Screening guidelines for retinopathy of prematurity: the need for revision in extremely low birth weight infants

Causes of Childhood Blindness in the United States Using the IRIS® Registry (Intelligent Research in Sight)

PURPOSE

To investigate causes of childhood blindness in the United States using the IRIS® Registry (Intelligent Research in Sight).

DESIGN

Cross-sectional study.

PARTICIPANTS

Patients ≤ 18 years of age with visual acuity (VA) 20/200 or worse in their better-seeing eye in the IRIS Registry during 2018.

METHODS

Causes of blindness were classified by anatomic site and specific diagnoses.

MAIN OUTCOME MEASURES

Percentages of causes of blindness.

RESULTS

Of 81 164 children with 2018 VA data in the IRIS Registry, 961 (1.18%) had VA 20/200 or worse in their better-seeing eye. Leading causes of blindness were retinopathy of prematurity (ROP) in 301 patients (31.3%), nystagmus in 78 patients (8.1%), and cataract in 64 patients (6.7%). The retina was the leading anatomic site (47.7%) followed by optic nerve (11.6%) and lens (10.0%). A total of 52.4% of patients had treatable causes of blindness.

CONCLUSIONS

This analysis offers a unique cross-sectional view of childhood blindness in the United States using a clinical data registry. More than one-half of blind patients had a treatable cause of blindness.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Rate and Treatment of Retinopathy of Prematurity in Extremely Low Birth Weight Infants with Gestational Age ≤28 Weeks in Eastern China

Purpose

To investigate the incidence and clinical characteristics of ROP in extremely preterm (EP) and extremely low birth weight (ELBW) infants in eastern China.

Patients and Methods

This retrospective study included 104 infants with a birth weight (BW) ≤ 1000 g and gestational age (GA) ≤ 28 weeks, who were admitted to the Eye and ENT Hospital of Fudan University over 10 years. The infants were examined for ROP with RetCam. Infants with type 1 ROP and aggressive posterior ROP (AP-ROP) were treated. The risk factors evaluated were GA and BW.

Results

Mean GA was 26.63 ± 0.88 weeks and mean BW was 892.39 ± 108.06 g. Of the 104 infants, 83 (79.8%) developed ROP, three (2.9%) had AP-ROP, 14 (13.5%) had type 1 ROP, and 10 (9.6%) had type 2 ROP. The proportions of infants with BW ≤750 g and 751-1000 g were 8.7% and 91.3%, respectively, and the incidences of severe ROP in these infants were 22.2% and 15.8%, respectively. The infants with severe ROP had a mean GA of 26.56 ± 0.68 weeks and mean BW of 860.00 ± 163.48 g, and 47.1% of severe ROP occurred in infants with a GA of 26 weeks. However, multivariate logistic regression showed that the severity of ROP was not directly inversely related to GA or BW in this study population.

Conclusion

In EP and ELBW Chinese infants, who were admitted to the Eye and ENT Hospital of Fudan University, the development of ROP was more frequent and the incidence of severe ROP that progressed to the stage that required treatment was high.

Retinopathy of Prematurity: Screening Guidelines Need to be Reevaluated for Developing Countries

Purpose.

Timely screening of premature babies is an important initial step in the management of retinopathy of prematurity (ROP) as earlier treatment results in improved visual prognosis. Screening criteria for ROP currently recommended by the American Academy of Pediatrics may not be applicable in developing countries. The aim of the present study is to find out the incidence of ROP in infants with a gestational age (GA) of ≥32 weeks in Eskisehir, Turkey, to provide information to assist in determining screening criteria.

Methods.

A total of 96 infants with a GA of 32–35 weeks who were referred for ROP between January 1, 2004, and December 31, 2008, were studied. ROP screening, follow-up, and appropriate therapies were applied.

Results.

During ROP screening, there were 42 of 96 (43.8%) infants with no ROP. A total of 54/96 (56.2%) infants were noted to have ROP. Among all infants, 7 (7.3%) had threshold ROP. Two infants with threshold disease were born at the 32nd, 2 at the 33rd, and 3 at the 34th week of gestation. The mean birthweight was 1857.9 (range 1060–3200) grams.

Conclusions.

In our study, it was found that more mature infants may also develop threshold ROP and require early treatment. After more information is gained and widespread screening, screening protocols covering more mature infants can be designed especially for developing countries.

Incidence and main risk factors for severe retinopathy of prematurity in infants weighing less than 1000 grams in Brazil

OBJECTIVES

This study evaluated the incidence and risk factors for severe retinopathy of prematurity (ROP) in babies <1000 g at Porto Alegre, Brazil.

METHODS

Prospective cohort study including premature children with birth weight ≤1000 g was conducted. Main outcome was the occurrence of severe ROP needing treatment.

RESULTS

A total of 157 infants were included. Severe ROP occurred in 20 infants (12.7%). Nineteen patients were treated by laser photocoagulation. Main risk factors for severe ROP were gestational age (P = 0.029), infant's weight measured at sixth week of life (P < 0.001) and number of days of oxygen therapy under mechanical ventilation (P < 0.001). After logistic regression, infant's weight at sixth week of life and number of days in mechanical ventilation were associated to severe ROP.

CONCLUSIONS

We reported the incidence of 12.7% of severe ROP among babies born ≤ 1000 g in our institution. Laser photocoagulation was effective to stabilize the disease among 19 treated patients.

Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants

OBJECTIVE

The objective of this study is to investigate the relationship between glycemic status and severe retinopathy of prematurity (ROP).

STUDY DESIGN

This is a retrospective cohort study of 114 infants <1000 g admitted to a level IV neonatal intensive care unit within 48 h of life. A cumulative, time-weighted glucose level (TWGL) derived from plotting glucose values over time was included in logistic regression analysis to identify predictors for severe ROP.

RESULT

Infants had 26.6 ± 2 weeks gestational age and had a birth weight of 782 ± 136 g. TWGL during first 10 and 30 days of life were greater in the severe ROP group (P<0.01). Unlike single events of glucose levels ≥ 150 mg dl(-1), 10 days TWGL ≥ 100 mg dl(-1) (odds ratio (OR) 5.2, P<0.02) and 30 days TWGL ≥ 118 mg dl(-1) (OR 5.7, P<0.02) were predictors for severe ROP (univariate). Multivariate regression confirmed 30 days TWGL ≥ 118 mg dl(-1) (OR 9.4 to 10) and gram-positive sepsis (OR 4.1 to 5) as predictors for severe ROP (P<0.05).

CONCLUSION

High overall glycemic status is associated with the development of severe ROP.

Lack of association of genetic polymorphisms of angiotensin-converting enzyme gene I/D and glutathione-S-transferase enzyme T1 and M1 with retinopathy of prematures

One of the most frequently observed causes of blindness in infancy is the pathogenesis known as retinopathy of prematurity (ROP). Angiotensin-converting enzyme (ACE) is a vital enzyme in the renin-angiotensin-aldosterone system; it is involved in the development of cardiovascular system diseases linked to I/D polymorphism of the ACE gene. Glutathione-S-transferase enzyme (GST) is one of the most important regulating components of the antioxidant system; there are indications that certain polymorphisms of GST genes (GSTT1, GSTM1), especially the null genotypes, increase the tendency for oxidative stress diseases. We investigated a possible correlation between ACE gene I/D and GSTT1 and GSTM1 gene polymorphisms in 56 prematures suffering from ROP and a control group composed of 48 prematures without ROP in a hospital in Turkey. PCR was used to detect the ACE I/D, GSTT1 and GSTM1 gene polymorphisms. Genotype was determined based on bands formed on agarose gel electrophoresis. We found no significant differences in genotype frequency of the ACE I/D, GSTT1 and GSTM1 genes between normal subjects and patients with ROP. Our results do not support an association of ACE I/D, GSTT1 and GSTM1 gene polymorphisms with risk for ROP.

Retinopathy of prematurity in extremely low birth weight infants in Malaysia

PURPOSE

To identify differences in incidence, risk factors, and outcomes of retinopathy of prematurity (ROP) between 2 birth weight categories within a cohort of extremely low birth weight (ELBW) infants in Malaysia.

METHODS

This was a prospective study of infants in the Special Care Nursery at the University of Malaya Medical Centre between 2003 and 2005. Outcome measures were presence or absence of ROP, most severe stage of ROP observed, and whether laser treatment was performed. Risk factors for treatment were analyzed in this cohort of treated patients, who were further divided into groups of birth weight <751 g and birth weight 751-1,000 g.

RESULTS

The study protocol identified 70 qualifying ELBW infants. Of these, 41 (58.6%) developed ROP and 23 (32.9%) required laser treatment. Mean birth weight was 806.8 g (SD +/- 142.5); mean gestation was 27.4 weeks (SD +/- 2.2). Infants with birth weight <750 g were twice as likely to require treatment (OR = 2, p = 0.038). The risk factors for laser treatment by bivariate analysis were gestation <28 weeks (OR = 1.8, p = 0.001), duration of ventilation >1 week (OR = 1.5, p = 0.012), and intraventricular hemorrhage (OR = 2.5, p = 0.010). Zone 1 ROP was observed only in infants <751 g.

CONCLUSIONS

The incidence of ROP in ELBW infants in Malaysia is comparable to that seen in the ETROP and CRYO-ROP studies. Within this group, birth weight <750 g doubled the likelihood that treatment would be required.

Retinopathy of prematurity

This article briefly reviews the history of ROP followed by a discussion of the pathogenesis of this complex disorder. We describe the International Classification System for ROP and identify risk factors and screening recommendations. Finally, we discuss some of the measures that have been used in an attempt to both prevent and treat ROP.

Must screening examinations for retinopathy of prematurity necessarily be painful?

PURPOSE

This study investigates the impact of the length of the examination, the insertion of eyelid specula, and the indentation of the globe on the pain and stress sensation of premature infants.

METHODS

Ninety-two premature infants in three neonatal wards were included. In two wards, the patients were examined using eyelid specula and scleral indentation as recommended in the official guidelines. In the third ward, the investigation time was minimized and ophthalmoscopy was performed without eyelid specula and scleral indentation. Physical and mental disturbance of the patients was assessed by the Neonatal Infant Pain Score and by monitoring the heart rate. The results were divided into two groups: in the one, eyelid specula and scleral indentation were used, whereas in the other one, they were not used. An independent-samples t-test was performed, which allowed us to calculate the correlation between the way the examination was executed and the condition of the patients.

RESULTS

Demographic data and baseline values of heart rate and pain score did not differ between the two groups. Heart rate and pain score during and after the investigation were significantly higher and increased significantly with the duration of the examination for the patients who were investigated using lid specula and scleral indentation.

CONCLUSION

Our study shows that indirect ophthalmoscopy without specula causes significantly less stress to infants than screening with lid specula and scleral indentation.

[Risk factors and prevention of retinopathy of prematurity]

The history of retinopathy of prematurity (ROP) gives a prime example of how dangerous the uncontrolled introduction of a new medical treatment--particularly in the field of neonatology--may be. The most important risk factors for the development of ROP are the immaturity of premature infants as well as uncontrolled and/or inadequate treatment with oxygen. In comparison to the fetus, the premature infant is exposed to a nonphysiologically high oxygen concentration. This hyperoxia leads to formation of aggressive oxygen radicals on the one hand and, on the other hand, to temporarily reduced production of growth factors such as vascular endothelial growth factor and erythropoietin, which both play an important role in the pathogenesis of ROP. The most important measure to prevent ROP is restrictive and carefully monitored oxygen treatment. Medical treatment to prevent ROP includes injection of D-penicillamine and retinol, but the available data are still limited, particularly with regard to the long-term effects of this treatment. A higher oxygenation in prethreshold ROP does not lead to recovery of ocular findings, but it increases the incidence of pulmonary complications. A reduction of light intensity in neonatal intensive care units proved not to be efficient for preventing ROP. To avoid blindness, standardized screening of the risk group is needed.

Comparison of neonatal intensive care: Trento area versus Vermont Oxford Network

BACKGROUND

S. Chiara hospital is the only neonatal intensive care unit (NICU) in the Province of Trento (Italy). It serves a population of about 460000 people with about 5000 infants per year, admitting the totality of the inborn and outborn VLBWI of the province. The aim of this work is to compare mortality, morbidity and neonatal treatment of the very low birth weight infants (VLBWI) of Trento area with those recorded in the Vermont Oxford Network (VON) during 2004.

METHODS

In this retrospective analysis, the rates of complications and related treatments reported in VLBWI admitted in the S. Chiara NICU during the period 2000-2005 were compared with those recorded in the VON in 2004. The analysis included both the total populations and different weight groups.

RESULTS

The frequency of inborn infants was significantly higher in Trento than in VON: 91% vs 84% (MH 8.56; p-value 0.003). The administration of prenatal steroids (82% vs 74%; MH 7.47 and p-value 0.006) and caesarean section were significantly more frequent in the Trento area than in VON. In Trento significantly more VLBWI with BW

CONCLUSION

On the basis of this analysis, a less aggressive therapeutic strategy based on perinatal prevention in global management, such as that employed in Trento area, may be associated with an improvement in clinical outcomes in very low birth weight infants.

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Affiliation(s)

Giuseppe De Nisi Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
Mariarosaria Berti Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
Riccardo Malossi Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
Fabio Pederzini Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
Anna Pedrotti Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy
Alberta Valente Neonatology and neonatal intensive care, S. Chiara Hospital, Trento, Italy

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Screening for retinopathy of prematurity

The CRYO-ROP study confirmed the success of treatment for ROP and made screening mandatory. National based screening has been influenced by the varied incidence of disease in developed and developing countries. Most ophthalmologists in developed countries screen infants born between 1000 and 1500 g and between 28 and 31 weeks gestation post menstrual age. The 1984 classification has been updated to highlight the importance of plus disease. The ETROP study findings have resulted in earlier treatment and elevated the importance of screening. Measures such as nesting may help to reduce infant distress during examination. It is important for neonatal units to have an agreed policy on screening and both neonatologist and neonatal nurses have an invaluable role. Diagnostic retinal imaging and telemedicine may have an increasing role in future screening. Timely and accurate screening is the most important first step as earlier treatment results in improved visual prognosis.

Retinopathy of prematurity: the disease process, classifications, screening, treatment, and outcomes

Retinopathy of prematurity (ROP) is the cessation of normal eye development and subsequent abnormal vessel growth that occurs exclusively in premature infants. ROP was first discovered in the 1940s and was for two decades the leading cause of blindness in children. Currently, the disease causes about 500 new cases of blindness per year. The severity of the disease increases with decreasing gestational age. The pathogenesis of ROP involves disruption of normal retinal vascularization. Vessel endothelial growth factor, insulin-like growth factor, and oxygen play important roles in its development. ROP is classified using an international classification system that provides direction for screening and treatment of premature infants. Examinations are performed by ophthalmologists, who identify the scope of vascularization, the degree of abnormal vessel growth, and the amount of the eye that is affected. Treatment modalities include cryosurgery and laser photocoagulation. Long-term outcomes include both structural and functional vision problems.

Hyperoxia inhibits several critical aspects of vascular development

Normal human retinal vascular development uses angiogenesis and vasculogenesis, both of which are interrupted in the vaso-obliteration phase of retinopathy of prematurity (ROP). Canine oxygen-induced retinopathy (OIR) closely resembles human ROP. Canine retinal endothelial cells (ECs) and angioblasts were used to model OIR and characterize the effects of hyperoxia on angiogenesis and vasculogenesis. Cell cycle analysis showed that hyperoxia reduced the number of G1 phase cells and showed increased arrest in S phase for both cell types. Migration of ECs was significantly inhibited in hyperoxia (P < 0.01). Hyperoxia disrupted the cytoskeleton of angioblasts but not ECs after 2 days. Differentiation of angioblasts into ECs (determined by acetylated low-density lipoprotein uptake) was evaluated after basic fibroblast growth factor treatment. Differentiation of angioblasts into pericytes was determined by smooth muscle actin expression after treatment with platelet-derived growth factor. Differentiation into ECs was significantly inhibited by hyperoxia (P < 0.0001). The percentage of CXCR4(+) cells (a marker for retinal vascular precursors) increased in both treatment groups after hyperoxia. These data show novel mechanisms of hyperoxia-induced disruption of vascular development.

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

AIMS

To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants.

METHODS

A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was < or = 1000 g and the VLBW group comprised those infants whose BW were > 1000 g and < or = 1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis.

RESULTS

Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing < 1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P=0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P=0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P=0.016).

CONCLUSION

This study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

Étude épidémiologique de la rétinopathie du prématuré : les facteurs de risque au CHU de Tours

BACKGROUND

A prospective analysis of the incidence of retinopathy of prematurity (ROP) by documenting clinical perinatal characteristics of affected infants, in an attempt to describe risk factors for ROP.

MATERIALS AND METHODS

Between March 2002 and April 2004, 161 infants, with a gestational age under 31 weeks and/or a birth weight under 1500 g, were screened according to CRYO-ROP guidelines, using direct ophthalmoscopy with a Layden contact lens. Risk factors for ROP were analyzed with the Student and Fischer tests.

RESULTS

ROP developed in 15% of the cases studied, with one out of five at prethreshold or threshold levels of ROP. Gestational age at birth (p<0.0001), low birth weight (p<0.0001), the length of the infant's stay in the neonatal intensive care unit (p<0.0001), the duration of mechanical ventilation (p<0.0001), the duration of oxygen provided (p<0.0001), blood transfusions (p<0.0001), hyaline membrane disease (p=0.0257), and bronchodysplasia (p=0.0012) were significant risk factors for ROP.

CONCLUSION

Despite progress in neonatal intensive care, ROP persists and can be explained by greater and greater prematurity and earlier screening. Effective screening, done between 4 and 6 weeks of life, taking risk factors into account, can improve prognosis.

Screening for retinopathy of prematurity: results of a 7-year study of underweight newborns

BACKGROUND

Retinopathy of prematurity (ROP) is a serious complication of treatment and extension of survival in premature infants and leads to blindness unless recognized and treated early. An ROP prospective screening survey was performed, enrolling all premature newborns weighing <2000 g at delivery.

METHODS

A total of 2014 infants had a retinal evaluation by indirect ophthalmoscopy at 4-6 weeks of age. If any ROP stage was detected, the patient was followed periodically to assess treatment. All premature infants with threshold retinopathy were treated by transscleral cryotherapy at the time of detection.

RESULTS

We found 449 infants (22.2%) with ROP in any stage, and 230 (11.42%) with threshold retinopathy who underwent cryotherapy. In the 500-1000 g group (n = 334), 48.2% had ROP in any stage and 92 (27.5%) had threshold retinopathy. In the 1001-1500 g group (n = 1374), 257 (18.7%) had any ROP stage and 122 (8.8%) had stage 3. In the 1501-2000 g group, 306 neonates were evaluated, 31 (10%) had any ROP stage and 16 (5.2%) underwent cryotherapy. A total of 198/230 infants (86%) with threshold retinopathy who received cryotherapy had complete recovery, but 5% developed unilateral and 9% bilateral retinal detachment. There were no complications related to anesthesia.

CONCLUSIONS

Overall ROP rate was 2.68/1000 deliveries and 22.2% of premature infants <2000 g had any ROP stage, 11.42% with retinal detachment risk received cryotherapy with 86% successful results.

Do current retinopathy of prematurity screening guidelines miss the early development of pre-threshold type 1 ROP in small for gestational age neonates?

PURPOSE

To investigate whether current UK retinopathy of prematurity (ROP) screening guidelines miss the early development of pre-threshold type 1 ROP in some neonates born small for gestational age (SGA) and consider if the guidelines should be changed.

METHODS

Data were collected on neonates of < or =31 completed weeks gestation and/or birth weight (BW) < or =1500 g born over a 37-month period. Babies who did not complete the screening programme in Cambridge and those with other ocular abnormalities were excluded. We compared the time course of ROP progression and the development of the early treatment for ROP pre-threshold ROP in relation to the gestational age and the BW of the babies.

RESULTS

A total of 105 neonates were included, 11 (10.5%) were born SGA (less than 9th centile of predicted BW). Of these 11, 2 (18.2%) had pre-threshold ROP at their first screen (median post-natal age (PNA) 6.5 weeks, median postmenstrual age (PMA) 33.5 weeks). No other neonate in this group developed pre-threshold ROP.Of the 94 other neonates, none had pre-threshold ROP at first screen (median PNA 7.1 weeks). Pre-threshold ROP developed in 12 (12.8%) of these babies between 8 and 12 (median 11.5) post-natal weeks, at a PMA of 33-38 (median 35.5) weeks.

CONCLUSION

Current UK ROP screening guidelines recommend first screening at 6-7 post-natal weeks. Our study suggests that pre-threshold type 1 ROP can develop before this especially in SGA babies. We suggest that screening should either start at 4 post-natal weeks in such babies, or be based on PMA rather than PNA, to allow timely laser therapy.

Retinopathy of prematurity: an optimum screening strategy

OBJECTIVE

We sought to find out whether birth weight of less than 1251 g or gestational age less than 30 weeks could provide a safe and efficient screening criteria of detecting treatable retinopathy of prematurity (ROP).

METHODS

Infants either with a birth weight less than 1500 g or gestational age less than 32 weeks were screened for ROP during an 8-year period.

RESULTS

In our study, the incidence of ROP was 36 of 187 (19.3%) infants. Although there was a slight increase in the number of infants screened over the years, the incidence of ROP of any stage remained stable. The maximum stage of ROP reached was stage 1 in 10 of 187 (5.3%), stage 2 in 8 of 187 (4.3%), and stage 3 in 18 of 187 (9.6%) infants. Among those with stage 3 disease, threshold ROP was present in 16 of 18 (88.9%). All infants with threshold ROP had a BW less than 1100 g and gestational age less than or equal to 28 weeks. Significantly fewer babies (105/187, or 56%) would have been examined had inclusion criteria of a birth weight of less than 1251 g and gestational age less than 30 weeks been applied. In addition, 31% (134/437) of screening examinations could have been avoided.

CONCLUSIONS

Our study suggests that a birth weight of less than 1251 g and gestational age less than 30 weeks can be safely and efficiently used to screen infants without missing a diagnosis of sight-threatening ROP in our catchment population.

Rétinopathie du prématuré : résultats de l’examen du fond d’œil chez 94 enfants à risque

PURPOSE

The purpose of this study was to evaluate the incidence and severity of retinopathy of prematurity (ROP) in infants of birth weight less than 1.500 g and/or under 32 weeks'gestation.

METHODS

Ninety-four preterm infants were examined following the Royal College of Ophthalmologists guidelines and retinopathy was graded using the International Classification of ROP. Screening limits were 1 500 g birth weight or 32 weeks'gestational age. Fundus examinations for ROP were performed at 5 weeks'chronological age from birth. Pupil dilation was obtained with instillation of 1% tropicamide three times at 15-minute intervals.

RESULTS

The 94 infants examined for ROP had a median gestational age of 292.3 weeks and a median birth weight of 1 110340 g. ROP was diagnosed in 21 of 94 subjects (22.3%) by fundus examination. ROP stage 3 developed in one preterm infant, ROP stage 2 developed in five preterm infants, and ROP stage 1 developed in 15 preterm infants. No premature babies developed stage 4 or stage 5 ROP. The disease regressed spontaneously in all cases and none of the infants required cryo/laser therapy. In the most premature infants, 23-26 weeks'gestation, 57% developed ROP and one developed severe ROP (stage 3). No disease more posterior to peripheral zone 2 was observed. The incidence of ROP was higher in infants exposed to greater than 21% oxygen (24.2%) than in infants who did not receive oxygen (17.8%). Oxygen, blood transfusion, and cardiopathy appear to be associated with an increased incidence of retinopathy of prematurity.

CONCLUSIONS

ROP continues to be a common problem associated with prematurity in France. This study found a similar incidence of prethreshold ROP when compared to recent studies. The data showed that blood transfusion and cardiopathy may play a role in the development of ROP in premature infants.

Screening for retinopathy of prematurity: results of a retrospective 3-year study of 502 infants

PURPOSE

To describe the surveillance, results of screening, and treatment of retinopathy of prematurity (ROP) in a university hospital setting in southeast France.

PATIENTS AND METHODS

Five hundred two premature infants were included in the screening protocol between January 1997 and December 1999. Criteria for inclusion in the study were a gestational age of 32 weeks or younger, a birth weight of less than 1,501 g, or both. The first fundus examination was performed between 4 and 6 weeks of life. Thereafter, fundus examination was performed in the absence of ROP every 2 weeks until complete retinal vasculature developed, gestational age of 50 weeks, or death. Examination was weekly in cases of retinopathy, biweekly if progression was ascertained, and less frequent only if regression was evident. Hospital records were reviewed to assess the presence or absence and eventual degree of ROP.

RESULTS

Stage 1 was observed in 32 infants, and stage 2 in 11 infants; all of these cases regressed. Three cases of bilateral stage 3 (two threshold and one prethreshold) disease underwent diode laser peripheral retinal ablation and regressed. One infant with bilateral stage 3 disease who underwent peripheral cryoablative surgery progressed to stage 4A in one eye and 4B in the other eye and then underwent scleral buckling surgery in the second eye.

CONCLUSIONS

Despite survival increasing with improved neonatal intensive care, the incidence of ROP does not appear to be increasing. In our center, the incidence appears to be lower than previously reported.

Is retinopathy of prematurity increasing among infants less than 1250 g birth weight?

OBJECTIVE

Retinopathy of prematurity (ROP) is a complication seen in many very low birth weight infants. Severe ROP has been called a "marker" for severe disability. The purpose of this study was to evaluate the occurrence and severity of ROP among infants < or =1250 g birth weight treated in the Special Care Nursery at Women & Infants' Hospital over a period of 7 years from 1994 to 2000.

STUDY DESIGN

This was a retrospective review of ROP data combined with neonatal follow-up data. Of the 1002 infants born with birth weights <1250 g, ophthalmologic data were available for 739 of 839 survivors. Analysis of variance and chi2 along with logistic regression were used to analyze outcomes.

RESULTS

An increase in the overall occurrence of ROP was identified (40% to 54% linear trend, p=0.007). The occurrence of threshold ROP ranged from 2% to 5% (NS). Infants at greatest risk of ROP were those micropremies with birth weights <750 g (p<0.001).

CONCLUSION

Severe ROP continues to be a significant morbidity among infants <750 g.

Retinopathy of prematurity

PURPOSE OF REVIEW

This review highlights recent advances in basic science and clinical research on retinopathy of prematurity (ROP).

RECENT FINDINGS

The modern concept of ROP pathophysiology is discussed, as are studies investigating anti-angiogenic agents for treatment. Results of the largest clinical trials are summarized. Current screening criteria, potential modifications to them, and telephotoscreening are discussed.

SUMMARY

ROP is a challenging and involving area of pediatric ophthalmology.

[Retinopathy of prematurity screening and follow-up with Retcam120: expertise of a team of neonatologists concerning 145 patients]

OBJECTIVES

The high incidence of retinopathy in very premature infants requires strict evaluation and follow-up in neonatal intensive care. The strict organization required in each center, under the responsibility of ophthalmologists, is sometimes puzzling. Therefore, we tested the hypothesis that the introduction of the Retcam allows the neonatologist under the control of ophthalmologist to diagnose retinopathy of prematurity then preventing sequelae, by comparison of pictures interpretations between neonatologists and ophthalmologists.

METHODS

The Retcam gives a 120 degrees picture of the retina which is captured digitally. Then, the interpretation of the neonatologist can be reviewed by the ophthalmologist. We screened premature babies less than 32 weeks of gestation and less than 1500 g, during 1 year, including learning experience. We compared pictures interpretation by neonatologists and ophthalmologists of Retcam recordings.

RESULTS

One hundred and forty-five patients were included. Eight cases of retinopathy were diagnosed with an exact correlation : 3 grade III in zone 2 form plus disease, 1 stage III zone 2 unilateral, 1 stage II in zone 3, 2 stage II en zone 2, 1 grade I zone 3 on at least 5 h contiguous. We had neither false positive, nor false negative. Five infants were treated without significant sequelae.

CONCLUSIONS

Retcam 120 allows an easy diagnosis and follow-up for the retinopathy of prematurity by the neonatologist. We advocate to spread Retcam to the wards where the screening of retinopathy is difficult for the ophthalmology department. As every case requiring therapy is diagnosed, prevention of severe visual handicap is completed. The cost of this apparatus is equivalent to the cost of the care for a congenital blindness.

[Retinopathy of prematurity: casuistics between 1996 and 2001]

BACKGROUND

Retinopathy of prematurity (ROP) is a cause of neurosensorial morbidity.

OBJECTIVES

To study the incidence, associated risks factors, treatment, and outcome of ROP in premature infants born at less than 32 weeks in our hospital.

METHODS

We performed a descriptive study of patients born between the January 1, 1995, and December 31, 2001, in Sant Joan de Déu Hospital in Barcelona (Spain) at <= 32 weeks of gestation who survived until their first month of life. An ocular evaluation was performed between weeks 4 and 6 of life and was repeated every 1-2 weeks until retinal vascularization was complete. Ocular sequelae and visual function were evaluated. Bivariate comparison of groups with and without ROP was performed.

RESULTS

Of the 324 patients evaluated, 74 presented ROP (22.8 %), of which 63 patients (21.7 %) were classified as stage 1 or 2 and 11 (3.7 %) as stage 3. An inverse correlation between the incidence of retinopathy and weight and gestational age was found. Threshold disease (3 plus) was detected in 9 patients (16 eyes; 3.1 % of the study sample and 12.1 % of the neonates with retinopathy). All of these neonates were treated with laser therapy. Ocular sequelae were mild in 2.7 % of the patients, moderate in 0.6 % and severe in 0.6 %. The visual function (n 236) of infants with ROP (n 74) was altered in 4 patients (1.7 %). Of these, alterations were severe in 2 patients (0.8 %). Bivariate analysis revealed significant differences (p < 0.001) in low birth weight, gestational age, days of oxygen therapy, days of mechanical ventilation, days of antibiotic therapy, and number of blood transfusions.

CONCLUSIONS

In this study the incidence of ROP was similar to that in other centers. Development of ROP was strongly associated with its various risk factors. Severe stages were not seen above 30 weeks of gestational age. The results of laser therapy were optimal, with fewer alterations in ocular examination and visual function than those estimated in patients without treatment.

Screening for retinopathy of prematurity: evaluation and modification of guidelines

AIMS

To evaluate current screening guidelines for ROP (retinopathy of prematurity) and to determine whether they can be modified.

METHODS

In accordance with the authors' present criterion, infants born in Stockholm County, Sweden, from 1 August 1998 to 31 July 2000, with a gestational age of < or =32 weeks, were screened for ROP. The effectiveness of screening was studied.

RESULTS

The incidence of ROP was 25.5% in this study. A dropout group comprising almost 20% of the population studied (< or =32 weeks), was never referred, were lost to follow up, or died before screening was completed. No infant with a gestational age of >31 weeks at birth developed severe ROP (stages 3-5) and no infant with a gestational age of >29 weeks was treated for ROP.

CONCLUSION

80% of infants in this population with a gestational age at birth of < or =32 weeks, the current screening criterion, were effectively screened for ROP. The authors recommend that the screening criterion be lowered to Collapse

Key Words

• retinopathy of prematurity
• screening
• guidelines

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MESH Headings

• Birth Weight
• Female
• Gestational Age
• Humans
• Incidence
• Infant, Newborn
• Infant, Premature
• Logistic Models
• Male
• Practice Guidelines as Topic
• Predictive Value of Tests
• Prospective Studies
• Regression Analysis
• Retinopathy of Prematurity/diagnosis
• Retinopathy of Prematurity/epidemiology
• Sweden/epidemiology
• Vision Screening/methods

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Affiliation(s)

E Larsson Department of Ophthalmology, University Hospital, Uppsala, Sweden
G Holmström

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Retinopathy of prematurity: clinical aspects

There have been many major advances recently that have improved the identification and management of retinopathy of prematurity (ROP). This chapter describes the clinical features of ROP and then considers briefly the incidence and epidemiology of acute phase disease. This is followed by a discussion of the two ROP epidemics and ROP-induced disability in high, low and middle income countries, and how this has been impacted by treatment. The principles and specifics of screening for ROP are considered, focusing on certain topical issues such as whether one screening guideline suits all populations. Treatment has undergone several advances, so that now laser therapy has overtaken cryotherapy as the preferred mode of treatment, and treatment at an earlier stage is now being considered. Finally, the authors attempt to look into the future and wonder how the criteria for treatment will change, and whether innovations in ocular imaging will impact ROP screening in both high and middle income countries.