | - Raj Vardhan Azad
- Professor of Ophthalmology, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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15
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Narnaware SH, Bawankule PK, Raje D. Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment. J Ophthalmic Vis Res 2021; 16:400-407. [PMID: 34394869 PMCID: PMC8358764 DOI: 10.18502/jovr.v16i3.9437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/15/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. Methods This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): <28 (n = 7), 28–30 (n = 11), >30 (n = 10). BW (in grams): <1000 (n = 8), 1000–1200 (n = 10), >1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32–34 (n = 18), >34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. Results The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were <28 weeks of GA (one eye) and 28–30 weeks (two eyes). One baby (one eye) was <1000 gm and the other (two eyes) was >1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). Conclusion In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.
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Affiliation(s)
- Shilpi H Narnaware
- Consultant Vitreo-retina & ROP Specialist, Sarakshi Netralaya, Rajiv Nagar, Wardha Road, Nagpur 440025, Maharashtra, India
| | - Prashant K Bawankule
- Vitreo-Retinal Surgeon, Rajiv Nagar, Wardha Road, Nagpur 440025 Maharashtra, India
| | - Dhananjay Raje
- Head, Data Analysis Group, MDS Bio-analytics Pvt. Ltd., Shankar Nagar, Nagpur 440010, Maharashtra, India
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Systemic Factors Associated with a Thinner Choroid in Preterm Infants. OPHTHALMOLOGY SCIENCE 2021; 1:100032. [PMID: 36249299 PMCID: PMC9559969 DOI: 10.1016/j.xops.2021.100032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/30/2022]
Abstract
Purpose To identify systemic health factors associated with a thinner choroid, which has been hypothesized as a cause of poor visual outcomes in low–birth weight infants. Design The prospective, observational Study of Eye Imaging in Preterm Infants (BabySTEPS) enrolled infants recommended for retinopathy of prematurity screening based on the American Association of Pediatrics guidelines. Participants Infants who underwent imaging with investigational handheld OCT at 36 ± 1 weeks’ postmenstrual age (PMA) as part of BabySTEPS. Methods Average choroidal thickness was measured across the central subfoveal 1 mm. We concurrently collected maternal and infant clinical health data. Univariate and multivariate linear regression analyses were performed to evaluate factors associated with choroidal thickness. The left and right eyes showed similar thicknesses, so their average was used for analysis. Main Outcomes Measures Association between infant health factors and subfoveal choroidal thickness. Results Subfoveal choroidal thickness was measurable in 82 of 85 infants and 94% of eyes. Mean choroidal thickness was 231 ± 78 μm. In the univariate analysis, a thinner choroid was associated with decreased growth velocity (P < 0.001), lower birth weight (P < 0.001), smaller head circumference (P < 0.001), younger gestational age (P = 0.01), the presence of patent ductus arteriosus (P = 0.05), sepsis or necrotizing enterocolitis (P = 0.03), bronchopulmonary dysplasia (P = 0.03), pulmonary interstitial emphysema (P = 0.002), more days on oxygen support (P < 0.001), and being on oxygen support at 36 weeks (P < 0.001) and at the time of imaging (P < 0.001). In the multivariate analysis, growth velocity (P = 0.002) and oxygen support at the time of OCT imaging (P = 0.004) remained associated with a thinner choroid. Conclusions A thinner choroid is associated independently with growth velocity and receiving oxygen support at 36 ± 1 weeks PMA. This suggests that choroidal development in preterm infants may be related to growth rate in the first weeks of life and the prolonged use of supplemental oxygen. Longitudinal studies are needed to assess differences in choroidal thickness before 36 weeks PMA and to assess their impact on visual outcomes.
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17
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Abdel Salam Gomaa N, Helmy YAH, Maher S, Hassanein D, Shuaib A, Hegazy AI, Ali AA. Clinical Characteristics of Preterm Neonates with Aggressive Posterior Retinopathy of Prematurity. Clin Ophthalmol 2021; 15:2263-2277. [PMID: 34103890 PMCID: PMC8179817 DOI: 10.2147/opth.s292712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to identify the risk factors that may predispose preterm neonates to develop aggressive posterior retinopathy of prematurity (APROP). Methods This retrospective case control study included 16 infants with APROP in zone 1 or posterior zone 2. Thirty-four gestational age and birth weight-matched controls with stage 2 or less ROP were included. We reviewed medical records on infant birth and postnatal characteristics. Results Patients who developed APROP had a significantly longer duration of caffeine therapy, were significantly more likely to be small for gestational age (SGA), and were more likely to have a positive blood culture than patients who developed less severe ROP. Patients with APROP who required retreatment had received inotropes for a longer duration of time, had received more plasma transfusions, were more likely to have IVH, and had a greater decrease in the serum hemoglobin during hospitalization. Conclusion Being SGA, receiving caffeine for a longer duration, and having culture-proven sepsis were associated with APROP. IVH, a low serum hemoglobin, the need for more plasma transfusions, and a longer duration of inotropes were associated with APROP which required retreatment.
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Affiliation(s)
| | - Youssef A H Helmy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sara Maher
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Hassanein
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asmaa Shuaib
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed I Hegazy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aliaa A Ali
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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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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19
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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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20
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Aggressive Posterior Retinopathy of Prematurity: Clinical and Quantitative Imaging Features in a Large North American Cohort. Ophthalmology 2020; 127:1105-1112. [PMID: 32197913 DOI: 10.1016/j.ophtha.2020.01.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/06/2019] [Accepted: 01/29/2020] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Aggressive posterior retinopathy of prematurity (AP-ROP) is a vision-threatening disease with a significant rate of progression to retinal detachment. The purpose of this study was to characterize AP-ROP quantitatively by demographics, rate of disease progression, and a deep learning-based vascular severity score. DESIGN Retrospective analysis. PARTICIPANTS The Imaging and Informatics in ROP cohort from 8 North American centers, consisting of 947 patients and 5945 clinical eye examinations with fundus images, was used. Pretreatment eyes were categorized by disease severity: none, mild, type 2 or pre-plus, treatment-requiring (TR) without AP-ROP, TR with AP-ROP. Analyses compared TR with AP-ROP and TR without AP-ROP to investigate differences between AP-ROP and other TR disease. METHODS A reference standard diagnosis was generated for each eye examination using previously published methods combining 3 independent image-based gradings and 1 ophthalmoscopic grading. All fundus images were analyzed using a previously published deep learning system and were assigned a score from 1 through 9. MAIN OUTCOME MEASURES Birth weight, gestational age, postmenstrual age, and vascular severity score. RESULTS Infants who demonstrated AP-ROP were more premature by birth weight (617 g vs. 679 g; P = 0.01) and gestational age (24.3 weeks vs. 25.0 weeks; P < 0.01) and reached peak severity at an earlier postmenstrual age (34.7 weeks vs. 36.9 weeks; P < 0.001) compared with infants with TR without AP-ROP. The mean vascular severity score was greatest in TR with AP-ROP infants compared with TR without AP-ROP infants (8.79 vs. 7.19; P < 0.001). Analyzing the severity score over time, the rate of progression was fastest in infants with AP-ROP (P < 0.002 at 30-32 weeks). CONCLUSIONS Premature infants in North America with AP-ROP are born younger and demonstrate disease earlier than infants with less severe ROP. Disease severity is quantifiable with a deep learning-based score, which correlates with clinically identified categories of disease, including AP-ROP. The rate of progression to peak disease is greatest in eyes that demonstrate AP-ROP compared with other treatment-requiring eyes. Analysis of quantitative characteristics of AP-ROP may help improve diagnosis and treatment of an aggressive, vision-threatening form of ROP.
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21
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Abstract
Retinopathy of prematurity (ROP) is a serious disease affecting premature infants. Rates of ROP increase with decreasing gestational age. Duration of oxygen exposure is correlated with ROP. Many studies evaluating oxygen have been performed to assess impact on ROP. This article describes recent findings for oxygen saturation target studies and suggests area of future study for ROP.
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Affiliation(s)
- Rosemary D Higgins
- College of Health and Human Services, George Mason University, 4400 University Drive, 2G7, Peterson Family Health Science Hall, Room 5415, Fairfax, VA 22030, USA.
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22
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Chen TA, Shields RA, Bodnar ZH, Callaway NF, Schachar IH, Moshfeghi DM. A Spectrum of Regression Following Intravitreal Bevacizumab in Retinopathy of Prematurity. Am J Ophthalmol 2019; 198:63-69. [PMID: 30312578 DOI: 10.1016/j.ajo.2018.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe an improved understanding of the regression patterns following off-label intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP). DESIGN Retrospective cohort study. METHODS All infants treated with IVB for type 1 ROP at a single institution from June 2013 to March 2018 were retrospectively reviewed and the amount of retinal nonperfusion on fluorescein angiogram was calculated. RESULTS In the 92 eyes of 46 patients analyzed, only 3 eyes (3.3%) reached full vascular maturity. Of the 89 eyes not reaching maturity, 39 eyes (43.8%) had vascular arrest alone (VAA), 34 eyes (38.2%) had vascular arrest with persistent tortuosity (VAT), and 16 eyes (18.0%) had ROP reactivation. Those eyes that reactivated were more likely to be initially classified as having aggressive posterior ROP (P = .004) and of Asian ethnicity (P = .008). There were greater areas of ischemia in eyes with reactivation as compared to VAT and VAA (112.1 mm2 vs 72.5 mm2 vs 56.6 mm2, respectively, P = .007). Younger gestational age at birth was found to be an independent predictor of persistent tortuosity (VAT vs VAA) in a logistic regression model. CONCLUSIONS Incomplete vascularization following IVB is very common and is associated with a younger gestational age at birth, Asian ethnicity, and aggressive posterior ROP. The presence of tortuosity following IVB may be indicative of persistently elevated vascular endothelial growth factor levels and an early indicator of potential reactivation.
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Villamor-Martinez E, Cavallaro G, Raffaeli G, Mohammed Rahim OMM, Gulden S, Ghazi AMT, Mosca F, Degraeuwe P, Villamor E. Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis. PLoS One 2018; 13:e0205838. [PMID: 30332485 PMCID: PMC6192636 DOI: 10.1371/journal.pone.0205838] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CA-exposed group was significantly associated with a higher risk of ROP. Meta-analyses of studies with data adjusted for confounders could not find a significant association between CA and ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.
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Affiliation(s)
- Eduardo Villamor-Martinez
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Owais M. M. Mohammed Rahim
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Silvia Gulden
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Amro M. T. Ghazi
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pieter Degraeuwe
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
- * E-mail:
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Tong Q, Yin H, Zhao M, Li X, Yu W. Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab. BMC Ophthalmol 2018; 18:150. [PMID: 29940900 PMCID: PMC6019321 DOI: 10.1186/s12886-018-0815-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background This study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment. Methods This was a retrospective study. A total of 83 preterm infants (160 eyes) diagnosed with APROP who were primarily treated with IVR were included. The 160 eyes were divided into two groups based on the anatomic outcomes. Group A included 35 eyes that developed retinal detachment, and Group B included 125 eyes without retinal detachment. The following patient factors were retrospectively reviewed: gender, gestational age (GA), birth weight (BW), postmenstrual age (PMA) at first treatment, iris neovascularizations, retinal hemorrhage, neutrophil and lymphocyte counts before the first intravitreal injection, neutrophil-to-lymphocyte ratio (NLR), anatomical outcomes, additional treatment and follow-up time. Three dummy variables were created as dependent variables based on the methods of retreatment. The possible risk factors for APROP were evaluated, and statistical analyses included univariate and multivariate logistic regression. Results A total of 160 eyes from 83 preterm infants (56 males and 27 females) underwent initial IVR treatment with a follow-up time of 17.17 ± 10.54 months. Thirty-five of the 160 (21.9%) eyes progressed to retinal detachment, and 82 of the 125 (65.6%) non-retinal detachment eyes needed retreatment, with favorable anatomical outcomes. The disease improved approximately 1.5 ± 1.2 weeks after the first IVR treatment. The mean recurrence period of APROP was approximately 7.5 ± 6.9 weeks after the first IVR treatment. Multiple logistic regression analysis revealed postmenstrual age (P < 0.001) and neutrophil count (P = 0.009) as the most significant factors for retinal detachment in APROP. Retinal hemorrhage (P = 0.007) and BW (P = 0.04) were most significantly associated with APROP recurrence and retreatment. Conclusions IVR injection is an effective treatment for APROP. In this study, older postmenstrual age and low neutrophil count were identified as risk factors for retinal detachment in APROP. In addition, retinal hemorrhage and low BW were significantly associated with recurrence and retreatment in non-retinal detachment APROP. Thus, patients with a lower BW, older postmenstrual age, low neutrophil count and retinal hemorrhage should be reexamined in a timely and more frequent manner.
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Affiliation(s)
- Qizhe Tong
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China.,Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Hong Yin
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China. .,Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China. .,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
| | - Mingwei Zhao
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China.,Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xiaoxin Li
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China.,Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Wenzhen Yu
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China.,Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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25
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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: 272] [Impact Index Per Article: 45.3] [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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Parlapani E, Agakidis C, Karagiozoglou-Lampoudi T, Sarafidis K, Agakidou E, Athanasiadis A, Diamanti E. The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity. J Matern Fetal Neonatal Med 2017; 32:1084-1091. [PMID: 29082786 DOI: 10.1080/14767058.2017.1399120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: The Mediterranean diet (MD) is associated with decreased risk of metabolic syndrome and gestational diabetes due to the anti-inflammatory and antioxidative properties of its components. The aim was to investigate the potential association of MD adherence (MDA) during pregnancy by mothers delivering prematurely, with intrauterine growth as expressed by neonates' anthropometry at birth and complications of prematurity. Participants and methods: This is a single-center, prospective, observational cohort study of 82 women who delivered preterm singletons at post conceptional age (PCA) ≤ 34 weeks and their live-born neonates. Maternal and neonatal demographic and clinical data were recorded. All mothers filled in a food frequency questionnaire, and the MDA score was calculated. Based on 50th centile of MD score, participants were classified into high-MDA and low-MDA groups. Results: The low-MDA mothers had significantly higher pregestational BMI and rates of overweight/obesity (odd ratios (OR) 3.5) and gestational hypertension/preeclampsia (OR 3.8). Neonates in the low-MDA group had significantly higher incidence of intrauterine growth restriction (IUGR) (OR 3.3) and lower z-scores of birth weight and BMI. Regarding prematurity-related complications, the low MDA-group was more likely to develop necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity (OR 3.2, 1.3, and 1.6, respectively), while they were less likely to develop respiratory distress syndrome (OR 0.49), although the differences were not statistically significant. However, adjustment for confounders revealed MDA as a significant independent predictor of hypertension/preeclampsia, IUGR, birth weight z-score, necrotizing enterocolitis, and bronchopulmonary dysplasia. Conclusions: High MDA during pregnancy may favorably affect intrauterine growth and certain acute and chronic complications of prematurity as well as maternal hypertension/preeclampsia.
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Affiliation(s)
- Elisavet Parlapani
- a 1st Department of Neonatology & NICU, Nutrition/Dietetics Department, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece.,b Clinical Nutrition Laboratory , Technological Education Institute of Thessaloniki , Thessaloniki , Greece
| | - Charalampos Agakidis
- a 1st Department of Neonatology & NICU, Nutrition/Dietetics Department, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece.,c 1st Department of Pediatrics, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece
| | | | - Kosmas Sarafidis
- a 1st Department of Neonatology & NICU, Nutrition/Dietetics Department, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece
| | - Eleni Agakidou
- a 1st Department of Neonatology & NICU, Nutrition/Dietetics Department, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece
| | - Apostolos Athanasiadis
- d 3rd Department of Obstetrics & Gynecology, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece
| | - Elisavet Diamanti
- a 1st Department of Neonatology & NICU, Nutrition/Dietetics Department, Faculty of Medicine , Aristotle University of Thessaloniki, Ippokrateion Hospital , Thessaloniki , Greece
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