PREOPERATIVE ANATOMICAL FEATURES ASSOCIATED WITH IMPROVED SURGICAL OUTCOMES FOR STAGE 5 RETINOPATHY OF PREMATURITY

Research hotspots and trends in retinopathy of prematurity from 2003 to 2022: a bibliometric analysis

Background

In order to understand the research hotspots and trends in the field of retinopathy of prematurity (ROP), our study analyzed the relevant publications from 2003 to 2022 by using bibliometric analysis.

Methods

The Citespace 6.2.R3 system was used to analyze the publications collected from the Web of Science Core Collection (WoSCC) database.

Results

In total, 4,957 publications were included in this study. From 2003 to 2022, the number of publications gradually increased and peaked in 2022. The United States was the country with the most publications, while Harvard University was the most productive institution. The top co-cited journal PEDIATRICS is published by the United States. Author analysis showed that Hellström A was the author with the most publications, while Good WV was the top co-cited author. The co-citation analysis of references showed seven major clusters: genetic polymorphism, neurodevelopmental outcome, threshold retinopathy, oxygen-induced retinopathy, low birth weight infant, prematurity diagnosis cluster and artificial intelligence (AI). For the citation burst analysis, there remained seven keywords in their burst phases until 2022, including ranibizumab, validation, trends, type 1 retinopathy, preterm, deep learning and artificial intelligence.

Conclusion

Intravitreal anti-vascular endothelial growth factor therapy and AI-assisted clinical decision-making were two major topics of ROP research, which may still be the research trends in the coming years.

Structural outcome following surgery for stage 5 retinopathy of prematurity based on the new international classification: ICROP 3

PURPOSE

This study investigated the outcomes of vitrectomy for stage 5 retinopathy of prematurity (ROP) based on the International Classification of Retinopathy of Prematurity 3rd edition (ICROP 3), in which stage 5 ROP is divided into three subgroups.

METHODS

Fifty-four eyes of 34 patients with stage 5 ROP who underwent vitrectomy between 2004 and 2020 were retrospectively analyzed. Data including sex, gestational age and weight at birth, ICROP 3 subcategories, perioperative use of intravitreal bevacizumab injection (IVB) and laser photocoagulation, surgical procedure and complications, final retinal reattachment, and follow-up period were collected.

RESULTS

Complete retinal reattachment was achieved in 16 eyes (88.9%) with stage 5A and 13 eyes (39.4%) with stage 5B (P = 0.0003, Wilcoxon rank-sum test). Three patients with stage 5C were considered inoperable. Postoperative anatomical failure was significantly associated with stage (stage 5B vs. 5A; odds ratio, 17.986; 95% confidence interval, 3.712-148.502; P = 0.0001, multivariate logistic regression analysis). Intraoperative IVB was significantly associated with lower postoperative incidence of vitreous hemorrhage and glaucoma (P = 0.041, chi-square test).

CONCLUSIONS

Staging of preoperative anatomical features based on ICROP 3 is a useful predictor for final anatomical success. Intraoperative IVB might reduce postoperative complication risks.

International Classification of Retinopathy of Prematurity, Third Edition

PURPOSE

The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system.

DESIGN

Review of evidence-based literature, along with expert consensus opinion.

PARTICIPANTS

International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men.

METHODS

The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification.

MAIN OUTCOME MEASURES

Consensus statement.

RESULTS

The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae.

CONCLUSIONS

These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.