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Zhang H, Jiang Y, Zhang X, Su L, Yu Y, Li L, Liu D. Risk factors for retinopathy of prematurity among preterm infants with bronchopulmonary dysplasia. J Matern Fetal Neonatal Med 2025; 38:2497058. [PMID: 40360447 DOI: 10.1080/14767058.2025.2497058] [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: 12/10/2024] [Revised: 03/24/2025] [Accepted: 04/18/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND This study was designed to investigate the risk factors for retinopathy of prematurity (ROP) among the preterm infants with bronchopulmonary dysplasia (BPD). METHODS This retrospective study included 225 preterm infants with BPD who were admitted to our hospital between January 2016 and March 2022. These preterm infants were divided into ROP group and non-ROP group based on the presence of ROP. Logistic regression analysis was given to analyze the risk factors for ROP in the preterm infants with BPD. Spearman correlation analysis was performed to investigate the correlation between ROP severity and BPD. RESULTS Logistic regression analysis indicated that noninvasive ventilation and oxygen therapy increased the risk of ROP among preterm infants with BPD. Low gestational age and low birth weight increased the risk of ROP among preterm infants with BPD. There was a positive correlation between severity of ROP and BPD. CONCLUSIONS Low gestational age, low birth weight, noninvasive ventilation, oxygen therapy via mask and nasal catheter were risk factors for ROP among preterm infants with BPD.
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Affiliation(s)
- Haiyan Zhang
- Department of Pediatrics Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunhong Jiang
- School of Medicine, Qingdao University, Qingdao, China
| | - Xinkai Zhang
- Department of Pediatrics Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Medicine, Qingdao University, Qingdao, China
| | - Linna Su
- Department of Pediatrics Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Yu
- Department of Pediatrics Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lili Li
- Department of Neonatology, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Dongyun Liu
- Department of Pediatrics Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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Mhina C, Mtogo Y, Mafwiri M, Sanyiwa A, Mosenene NS, Malik ANJ. Prevalence and associated factors for retinopathy of prematurity at a tertiary hospital in Dar es Salaam, Tanzania. Eye (Lond) 2025; 39:1476-1480. [PMID: 39948401 DOI: 10.1038/s41433-025-03651-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 12/20/2024] [Accepted: 01/24/2025] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is one of the leading causes of preventable childhood blindness worldwide. There has been a rapid increase in neonatal units in Tanzania leading to increased survival of preterm babies, which lead to increasing number of babies at risk of ROP. ROP screening started in Tanzania for the first time in Muhimbili National Hospital in Dar es Salaam in late 2019. This study determines the prevalence and factors associated with ROP in Muhimbili hospital from June 2020 to February 2021. METHODS A prospective cohort study was conducted among 193 preterm newborns with ≤34 weeks gestational age and ≤2000 g birth weight. ROP screening was performed using an indirect ophthalmoscope and 20D Volk lens on dilated fundus. Prevalence was determined as the proportion of babies with ROP. Cox regression model was used to assess the contribution of risk factors to the occurrence of ROP. RESULTS The prevalence of ROP was 29% (56/193), and of type 1 ROP was 8.8%. Majority had zone two (73.2%) and 41.1% had stage two disease. Aggressive ROP constituted 8.9%. Significant factors for ROP development were gestational age <32 weeks (hazard ratio 6.8, p value 0.00), birth weight <1500 g (hazard ratio 2.1, p value 0.02), Apgar score <7 (hazard ratio 1.9, p value 0.03), RDS (hazard ratio 3.3, p value 0.01) and oxygen supplementation for >1 week (hazard ratio 0.74, p value 0.03). Surfactant use had a protective effect (hazard ratio 0.2, p value 0.03). CONCLUSION Prevalence of ROP is fairly high in our setting. Screening is essential to prevent visual morbidity and blindness resulting from ROP in the country.
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Affiliation(s)
- Celina Mhina
- Department of Ophthalmology, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Yusta Mtogo
- Department of Ophthalmology, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Ophthalmology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Milka Mafwiri
- Department of Ophthalmology, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Sanyiwa
- Department of Ophthalmology, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ntsilane Suzan Mosenene
- Department of Ophthalmology, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aeesha N J Malik
- International Centre of Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Shehadeh W, Milhem F, Hajjeh O, AbuZahra M, Zahra AA, Etkaidek Z, Atawna A, Hassoun J, Shweiki S, Nazzal Z. Incidence and risk factors of retinopathy of prematurity in Palestine: a retrospective cohort study, 2024. BMC Ophthalmol 2025; 25:324. [PMID: 40448038 DOI: 10.1186/s12886-025-04152-2] [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: 03/04/2025] [Accepted: 05/21/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a major, yet preventable, cause of childhood blindness. This study aimed to determine the incidence in Palestine and the risk factors for ROP development. METHODS We conducted a retrospective cohort study involving 520 preterm infants born between January 2020 and December 2023 in 7 major Palestinian Neonatal Intensive Care Units (NICUs) who were screened for ROP. We examined a range of clinical variables from medical records to explore their relationship with the development of the disease. RESULTS The incidence of ROP and severe type 1 ROP was 42.9% and 8.8%, respectively. Many risk factors were significant in univariate analysis, such as respiratory distress syndrome (RDS), the duration of mechanical ventilation, the number of blood transfusions needed, and the need for supplemental oxygen at 28 days. However, only lower gestational age (OR, 10.4; 95% CI, 3.66-29.9; p < 0.001), lower birth weight (OR, 2.5; 95% CI, 1.3-4.7; p = 0.006), lower postmenstrual age at the time of diagnosis, and multiple gestations were significant in multivariate analysis. CONCLUSION ROP is a significant problem in Palestine, with a relatively higher incidence than in neighboring countries. Considering the statistically significant variables in the clinical practice will prevent missing severe cases that may progress to blindness.
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Affiliation(s)
- Waseem Shehadeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Fathi Milhem
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Orabi Hajjeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad AbuZahra
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anas Abu Zahra
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | - Amir Atawna
- Department of Neonatology, Makassed Hospital, Al-Quds University, East Jerusalem, Palestine
| | - Jawad Hassoun
- Department of Pediatrics, Rafidia Hospital- Palestinian Ministry of Health, Nablus, Palestine
| | - Sameeha Shweiki
- Retina Department, Hugo Chavez Hospital- Palestinian Ministry of Health, Turmus Ayya,, Palestine.
| | - Zaher Nazzal
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Ortiz A, Patiño S, Torres J, Mármol J, Serafin C, Dodhia R, Saidman G, Schbib V, Peña B, Monteoliva G, Martinez-Castellanos MA, Weeks WB, Lavista Ferres JM. AI-Enabled Screening for Retinopathy of Prematurity in Low-Resource Settings. JAMA Netw Open 2025; 8:e257831. [PMID: 40299381 PMCID: PMC12042057 DOI: 10.1001/jamanetworkopen.2025.7831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 02/27/2025] [Indexed: 04/30/2025] Open
Abstract
Importance Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness worldwide. If detected and treated early, ROP-associated blindness is preventable; however, identifying patients who might respond to treatment requires screening over time, which is challenging in low-resource settings where access to pediatric ophthalmologists and pediatric ocular imaging cameras is limited. Objective To develop and assess the performance of a machine learning algorithm that uses smartphone-collected videos to perform retinal screening for ROP in low-resource settings. Design, Setting, and Participants This diagnostic study used smartphone-obtained videos of fundi in premature neonates with and without ROP in Mexico and Argentina between May 12, 2020, and October 31, 2023. Machine-learning (ML)-driven algorithms were developed to process a video, identify the best frames within the video, and use those frames to determine whether ROP was likely or not. Eligible neonates born with gestational age less than 36 weeks or birth weight less than 1500 g were included on the study. Exposures An ML algorithm applied to a smartphone-obtained video. Main Outcomes and Measures The ML algorithms' ability to identify high-quality retinal images and classify those images as indicating ROP or not at the frame and patient levels, measured by accuracy, specificity, and sensitivity, compared with classifications from 3 pediatric ophthalmologists. Results A total of 524 videos were collected for 512 neonates with median gestational age of 32 weeks (range, 25-36 weeks) and median birth weight of 1610 g (range, 580-2800 g). The frame selection model identified high-quality retinal images from 397 of 456 videos (87.1%; 95% CI, 84.0%-90.1%) reserved for testing model performance. Across all test videos, 97.4% (95% CI, 96.7%-98.1%) of high-quality retinal images selected by the model contained fundus images. At the frame level, the ROP classifier model had a sensitivity of 76.7% (95% CI, 69.9%-83.5%); at the patient level, the classifier model had a sensitivity of 93.3% (95% CI, 86.4%-100%). At both levels, the model's sensitivity was higher than that for the panel of pediatric ophthalmologists (frame level: 71.4% [95% CI, 64.1%-78.7%]; patient level: 73.3% [95% CI, 61.0%-85.6%]). Specificity and accuracy were higher for ophthalmologist classification vs the ML model. Conclusions and Relevance In this diagnostic study, a process that used smartphone-collected videos of premature neonates' fundi to determine whether high-quality retinal images were present had high sensitivity to classify such images as indicating or not indicating ROP but lower specificity and accuracy than ophthalmologist assessment. This process costs a fraction of the current process for retinal image collection and classification and could be used to expand access to ROP screening in low-resource settings, with potential to help prevent the most common cause of preventable childhood blindness.
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Affiliation(s)
| | | | - Jehú Torres
- Microsoft AI for Good Lab, Redmond, Washington
| | - Juan Mármol
- Business Data Evolution, Mexico City, Mexico
| | | | | | - Gabriela Saidman
- Ophthalmology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vanina Schbib
- Ophthalmology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Brenda Peña
- Ophthalmology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Monteoliva
- Ophthalmology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Habibi MRM, JafariMoghadam A, Norouzkhani N, Nazari E, Imani B, Kheirdoust A, Fatemi Aghda SA. The use of neural networks to determine factors affecting the severity and extent of retinopathy in preterm infants. Int J Retina Vitreous 2025; 11:30. [PMID: 40087782 PMCID: PMC11909869 DOI: 10.1186/s40942-025-00650-z] [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: 12/27/2024] [Accepted: 02/24/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. Early identification of key risk factors is essential for effective screening and timely intervention. This study utilizes an artificial neural network (ANN) to analyze and identify the most influential factors affecting the severity and extent of ROP in preterm neonates. METHODS This descriptive-analytical study was conducted on 367 preterm infants in Bojnord, Iran, in 2021. The study examined multiple variables, including sex, history of multiple births, number of prior abortions, type of pregnancy and delivery, gestational age, oxygen therapy, severity of retinopathy, and disease extent within the retina. Statistical analyses were performed using one-way analysis of variance (ANOVA), Pearson's correlation coefficient, and an ANN to determine the relationships between independent variables and ROP progression. RESULTS The findings indicate that the severity of ROP was significantly associated with the type of pregnancy, gestational age, birth weight, and postnatal age (P < 0.05). Similarly, disease extent was significantly correlated with maternal parity, gestational age, birth weight, and postnatal age (P < 0.05). Among all factors examined, postnatal and gestational age exhibited the highest coefficient effects on ROP severity and disease extent. Additionally, follow-up evaluations revealed that infant age and birth weight were crucial in disease progression. DISCUSSION The results suggest that targeted interventions focusing on gestational age and neonatal weight may significantly reduce the incidence and severity of ROP in preterm infants. Integrating ANNs enhances predictive accuracy, enabling early diagnosis and improved clinical outcomes. CONCLUSION The findings of this study contribute to the advancement of ROP screening and treatment strategies in preterm neonates. Future research should focus on multi-center studies with larger sample sizes to refine predictive models and identify additional risk factors influencing ROP progression.
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Affiliation(s)
| | - Azadeh JafariMoghadam
- Department of Health Information Technology, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Nazari
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Imani
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azam Kheirdoust
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Fatemi Aghda
- Fakher Mechatronic Research Center, Kerman University of Medical Sciences, Kerman, Iran.
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, of Medical Sciences, Yazd, Iran.
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6
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Nakazawa Y, Yasukawa T, Goto H, Kobayashi S, Yokoi K. The Role of Acute Phase Reactants, Including α1-Acid Glycoprotein, in Predicting Onset and Severity of Retinopathy of Prematurity. Diagnostics (Basel) 2025; 15:571. [PMID: 40075818 PMCID: PMC11898616 DOI: 10.3390/diagnostics15050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/24/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Background: Retinopathy of prematurity (ROP) is a serious disease causing blindness in childhood. Gestational age (GA) and birth weight are major factors associated with the development and progression of ROP, but postnatal systemic inflammation is also an important well-known risk factor. Methods: This study retrospectively analyzed the relationship between systemic inflammation and ROP severity using the corrected GA (CGA), which reflects the intrinsic immaturity of the infant, rather than days of life. Three acute phase reactants (APRs) were analyzed using discriminant probability and compared with conventional ROP prediction models: C-reactive protein, α1AG, and haptoglobin. Results: Alpha 1AG was the best predictor of ROP onset and progression, and could be predicted with blood samples up to 30 weeks (30 W) CGA (p = 0.006). Incorporation of APR into the conventional GA + body weight (BW), ROP score, and Children's Hospital of Philadelphia (CHOP) predictive models improved the decision to treat (4-5% increase in discrimination probability) and helped determine whether treatment of ROP was necessary by CGA 30 W. Conclusions: Therefore, simply adding α1AG protein to the assessment is useful for predicting the need to treat ROP.
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Affiliation(s)
- Yoko Nakazawa
- Department of Ophthalmology, Nagoya City University West Medical Center, Nagoya 462-8505, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Haruo Goto
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya 462-8505, Japan
| | - Satoru Kobayashi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya 462-8505, Japan
| | - Kyoko Yokoi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya 462-8505, Japan
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Moorjani R, Sanders E, Lavery K, Mehrem AA, Anand R, Dotchin SA. G-ROP versus WINROP for retinopathy of prematurity screening: a Calgary perspective. CANADIAN JOURNAL OF OPHTHALMOLOGY 2025:S0008-4182(25)00041-9. [PMID: 39978412 DOI: 10.1016/j.jcjo.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 12/19/2024] [Accepted: 02/03/2025] [Indexed: 02/22/2025]
Abstract
OBJECTIVE Retinopathy of prematurity (ROP) remains one of the leading causes of childhood blindness. The current screening criteria in Canada have extremely high sensitivity but low specificity, leading to unnecessary examinations of neonates. Moreover, a screening algorithm that reduces the burden of screening is urgently needed owing to the increase in neonatal survival after extreme premature delivery, combined with the limited number of physicians qualified to screen for ROP. This retrospective study aimed to validate and compare the accuracy of the postnatal growth and ROP (G-ROP) and Weight, Insulin-like growth factor-1, Neonatal Retinopathy of Prematurity (WINROP) models for identifying neonates at risk for developing treatment-requiring ROP in a Canadian cohort. DESIGN Single-center retrospective cohort study conducted in Calgary, Alberta, Canada. Data from preterm infants born between 23- and 31-week gestational age or birth weight less than or equal to 1 250 grams were analyzed. A total of 1 001 infants were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value for WINROP, and G-ROP algorithms were assessed in identifying neonates at risk of treatment-requiring ROP. RESULTS The WINROP algorithm yielded 95.7% sensitivity in identifying infants requiring ROP treatment compared to 100% sensitivity with the G-ROP model. Specificity for treatment-requiring ROP for WINROP was 41.7% and G-ROP was 30.4%. CONCLUSIONS The G-ROP model was found to be more appropriate in our cohort, lending itself seamlessly to clinical care, while providing 100% sensitivity and greater specificity compared to current screening guidelines in our cohort.
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Affiliation(s)
- Rahul Moorjani
- Department Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Emi Sanders
- Section of Ophthalmology, Department of Surgery, University of Calgary, and Alberta Health Services Calgary, AB, Canada
| | - Kyla Lavery
- Section of Ophthalmology, Department of Surgery, University of Calgary, and Alberta Health Services Calgary, AB, Canada
| | - Ayman Abou Mehrem
- Section of Newborn Critical Care, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Ravina Anand
- Section of Ophthalmology, Department of Surgery, University of Calgary, and Alberta Health Services Calgary, AB, Canada
| | - Stephanie A Dotchin
- Section of Ophthalmology, Department of Surgery, University of Calgary, and Alberta Health Services Calgary, AB, Canada.
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Nian S, Zeng Y, Heyden KE, Cagnone G, Yagi H, Boeck M, Lee D, Hirst V, Hua Z, Lee J, Wang C, Neilsen K, Joyal JS, Field MS, Fu Z. Folic Acid Supplementation Inhibits Proliferative Retinopathy of Prematurity. Biomolecules 2025; 15:309. [PMID: 40001612 PMCID: PMC11852370 DOI: 10.3390/biom15020309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/11/2025] [Accepted: 02/17/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is the major cause of blindness in children. It is a biphasic disease with retinal vessel growth cessation and loss (Phase I) followed by uncontrolled retinal vessel growth (Phase II). Folate is an essential nutrient for fetal development and growth. Premature infants have a high risk for folate deficiency. However, the contribution of folate to ROP risk remains unknown. METHODS In mouse oxygen-induced retinopathy (OIR), the nursing dams were fed with a folic acid-deficient or control diet after delivery until the end of hyperoxia. Alternatively, pups received direct injection of either folic acid or vehicle during Phase I hyperoxia. Genes involved in the folate cycle and angiogenic responses were examined using real-time PCR. Total retinal folate levels were measured with the Lactobacillus casei assay. RESULTS Maternal folic acid deficiency in early life exacerbated pathological retinal vessel growth, while supplementation with folic acid suppressed it. Genes involved in the folate cycle were downregulated in Phase I OIR retinas and were highly expressed in Müller glia. Folic acid reduced pro-angiogenic signaling in cultured rat retinal Müller glia in vitro. CONCLUSIONS Appropriate supplementation of folic acid might be a new and safe treatment for ROP at an early stage.
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Affiliation(s)
- Shen Nian
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
- Department of Pathology, Xi’an Medical University, Xi’an 710021, China
| | - Yan Zeng
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Katarina E. Heyden
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (K.E.H.); (M.S.F.)
| | - Gaël Cagnone
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC H3T 1C5, Canada (J.-S.J.)
| | - Hitomi Yagi
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Myriam Boeck
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Deokho Lee
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Victoria Hirst
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Zhanqing Hua
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Jeff Lee
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Chaomei Wang
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Katherine Neilsen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
| | - Jean-Sébastien Joyal
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC H3T 1C5, Canada (J.-S.J.)
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Martha S. Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (K.E.H.); (M.S.F.)
| | - Zhongjie Fu
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (S.N.); (Y.Z.); (H.Y.); (D.L.); (V.H.); (Z.H.); (C.W.); (K.N.)
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9
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Zupan M, Binenbaum G, Tekavčič Pompe M. Validation of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Slovenian cohort. J AAPOS 2025; 29:104113. [PMID: 39863267 DOI: 10.1016/j.jaapos.2025.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 10/05/2024] [Accepted: 10/13/2024] [Indexed: 01/27/2025]
Abstract
PURPOSE To validate the Postnatal Growth and ROP (G-ROP) study criteria for retinopathy of prematurity (ROP) screening in a Slovenian cohort. METHODS We conducted a retrospective cohort study of preterm infants screened in 2021 at the University Medical Centre Ljubljana, Slovenia. The G-ROP criteria were systematically applied. Primary outcomes were sensitivity for ROP requiring treatment, sensitivity for any ROP, and reduction in the number of infants screened. RESULTS Of 102 infants screened, 27 (26.4%) developed ROP. Eleven infants (10.7%) had type 1 ROP, of whom 2 (1.9%) had aggressive ROP; 5 infants (4.9%) had type 2 ROP, and 11 (10.7%) had milder ROP. Using the original or simplified G-ROP criteria, all infants who developed type 1 ROP (sensitivity, 100% [95% CI, 74%-100%]), and all infants who developed ROP (sensitivity, 100% [95% CI, 88%-100%]) were correctly identified. Application of the original G-ROP criteria would have reduced the number of infants screened by 29.4% (30 of 102). CONCLUSIONS In our cohort, both the original and simplified G-ROP criteria showed 100% sensitivity for predicting ROP type 1 while reducing the number of unnecessary screenings. These results confirm the reliability of the G-ROP criteria in the Slovenian context and suggest that their use improves screening efficiency.
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Affiliation(s)
- Matej Zupan
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Manca Tekavčič Pompe
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
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10
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Sahu S, Behera S, Bishi G, Choudhury L, Mishra S. Clinicoepidemiological Profile of Retinopathy of Prematurity. Cureus 2024; 16:e69831. [PMID: 39435203 PMCID: PMC11491872 DOI: 10.7759/cureus.69831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2024] [Indexed: 10/23/2024] Open
Abstract
Purpose In previously performed studies, retinopathy of prematurity (ROP) has been shown to occur postpartum. As a result, mechanical ventilation and oxygen dependence were eventually connected to the development of ROP in these preterm children, and ROP prevalence is on the rise globally. Despite various improvements in childcare, ROP still tends to arise due to various risk factors associated with the disease. So, clinically the research was performed to determine the clinical and epidemiological profile of ROP. Materials and methods A total of 268 participants were to be enrolled in the study. It was an observational, cross-sectional study carried out at Department of Ophthalmology and Neonatal Intensive Care Unit in Veer Surendra Sai Institute of Medical Sciences and Research Centre, Burla, Sambalpur, Odisha, India. Ethical approval was provided on 30 November 2019. Results Overall 123 (46%) infants out of 268 infants developed retinopathy of prematurity. Majorly, the infants had stage 1 and stage 2 ROP. Most of the infants were male. Birth weight in ROP patients was 1000 g or less in 54% of infants, 1000-1500 g in 46% of infants and >1500 g in 33% of infants. Gestational age was found to be a predictor of retinopathy of prematurity. The adverse events that were found to be associated with retinopathy of prematurity were sepsis (53%), respiratory distress syndrome (RDS) (54.6%), intraventricular haemorrhage (IVH) (60%), anaemia (61.5%). Conclusion It has been observed that babies with higher birth weights and older gestations are also susceptible to developing ROP. Therefore, the greater birth weight newborns up to 1750 g and older gestational age babies >34 weeks should also be included in the screening criteria, especially if they have risk factors such as oxygen supplementation, sepsis, RDS, and anaemia.
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Affiliation(s)
- Sasmita Sahu
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, IND
| | - Sharmistha Behera
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, IND
| | - Gurudev Bishi
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, IND
| | - Lihalin Choudhury
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, IND
| | - Smruti Mishra
- Department of Ophthalmology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, IND
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11
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Aulakh S, Houtman AC, Rathod D, Biswas S, McLoone E, Shafiq AE, Nassar MM, Connor AJ, Hillier RJ. The Royal College of Paediatrics and Child Health Retinopathy of Prematurity Screening Guidelines (2022): a series of treated infants falling outside the updated criteria. Eye (Lond) 2024; 38:2557-2560. [PMID: 38658679 PMCID: PMC11384725 DOI: 10.1038/s41433-024-03076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES Screening for retinopathy of prematurity (ROP) is a core healthcare intervention in premature babies to avoid preventable sight loss. A variety of screening criteria are in place globally for this purpose. The Royal College of Paediatrics and Child Health recently updated the United Kingdom ROP screening guidelines (March 2022). A key change was the reduction in the gestational age (GA) to warrant retinal screening (from 32 to 31 weeks). SUBJECTS/METHODS In the course of informal national surveillance during guideline development (2017-2022) and soon after, babies under our care falling outside the updated screening criteria who underwent treatment for ROP were identified. A retrospective case review was carried out. RESULTS Six babies were identified as having undergone screening and treatment, prior to implementation of the new guidance. Screening and treatment would have been forfeited as per the March 2022 guidelines. All six had numerous systemic risk factors for developing ROP. Specifically, all had documented poor postnatal weight gain. CONCLUSIONS We present this case series to bring forth an urgent discussion amongst key stakeholders as to whether the new guidance, as it stands, is safe and fit for purpose.
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Affiliation(s)
| | - Anne Cees Houtman
- Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Dinesh Rathod
- Swansea Bay University Health Board, Port Talbot, UK
| | - Susmito Biswas
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eibhlin McLoone
- Royal Victoria Hospital, Belfast Trust and Social Care Trust, Belfast, UK
| | - Ayad E Shafiq
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Mahmoud M Nassar
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Alan J Connor
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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12
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Cioboata DM, Costescu OC, Manea AM, Doandes FM, Zaharie M, Popa ZL, Costescu S, Stoica F, Boia M. Predicting Retinopathy of Prematurity Risk Using Plasma Levels of Insulin-like Growth Factor 1 (IGF1), Tumor Necrosis Factor-Alpha (TNF-Alpha), and Neonatal Parameters. Clin Pract 2024; 14:1515-1528. [PMID: 39194926 DOI: 10.3390/clinpract14040122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/21/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND/OBJECTIVES Retinopathy of Prematurity (ROP) remains a leading cause of vision impairment in premature infants, especially those with Respiratory Distress Syndrome (RDS) necessitating respiratory support. This study aimed to identify correlations between plasma levels of Insulin-like Growth Factor 1 (IGF1) and Tumor Necrosis Factor-alpha (TNF-alpha), and the risk of developing ROP. Additionally, it explored the association of ROP severity grades with plasma levels of glucose, lactate dehydrogenase (LDH), creatin phosphokinase (CPK), and other biomarkers, aiming to uncover predictive markers for ROP risk and severity in this population. METHODS This prospective study included premature neonates admitted with RDS requiring respiratory support, conducted over 18 months at the Neonatal Intensive Care Unit of the Louis Turcanu Emergency Clinical Hospital for Children, Timisoara. Plasma levels of IGF1 and TNF-alpha were measured on days 1 and 14 post-birth, alongside the initial assessment of glucose, LDH, and CPK levels. RESULTS Significant correlations were observed between lower gestational age and elevated LDH levels on day 7-10 (rho = -0.341, p = 0.0123) and between TNF-alpha levels at 2 weeks and ROP severity (rho = 0.512, p = 0.0004). Elevated IGF1 levels were protective against ROP, with Beta coefficients of 0.37 (p = 0.0032) for the first collection and 0.32 (p = 0.0028) for the second, suggesting their potential as biomarkers for ROP risk assessment. Higher levels of TNF-alpha at 2 weeks were associated with an increased risk of ROP (Beta = -0.45, p = 0.0014), whereas higher IGF1 levels offered protective effects against ROP, with Beta coefficients of 0.37 (p = 0.0032) for the first collection and 0.32 (p = 0.0028) for the second. Elevated LDH levels on day 7-10 post-birth were linked to an increased risk of ROP (Beta = 0.29, p = 0.0214). CONCLUSIONS These findings highlight the potential of IGF1 and TNF-alpha as predictive biomarkers for ROP, offering avenues for early intervention and improved management strategies in this high-risk group.
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Affiliation(s)
- Daniela Mariana Cioboata
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Oana Cristina Costescu
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Aniko Maria Manea
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Florina Marinela Doandes
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mihaela Zaharie
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Sergiu Costescu
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Florina Stoica
- Department of Ophthalmology, Emergency Municipal Clinical Hospital, 300172 Timisoara, Romania
| | - Marioara Boia
- Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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13
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Ebrahimi B, Le D, Abtahi M, Dadzie AK, Rossi A, Rahimi M, Son T, Ostmo S, Campbell JP, Paul Chan RV, Yao X. Assessing spectral effectiveness in color fundus photography for deep learning classification of retinopathy of prematurity. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:076001. [PMID: 38912212 PMCID: PMC11188587 DOI: 10.1117/1.jbo.29.7.076001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
Significance Retinopathy of prematurity (ROP) poses a significant global threat to childhood vision, necessitating effective screening strategies. This study addresses the impact of color channels in fundus imaging on ROP diagnosis, emphasizing the efficacy and safety of utilizing longer wavelengths, such as red or green for enhanced depth information and improved diagnostic capabilities. Aim This study aims to assess the spectral effectiveness in color fundus photography for the deep learning classification of ROP. Approach A convolutional neural network end-to-end classifier was utilized for deep learning classification of normal, stage 1, stage 2, and stage 3 ROP fundus images. The classification performances with individual-color-channel inputs, i.e., red, green, and blue, and multi-color-channel fusion architectures, including early-fusion, intermediate-fusion, and late-fusion, were quantitatively compared. Results For individual-color-channel inputs, similar performance was observed for green channel (88.00% accuracy, 76.00% sensitivity, and 92.00% specificity) and red channel (87.25% accuracy, 74.50% sensitivity, and 91.50% specificity), which is substantially outperforming the blue channel (78.25% accuracy, 56.50% sensitivity, and 85.50% specificity). For multi-color-channel fusion options, the early-fusion and intermediate-fusion architecture showed almost the same performance when compared to the green/red channel input, and they outperformed the late-fusion architecture. Conclusions This study reveals that the classification of ROP stages can be effectively achieved using either the green or red image alone. This finding enables the exclusion of blue images, acknowledged for their increased susceptibility to light toxicity.
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Affiliation(s)
- Behrouz Ebrahimi
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - David Le
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Mansour Abtahi
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Albert K. Dadzie
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Alfa Rossi
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Mojtaba Rahimi
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Taeyoon Son
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
| | - Susan Ostmo
- Oregon Health and Science University, Casey Eye Institute, Department of Ophthalmology, Portland, Oregon, United States
| | - J. Peter Campbell
- Oregon Health and Science University, Casey Eye Institute, Department of Ophthalmology, Portland, Oregon, United States
| | - R. V. Paul Chan
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
- University of Illinois Chicago, Department of Ophthalmology and Visual Sciences, Chicago, Illinois, United States
| | - Xincheng Yao
- University of Illinois, Chicago, Department of Biomedical Engineering, Chicago, Illinois, United States
- University of Illinois Chicago, Department of Ophthalmology and Visual Sciences, Chicago, Illinois, United States
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14
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Zhang Y, Ye X, Wu W, Luo Y, Chen M, Du Y, Wen Y, Song H, Liu Y, Zhang G, Wang L. Morphological Rule-Constrained Object Detection of Key Structures in Infant Fundus Image. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2024; 21:1031-1041. [PMID: 37018340 DOI: 10.1109/tcbb.2023.3234100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The detection of optic disc and macula is an essential step for ROP (Retinopathy of prematurity) zone segmentation and disease diagnosis. This paper aims to enhance deep learning-based object detection with domain-specific morphological rules. Based on the fundus morphology, we define five morphological rules, i.e., number restriction (maximum number of optic disc and macula is one), size restriction (e.g., optic disc width: 1.05 +/- 0.13 mm), distance restriction (distance between the optic disc and macula/fovea: 4.4 +/- 0.4 mm), angle/slope restriction (optic disc and macula should roughly be positioned in the same horizontal line), position restriction (In OD, the macula is on the left side of the optic disc; vice versa for OS). A case study on 2953 infant fundus images (with 2935 optic disc instances and 2892 macula instances) proves the effectiveness of the proposed method. Without the morphological rules, naïve object detection accuracies of optic disc and macula are 0.955 and 0.719, respectively. With the proposed method, false-positive ROIs (region of interest) are further ruled out, and the accuracy of the macula is raised to 0.811. The IoU (intersection over union) and RCE (relative center error) metrics are also improved .
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15
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Aschner M, Skalny AV, Paoliello MMB, Tinkova MN, Martins AC, Santamaria A, Lee E, Rocha JBT, Farsky SHP, Tinkov AA. Retinal toxicity of heavy metals and its involvement in retinal pathology. Food Chem Toxicol 2024; 188:114685. [PMID: 38663763 PMCID: PMC11818481 DOI: 10.1016/j.fct.2024.114685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
The objective of the present review is to discuss epidemiological evidence demonstrating the association between toxic metal (Cd, Pb, Hg, As, Sn, Ti, Tl) exposure and retinal pathology, along with the potential underlying molecular mechanisms. Epidemiological studies demonstrate that Cd, and to a lesser extent Pb exposure, are associated with age-related macular degeneration (AMD), while the existing evidence on the levels of these metals in patients with diabetic retinopathy is scarce. Epidemiological data on the association between other toxic metals and metalloids including mercury (Hg) and arsenic (As), are limited. Clinical reports and laboratory in vivo studies have shown structural alterations in different layers of retina following metal exposure. Examination of retina samples demonstrate that toxic metals can accumulate in the retina, and the rate of accumulation appears to increase with age. Experimental studies in vivo and in vitro studies in APRE-19 and D407 cells demonstrate that toxic metal exposure may cause retinal damage through oxidative stress, apoptosis, DNA damage, mitochondrial dysfunction, endoplasmic reticulum stress, impaired retinogenesis, and retinal inflammation. However, further epidemiological as well as laboratory studies are required for understanding the underlying molecular mechanisms and identifying of the potential therapeutic targets and estimation of the dose-response effects.
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Affiliation(s)
- Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Anatoly V Skalny
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, Yaroslavl, 150003, Russia; Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119435, Russia
| | - Monica M B Paoliello
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY 10461, USA
| | | | - Airton C Martins
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Abel Santamaria
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, 04510, Mexico; Laboratorio de Nanotecnología y Nanomedicina, Departamento de Cuidado de La Salud, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | - Eunsook Lee
- Department of Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - Joao B T Rocha
- Departamento de Bioquímica e Biologia Molecular, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria 97105-900, RS, Brazil
| | - Sandra H P Farsky
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo 05508-000, SP, Brazil
| | - Alexey A Tinkov
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, Yaroslavl, 150003, Russia; Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119435, Russia.
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16
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Chopra J, Haider KM, Boente CS. Comparing reactivation and retreatment for three doses of bevacizumab in type 1 retinopathy of prematurity. J AAPOS 2024; 28:103866. [PMID: 38458598 PMCID: PMC10999324 DOI: 10.1016/j.jaapos.2024.103866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To determine timing and rates of reactivation and retreatment of type 1 retinopathy of prematurity (ROP) after treatment with either 0.125 mg, 0.250 mg, or 0.500 mg of intravitreal bevacizumab (IVB). METHODS Retrospective data, including demographic information, past medical history, and ROP characteristics were analyzed for babies with type 1 ROP treated with IVB at Riley Hospital for Children for the perioed 2014-2021. RESULTS A total of 84 patients met inclusion criteria: 29 patients received 0.125 mg of IVB; 39, 0.250 mg; and 16, 0.500 mg. Of the 84, 67 (80%) had additional laser treatment because of late reactivation (n = 52) or persistent avascular retina (PAR) (n = 15). Subsequent laser treatment was more common with lower doses: 0.125 mg (n = 27 [93%]); 0.250 mg (n = 31 [80%]); 0.500 mg (n = 9 [57%]) (P = 0.012). There was no difference between groups with regard to reason for subsequent laser treatment (reactivation vs PAR). The 0.125 mg group required retreatment because of reactivation 3.8 weeks sooner than the other dosing groups (P = 0.047). CONCLUSIONS The outcomes comparing three doses of IVB for severe ROP showed a difference in the timing of secondary treatment, with the lower dosing group requiring laser for reactivation earlier.
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Affiliation(s)
- Jay Chopra
- Indiana University School of Medicine, Indianapolis
| | - Kathryn M Haider
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Charline S Boente
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis.
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17
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Bishnoi K, Prasad R, Upadhyay T, Mathurkar S. A Narrative Review on Managing Retinopathy of Prematurity: Insights Into Pathogenesis, Screening, and Treatment Strategies. Cureus 2024; 16:e56168. [PMID: 38618439 PMCID: PMC11015904 DOI: 10.7759/cureus.56168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Retinopathy of prematurity (ROP) is a rare proliferative ocular condition that can happen in premature babies (born preterm <36 weeks) or who weigh <1.5 kg at birth (low birth weight babies). ROP is a major cause of childhood blindness. It is a premature disease since retina vascularization is completed only by 40 weeks of life. The survivability for preterm infants has increased owing to recent improvements in neonatal care during the past decade. As a result, the prevalence of ROP has risen concurrently. The abnormal development of blood vessels in the retina is the cause of this illness. It occurs in two phases, phases 1 and 2. Most preterm infants weighing <1.5 kg need supplemental oxygen for respiratory support at birth. This leads to the initiation of phase 1 (vasoconstrictive phase). Phase 1 is characterized by loss of maternal-fetal connection and hyperoxia due to supplemental oxygen therapy. Oxygen's vasoconstrictive and obliterative action is primarily observed in developing retinal vessels. The inhibition of vascular endothelial growth factor follows from this. Phase 2 (vasoproliferative phase) shows the dilatation and tortuosity of the bigger existing vessels together with neovascularization and proliferation of new vessels into the vitreous when the baby is shifted from respiratory support to room air. Now, the retina gets hypoxic, where the retina becomes more metabolically active but is yet minimally vascularized, leading to VEGF-induced vasoproliferation, which might result in retinal detachment. Patients with ROP face the danger of loss of vision. If correct and quick treatment is not provided, they might land into permanent blindness. Yet, ROP remains one of the most preventable causes of childhood blindness worldwide. Blindness caused by ROP can only be avoided if screening programs are readily available, pertinent, and appropriate. The initial stage in the therapy of ROP is the screening of premature neonates. Timely screening and management for ROP is important to avoid this irreversible loss of vision. The treatment is based on the severity of the disease. Management may include pharmacological interventions like intravitreal and anti-vascular endothelial growth factor and non-pharmacological interventions like laser surgery, vitrectomy, and scleral buckling. We conducted a thorough literature search of studies on pathogenesis, risk factors, classification, and various treatment options for retinopathy of prematurity in infants, using a mixture of pertinent keywords. Only those studies published in peer-reviewed journals between 2010 and 2023 and written in English were included. Duplicate studies, unavailable in full-text for free, or studies unrelated to our subject matter were excluded. After thoroughly evaluating the selected studies, the results were synthesized and presented narratively. This article sheds light on the pathogenesis of ROP, particularly its relation to oxygen use, screening, and potential therapeutic management of ROP. Today advances in screening techniques have improved the outcomes for infants with ROP. Still, ongoing research is needed to optimize management strategies and reduce the burden of this condition.
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Affiliation(s)
- Kratika Bishnoi
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tanisha Upadhyay
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapneel Mathurkar
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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18
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Lu F, Chen Q, Tang Y, Yao D, Yin Y, Liu Y. Image-free recognition of moderate ROP from mild with machine learning algorithm on plasma Raman spectrum. Exp Eye Res 2024; 239:109773. [PMID: 38171476 DOI: 10.1016/j.exer.2023.109773] [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: 04/01/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Abstract
The retinopathy of prematurity (ROP) can cause serious clinical consequences and, fortunately, it is remediable while the time window for treatment is relatively narrow. Therefore, it is urgent to screen all premature infants and diagnose ROP degree timely, which has become a large workload for pediatric ophthalmologists. We developed a retinal image-free procedure using small amount of blood samples based on the plasma Raman spectrum with the machine learning model to automatically classify ROP cases before medical intervention was performed. Statistical differences in infrared Raman spectra of plasma samples were found among the control, mild (ZIIIS1), moderate (ZIIIS2 & ZIIS1), and advanced (ZIIS2) ROP groups. With the different wave points of Raman spectra as the inputs, the outputs of our support vector machine showed that the area under the curves in the receiver operating characteristic (AUC) were 0.763 for the pair comparisons of the control with the mild groups, 0.821 between moderate and advanced groups (ZIIS2), while more than 90% in comparisons of the other four pairs: control vs. moderate (0.981), control vs. advanced (0.963), mild vs. moderate (0.936), and mild vs. advanced (0.953), respectively. Our study could advance principally the ROP diagnosis in two dimensions: the moderate ROPs have been classified remarkably from the mild ones, which leaves more time for the medical treatments, and the procedure of Raman spectrum with a machine learning model based on blood samples can be conveniently promoted to those hospitals lacking of the pediatric ophthalmologists with experience in reading retinal images.
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Affiliation(s)
- Fang Lu
- Department of Ophthalmology, West China Hospital, Sichuan University, 37# Guo Xue Xiang Rd, Chengdu, China
| | - Qin Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, 37# Guo Xue Xiang Rd, Chengdu, China
| | - Yezhong Tang
- Chengdu Institute of Biology, Chinese Academy of Sciences, 4-9 South Renmin Rd, Chengdu, China
| | - Dezhong Yao
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, China
| | - Yu Yin
- Chengdu Pano AI Intelligent Technology Co., Ltd., 200 Tianfu Fifth Street, Chengdu, China.
| | - Yang Liu
- Chengdu Institute of Biology, Chinese Academy of Sciences, 4-9 South Renmin Rd, Chengdu, China.
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19
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Mishra S, Shrivastava N, Agrawal A, Shrivastava J. Serum Zinc Levels in Preterm Newborns and its Relation with Retinopathy of Prematurity. JOURNAL OF NEONATOLOGY 2023; 37:365-370. [DOI: 10.1177/09732179231173774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Background With the increased survival of preterm babies, retinopathy of prematurity (ROP) has become the leading cause of preventable childhood blindness. It is caused by oxidative damage to the immature retina and zinc may help in the prevention of ROP owing to its antioxidant properties. Objective To measure serum zinc levels in preterm neonates and study its association with the development of ROP. Methods A total of 360 preterm neonates of gestational age between 28 completed weeks to <37 weeks were included in this observational cross-sectional study. Serum zinc levels of the neonates aging <24 hours of life were measured at the time of admission in NICU by spectrophotometry. Taking the reference range of serum zinc levels between 70 to 150 mcg/dL babies were arbitrarily divided into 2 groups (<70 and >70 mcg/dL). ROP screening was done at appropriate postnatal age by indirect ophthalmoscopy. The results were analyzed by the SPSS software version. Results The mean serum zinc level was 114.99±54.47 mcg/dL. The overall prevalence of ROP was 26%; of which, 10% of neonates had severe ROP (≥stage 3). A significant association was found between gestational age and birth weight with ROP. Oxygen supplementation, respiratory distress syndrome, surfactant use, antibiotic use >7 days, and low serum zinc levels (<70 mcg/dL) were significant risk factors on univariate analysis and after multivariate analysis, gestational age, surfactant use, and low serum zinc levels (<70 mcg/dL) came out to be independent risk factors for ROP. Conclusion There was a statistically significant association of low serum zinc levels with the development of ROP and it was independent of other risk factors associated with ROP.
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Affiliation(s)
- Sukriti Mishra
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, Madhya Pradesh, India
| | - Neha Shrivastava
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, Madhya Pradesh, India
| | - Amit Agrawal
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, Madhya Pradesh, India
| | - Jyotsna Shrivastava
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, Madhya Pradesh, India
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Ndyabawe I, Namiiro F, Muhumuza AT, Nakibuka J, Otiti J, Ampaire A, Kasadhakawo M, Msonge F, Mohamed S, Nyanzi M, Tumukunde VS, Semulimi AW, Mukunya D, Bwonya D, Magala P, Gilbert C, Dietrich NMD, Cagliari PZ, Hedstrom A, Blair M, Jones B, Nyonyintono J, Doka AM, Nakitende BB, Graham HR, Carden SM, Subhi R, Nsibirwa GS. Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study. BMC Ophthalmol 2023; 23:478. [PMID: 37993817 PMCID: PMC10664491 DOI: 10.1186/s12886-023-03195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening. METHODS We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis. RESULTS 331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71-37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92-31.82)]. CONCLUSION 6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.
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Affiliation(s)
- Iddi Ndyabawe
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Flavia Namiiro
- Department of Paediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Anita Tumwebaze Muhumuza
- Department of Paediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Jesca Nakibuka
- Department of Paediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Juliet Otiti
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Ophthalmology, University of Antwerp, Antwerp, Belgium
| | - Anne Ampaire
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Kasadhakawo
- Department of Ophthalmology, Mulago National Referral Hospital, Kampala, Uganda
| | - Fransisco Msonge
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Siyad Mohamed
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mary Nyanzi
- Department of Paediatrics and Child Health, Kawempe National Referral Hospital, Kampala, Uganda
| | | | - Andrew Weil Semulimi
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Dan Bwonya
- Department of Ophthalmology, Mengo Hospital, Kampala, Uganda
| | | | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Anna Hedstrom
- Department of Neonatology, University of Washington, Seattle, United States of America
| | - Mike Blair
- Department of Ophthalmology, Pritzker School of Medicine, University of Chicago, Hyde Park, United States of America
| | - Becca Jones
- Department of Paediatrics, Kiwoko Hospital, Luwero, Uganda
| | | | - Aisha Muhamad Doka
- Department of Special Needs Education, Entebbe Parents Senior Secondary School, Entebbe, Uganda
| | | | - Hamish R Graham
- Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Mary Carden
- Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rami Subhi
- Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Subramaniam A, Orge F, Douglass M, Can B, Monteoliva G, Fried E, Schbib V, Saidman G, Peña B, Ulacia S, Acevedo P, Rollins AM, Wilson DL. Image harmonization and deep learning automated classification of plus disease in retinopathy of prematurity. J Med Imaging (Bellingham) 2023; 10:061107. [PMID: 37794884 PMCID: PMC10546198 DOI: 10.1117/1.jmi.10.6.061107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is a retinal vascular disease affecting premature infants that can culminate in blindness within days if not monitored and treated. A disease stage for scrutiny and administration of treatment within ROP is "plus disease" characterized by increased tortuosity and dilation of posterior retinal blood vessels. The monitoring of ROP occurs via routine imaging, typically using expensive instruments ($50 to $140 K) that are unavailable in low-resource settings at the point of care. Approach As part of the smartphone-ROP program to enable referrals to expert physicians, fundus images are acquired using smartphone cameras and inexpensive lenses. We developed methods for artificial intelligence determination of plus disease, consisting of a preprocessing pipeline to enhance vessels and harmonize images followed by deep learning classification. A deep learning binary classifier (plus disease versus no plus disease) was developed using GoogLeNet. Results Vessel contrast was enhanced by 90% after preprocessing as assessed by the contrast improvement index. In an image quality evaluation, preprocessed and original images were evaluated by pediatric ophthalmologists from the US and South America with years of experience diagnosing ROP and plus disease. All participating ophthalmologists agreed or strongly agreed that vessel visibility was improved with preprocessing. Using images from various smartphones, harmonized via preprocessing (e.g., vessel enhancement and size normalization) and augmented in physically reasonable ways (e.g., image rotation), we achieved an area under the ROC curve of 0.9754 for plus disease on a limited dataset. Conclusions Promising results indicate the potential for developing algorithms and software to facilitate the usage of cell phone images for staging of plus disease.
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Affiliation(s)
- Ananya Subramaniam
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Faruk Orge
- Case Medical Center University Hospitals, Department of Ophthalmology, Cleveland, Ohio, United States
| | - Michael Douglass
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Basak Can
- Case Medical Center University Hospitals, Department of Ophthalmology, Cleveland, Ohio, United States
| | | | - Evelin Fried
- Hospital Italiano de San Justo Agustin Rocca, Buenos Aires, Argentina
| | - Vanina Schbib
- Hospital de Niños Sor Maria Ludovica, Buenos Aires, Argentina
| | | | - Brenda Peña
- Centro Integral de Salud Visual Daponte, Buenos Aires, Argentina
| | - Soledad Ulacia
- Mineserio de Salud Argentina, Ministry of Public Works Building, Buenos Aires, Argentina
| | | | - Andrew M. Rollins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - David L. Wilson
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
- Case Western Reserve University, Department of Radiology, Cleveland, Ohio, United States
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Hu X, Zhang J, Zhang M, Chen X, Han S, Zhu J. Incidence and Risk Factors for Retinopathy of Prematurity in a Tertiary Hospital in China. Clin Ophthalmol 2023; 17:3189-3194. [PMID: 37904850 PMCID: PMC10613405 DOI: 10.2147/opth.s434173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Purpose To investigate the incidence and risk factors for the retinopathy of prematurity (ROP) in the neonatal intensive care unit (NICU) of Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, China. Methods This retrospective case-control study included 611 preterm infants with birth weight (BW)<1500 grams admitted to the Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University between January 2019 and December 2022. The incidence and risk factors for any stage and severe ROP were analyzed. Results Within 611 infants, 245(40.1%) developed ROP; 160(26.2%) infants were stage 1, 54(8.8%) were stage 2, and 31(5.1%) were stage 3, no stage 4 and 5. Among them, 22(3.6%) infants needed treatment. Multivariate analysis showed a higher gestational age (GA) was protective, whereas twin birth and moderate-to-severe BPD increased the hazard of any stage ROP; higher BW and male gender were significant risk factors for severe ROP. Conclusion Compared to other tertiary hospitals, the incidence of any stage ROP in our NICU was higher, but the rate of ROP needed treatment was lower. A higher GA was protective, whereas twin birth and moderate-to-severe BPD increased the hazard of any stage ROP; higher BW was protective, whereas male gender were risk factors for the development of severe ROP.
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Affiliation(s)
- Xiaoshan Hu
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Jun Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Min Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Xiaohui Chen
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Shuping Han
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
| | - Jingai Zhu
- Department of Neonatology, Obstetrics and Gynecology Hospital of Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210001, People’s Republic of China
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Ong J, Waisberg E, Kamran SA, Paladugu P, Zaman N, Sarker P, Tavakkoli A, Lee AG. Deep learning synthetic angiograms for individuals unable to undergo contrast-guided laser treatment in aggressive retinopathy of prematurity. Eye (Lond) 2023; 37:2834-2835. [PMID: 37500752 PMCID: PMC10482905 DOI: 10.1038/s41433-023-02400-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Xie EF, Hilkert Rodriguez S, Xie B, D’Souza M, Reem G, Sulakhe D, Skondra D. Identifying novel candidate compounds for therapeutic strategies in retinopathy of prematurity via computational drug-gene association analysis. Front Pediatr 2023; 11:1151239. [PMID: 37492605 PMCID: PMC10365641 DOI: 10.3389/fped.2023.1151239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness worldwide. Although interventions such as anti-VEGF and laser have high success rates in treating severe ROP, current treatment and preventative strategies still have their limitations. Thus, we aim to identify drugs and chemicals for ROP with comprehensive safety profiles and tolerability using a computational bioinformatics approach. Methods We generated a list of genes associated with ROP to date by querying PubMed Gene which draws from animal models, human studies, and genomic studies in the NCBI database. Gene enrichment analysis was performed on the ROP gene list with the ToppGene program which draws from multiple drug-gene interaction databases to predict compounds with significant associations to the ROP gene list. Compounds with significant toxicities or without known clinical indications were filtered out from the final drug list. Results The NCBI query identified 47 ROP genes with pharmacologic annotations present in ToppGene. Enrichment analysis revealed multiple drugs and chemical compounds related to the ROP gene list. The top ten most significant compounds associated with ROP include ascorbic acid, simvastatin, acetylcysteine, niacin, castor oil, penicillamine, curcumin, losartan, capsaicin, and metformin. Antioxidants, NSAIDs, antihypertensives, and anti-diabetics are the most common top drug classes derived from this analysis, and many of these compounds have potential to be readily repurposed for ROP as new prevention and treatment strategies. Conclusion This bioinformatics analysis creates an unbiased approach for drug discovery by identifying compounds associated to the known genes and pathways of ROP. While predictions from bioinformatic studies require preclinical/clinical studies to validate their results, this technique could certainly guide future investigations for pathologies like ROP.
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Affiliation(s)
- Edward F. Xie
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, United States
| | - Sarah Hilkert Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Bingqing Xie
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Mark D’Souza
- Center for Research Informatics, The University of Chicago, Chicago, IL, United States
| | - Gonnah Reem
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Dinanath Sulakhe
- Center for Research Informatics, The University of Chicago, Chicago, IL, United States
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
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Ghosh TN, Rotake D, Kumar S, Kaur I, Singh SG. Tear-based MMP-9 detection: A rapid antigen test for ocular inflammatory disorders using vanadium disulfide nanowires assisted chemi-resistive biosensor. Anal Chim Acta 2023; 1263:341281. [PMID: 37225335 DOI: 10.1016/j.aca.2023.341281] [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: 12/11/2022] [Revised: 04/02/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023]
Abstract
A sensitive, non-invasive, and biomarker detection in tear fluids for inflammation in potentially blinding eye diseases could be of great significance as a rapid diagnostic tool for quick clinical decisions. In this work, we propose a tear-based MMP-9 antigen testing platform using hydrothermally synthesized vanadium disulfide nanowires. Also, various factors contributing to baseline drifts of the chemiresistive sensor including nanowire coverage on the interdigitated microelectrode of the sensor, sensor response duration, and effect of MMP-9 protein in different matrix solutions were identified. The drifts on the sensor baseline due to nanowire coverage on the sensor were corrected using substrate thermal treatment providing a more uniform distribution of nanowires on the electrode which brought the baseline drift to 18% (coefficient of variations, CV = 18%). This biosensor exhibited sub-femto level limits of detection (LODs) of 0.1344 fg/mL (0.4933 fmoL/l) and 0.2746 fg/mL (1.008 fmoL/l) in 10 mM phosphate buffer saline (PBS) and artificial tear solution, respectively. For a practical tear MMP-9 detection, the proposed biosensor response was validated with multiplex ELISA using tear samples from five healthy controls which showed excellent precision. This label-free and non-invasive platform can serve as an efficient diagnostic tool for the early detection and monitoring of various ocular inflammatory diseases.
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Affiliation(s)
- Tanmoya Nemai Ghosh
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, 502285, India
| | - Dinesh Rotake
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, 502285, India
| | - Saurabh Kumar
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, India; Manipal Academy of Higher Education, Manipal, 576104, India
| | - Inderjeet Kaur
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, India
| | - Shiv Govind Singh
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, 502285, India.
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Shen Y, Luo Z, Xu M, Liang Z, Fan X, Lu X. Automated detection for Retinopathy of Prematurity with knowledge distilling from multi-stream fusion network. Knowl Based Syst 2023; 269:110461. [DOI: 10.1016/j.knosys.2023.110461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2025]
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Pawar N, Somyashree D, Meenakshi R, Maheshwari D, Mohideen S, Uduman MS. Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity. Indian J Ophthalmol 2023; 71:2561-2568. [PMID: 37322680 PMCID: PMC10417983 DOI: 10.4103/ijo.ijo_1209_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: 05/14/2022] [Revised: 09/22/2022] [Accepted: 03/13/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). Methods The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type I ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age-matched, full-term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Results Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = -2.89 ± 3.1, range = -11.5 to -0.5 D). There were 75 eyes (56%) with low-to-moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with-the-rule (WTR) astigmatism. In 134 eyes, the SE was -1.78 ± 3.2 (range = -11.5 to 4 D); the SE of the 75 eyes with low-to-moderate myopia was -1.53 ± 1.2 (range = -0.50 to -5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low-to-moderate myopia was more than high myopia in patients with zone I and zone II ROP before treatment (60.0% and 54.5%, respectively). Conclusion Myopia was the major refractive error seen in post-IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors.
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Affiliation(s)
- Neelam Pawar
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - D Somyashree
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - R Meenakshi
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Devendra Maheshwari
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Syed Mohideen
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohammed Sithiq Uduman
- Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Huang W, Huang L, Wen Z, Honkanen RA, Rigas B. The Antiangiogenic Effect and Ocular Pharmacology of Novel Modified Nonsteroidal Anti-Inflammatory Drugs in the Treatment of Oxygen-Induced Retinopathy. J Ocul Pharmacol Ther 2023; 39:279-289. [PMID: 37172294 PMCID: PMC10178932 DOI: 10.1089/jop.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Purpose: To evaluate the hypothesis that 3 novel compounds, OXT-328, Q-922, and CL-717 show efficacy in the treatment of oxygen-induced retinopathy (OIR) and whether or not their route of administration is intravitreal, topical, or systemic. Methods: The OIR mouse model, characterized by an avascular area (AVA) and a neovascular area (NVA) of the retina, was used to study retinopathy of prematurity and other retinal diseases characterized by abnormal vessel growth. We measured the effect of our compounds on both the AVA and NVA in whole mounts of mouse retinal tissue. We also evaluated their ability to prevent new vessel formation in chicken chorioallantoic membranes (CAMs). Finally, we measured the in vitro uptake and biodistribution of topically applied CL-717 in human eye explants. Results: In mice with OIR, compared to controls, a single intravitreal administration of Q-922 or OXT-328 significantly reduced both AVA and NVA. CL-717 administered as eye drops over 5 days also reduced AVA and NVA, whereas OXT-328 eye drops had no effect. Q-922 given intraperitoneal (150 mg/kg/day × 5 days) reduced AVA and NVA. Remarkably, explanted human eyes bathed in CL-717 show rapid uptake and biodistribution in ocular tissues. In the chicken CAM model, all 3 compounds reduced the formation of new blood vessels by about one-third. No side effect in mice was observed, except for mild ocular surface irritation with Q-922. Conclusions: Systemic administration of Q-922 or topical administration of CL-717 holds particular promise for a simplified treatment of proliferative retinopathies without the necessity of intravitreal injections.
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Affiliation(s)
- Wei Huang
- Department of Ophthalmology, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Liqun Huang
- Medicon Pharmaceuticals, Inc., Setauket, New York, USA
| | - Ziyi Wen
- Medicon Pharmaceuticals, Inc., Setauket, New York, USA
| | - Robert A Honkanen
- Department of Ophthalmology, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Basil Rigas
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
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Zhang Z, Yang W, Lv H, Huang L, Yao T, He Y. The Top 100 Most Cited Manuscripts in Retinopathy of Prematurity: A Bibliometric Analysis. Semin Ophthalmol 2023; 38:306-311. [PMID: 36843278 DOI: 10.1080/08820538.2023.2177115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
PURPOSE To systematically summarize the research trends and emphases of ROP in the past decades by analyzing the characteristics of the top 100 cited ROP articles. METHODS The 100 most cited articles on ROP published from January 1, 1950 to December 31, 2021 were searched by Web of Science. Information such as year of publication, number of citations, journal and impact factor, type of research and topic, country of origin, institution and authorship of each article was extracted to analyze its characteristics. RESULTS A total of 15,928 articles were returned. These articles were published in 43 journals between 1952 and 2018, originating from 14 countries. The most widely published journal was Pediatrics (n = 19, IF = 8.109), followed by Archives of Ophthalmology (n = 15, IF = 4.399). The most cited paper (Gole et al. Archives of Ophthalmology 2005 Jul, 1614 citations) reported on the international classification of ROP. The most prevalent topic was the pathophysiology of ROP (n = 39), followed by the treatment of ROP (n = 32). Most were original research (n = 72), mainly based on research design of basic science. The most published articles were published in the United States (n = 61), and the institutions were Oregon Health & Science University, Dept Ophthalmol (n = 7). CONCLUSIONS These 100 most frequently cited papers reflect the significant progress and several hot topics of ROP in recent decades, and this paper will help us further understand the knowledge and progress of ROP diagnosis and treatment.
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Affiliation(s)
- Zhiru Zhang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - Wei Yang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - Hongbin Lv
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - Li Huang
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - Tianyu Yao
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - Yue He
- Department of Ophthalmology, the Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
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Retinopathy of Prematurity in the 21st Century and the Complex Impact of Supplemental Oxygen. J Clin Med 2023; 12:jcm12031228. [PMID: 36769876 PMCID: PMC9918247 DOI: 10.3390/jcm12031228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Not only do the epidemiologic determinants and distributions of patients with ROP vary worldwide, but clinical differences have also been described. The Third Edition of the International Classification of ROP (ICROP3) acknowledges that aggressive ROP (AROP) can occur in larger preterm infants and involve areas of the more anterior retina, particularly in low-resource settings with unmonitored oxygen supplementation. As sub-specialty training programs are underway to address an epidemic of ROP in sub-Saharan Africa, recognizing characteristic retinal pathology in preterm infants exposed to unmonitored supplemental oxygen is important to proper diagnosis and treatment. This paper describes specific features associated with various ROP presentations: oxygen-induced retinopathy in animal models, traditional ROP seen in high-income countries with modern oxygen management, and ROP related to excessive oxygen supplementation in low- and middle-income countries: oxygen-associated ROP (OA-ROP).
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Bujoreanu Bezman L, Tiutiuca C, Totolici G, Carneciu N, Bujoreanu FC, Ciortea DA, Niculet E, Fulga A, Alexandru AM, Stan DJ, Nechita A. Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies. Int J Gen Med 2023; 16:937-949. [PMID: 36942030 PMCID: PMC10024537 DOI: 10.2147/ijgm.s401122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/17/2023] [Indexed: 03/15/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder with an imminent risk of blindness, in cases where early diagnosis and treatment are not performed. The doctors' constant motivation to give these fragile beings a chance at life with optimal visual acuity has never stopped, since Terry first described this condition. Thus, throughout time, several specific advancements have been made in the management of ROP. Apart from the most known risk factors, this narrative review brings to light the latest research about new potential risk factors, such as: proteinuria, insulin-like growth factor 1 (IGF-1) and blood transfusions. Digital imaging has revolutionized the management of retinal pathologies, and it is more and more used in identifying and staging ROP, particularly in the disadvantaged regions by the means of telescreening. Moreover, optical coherence tomography (OCT) and automated diagnostic tools based on deep learning offer new perspectives on the ROP diagnosis. The new therapeutical trend based on the use of anti-VEGF agents is increasingly used in the treatment of ROP patients, and recent research sustains the theory according to which these agents do not interfere with the neurodevelopment of premature babies.
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Affiliation(s)
- Laura Bujoreanu Bezman
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Tiutiuca
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Correspondence: Carmen Tiutiuca, Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, 800008, Romania, Tel +40741330788, Email
| | - Geanina Totolici
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Nicoleta Carneciu
- Department of Ophthalmology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Florin Ciprian Bujoreanu
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Florin Ciprian Bujoreanu, Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, 800008, Romania, Tel +40741395844, Email
| | - Diana Andreea Ciortea
- Department of Pediatrics, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ana Fulga
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Anamaria Madalina Alexandru
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Neonatology, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Daniela Jicman Stan
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Aurel Nechita
- Department of Pediatrics, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
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Sobhy M, Cole E, Jabbehdari S, Valikodath NG, Al-Khaled T, Kalinoski L, Chervinko M, Cherwek DH, Chuluunkhuu C, Shah PK, K C S, Jonas KE, Scanzera A, Yap VL, Yeh S, Kalpathy-Cramer J, Chiang MF, Campbell JP, Chan RVP. Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework. Int Ophthalmol Clin 2023; 63:39-63. [PMID: 36598833 PMCID: PMC9839316 DOI: 10.1097/iio.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retinopathy of prematurity (ROP) is one of the leading causes of preventable pediatric blindness worldwide. ROP screening programs have been previously implemented in multiple low- and middle-income countries. On a global scale, it is crucial that evidence-based, standardized screening criteria are utilized in the early detection and treatment of ROP. In this review article, we utilize the National Public Health Performance Standards (NPHPS) Ten Essential Public Health Services Model organized by the core functions of assessment, policy development, and assurance to evaluate the barriers and successes of existing ROP screening programs. This framework can be applied to countries facing the third epidemic of ROP and can be used to establish a generalized model for eye care and screening worldwide.
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Boskabadi H, Shoeibi N, Bagheri F, Pourbadakhshan N, Moradi A, Zakerihamidi M. Potential Role of Bilirubin in Preventing Retinopathy of Prematurity. Curr Pediatr Rev 2023; 19:197-202. [PMID: 35986544 DOI: 10.2174/1573396318666220819151154] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. METHODS This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. RESULTS Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP. CONCLUSION According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Shoeibi
- Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bagheri
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Nafiseh Pourbadakhshan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- PhD (Tissue Engineering), Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Hsu HT, Yu-Chuan Kang E, Blair MP, Shapiro M, Komati R, Hubbard BG, Price KW, Capone A, Drenser KA, Trese MT, Shields R, Kondo H, Matsushita I, Yonekawa Y, Patel SN, Kusaka S, Mano F, Olsen KR, Ells A, Amphornphruet A, Walsh MK, Besirli CG, Moinuddin O, Baumal CR, Enriquez AB, Hwang YS, Lai CC, Wu WC. Late Vitreoretinal Complications of Regressed Retinopathy of Prematurity: Retinal Break, Vitreous Hemorrhage, and Retinal Detachment. Ophthalmol Retina 2023; 7:72-80. [PMID: 35843486 DOI: 10.1016/j.oret.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment. DESIGN International, multicenter, noncomparative retrospective case series. PARTICIPANTS We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP. METHODS Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared. MAIN OUTCOME MEASURES Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP. RESULTS A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P = 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement. CONCLUSIONS Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.
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Affiliation(s)
- Han-Tung Hsu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | | - Ryan Shields
- Associated Retinal Consultants, Royal Oak, Michigan
| | - Hiroyuki Kondo
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Itsuka Matsushita
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fukutaro Mano
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Karl R Olsen
- Retina Vitreous Consultants, Monroeville, Pennsylvania
| | - Anna Ells
- Calgary Retina Consultants, Southern Alberta Eye Center, Alberta, Canada
| | - Atchara Amphornphruet
- Rajavithi Hospital, Ministry of Public Health, College of Medicine, Rangsit University, Thailand
| | | | - Cagri G Besirli
- Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Omar Moinuddin
- Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | | | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Tawfik GM, Shahein EA, Dabour SA, Hassanein D, Elshewy AM. Comparison of intravitreal injection of ranibizumab versus bevacizumab for treatment of type 1 and aggressive retinopathy of prematurity in rural Egypt. A randomized clinical trial. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
ObjectiveThe objective of this study is to evaluate the efficacy of intravitreal ranibizumab (IVR) monotherapy compared with intravitreal bevacizumab (IVB) monotherapy for treatment of type 1 and aggressive retinopathy of prematurity (ROP) in rural Egypt.Methods36 eyes of 18 infants with bilateral aggressive or type 1 ROP were recruited between September 2020 and September 2022. Mean follow-up duration was 16.53 months. IVB was injected in the right eye and IVR in the left eye, rescue injection of the same initial anti-vascular endothelial growth factor (VEGF) in case of ROP reactivation. Outcome measures included regression achieved either by single injection or multiple injections or additional laser therapy at 55 weeks’ postmenstrual age (PMA), recurrence of ROP, total retinal vascularisation time and complications.ResultsInitial regression of ROP within 1 week occurred in 11/18 eyes (61.1%) in bevacizumab group and 15/18 eyes (83.3%) in ranibizumab group (p=0.137). Primary outcome measure was achieved in 14/18 eyes (77.8%) and 16/18 eyes (88.9%) in bevacizumab and ranibizumab groups, respectively (p=0.658). Late reactivation requiring retreatment with anti-VEGF was encountered in 4/18 eyes (22.2%) and 1/18 eyes (5.6%) in bevacizumab and ranibizumab groups, respectively (p=0.338). Peripheral laser therapy on the avascular retina was done in 3/18 eyes (16.7%) in each group at mean of 55.67 weeks' PMA.ConclusionBevacizumab and ranibizumab proved to be effective regarding regression of acute ROP and continuing peripheral retinal vascularisation. Higher proportion of reactivation with bevacizumab, however, clinically non-significant. Laser therapy can be postponed to reduce its complications.Trial registration numberNCT05033106.
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Gyllensten H, Humayun J, Sjöbom U, Hellström A, Löfqvist C. Costs associated with retinopathy of prematurity: a systematic review and meta-analysis. BMJ Open 2022; 12:e057864. [PMID: 36424118 PMCID: PMC9693652 DOI: 10.1136/bmjopen-2021-057864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To review and analyse evidence regarding costs for retinopathy of prematurity (ROP) screening, lifetime costs and resource use among infants born preterm who develop ROP, and how these costs have developed over time in different regions. DESIGN Systematic review and meta-analysis DATA SOURCES: PubMed and Scopus from inception to 23 June 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included studies presented costs for ROP screening and the lifetime costs (including laser treatment and follow-up costs) and resource use among people who develop ROP. Studies not reporting on cost calculation methods or ROP-specific costs were excluded. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened for inclusion and extracted data, including items from a published checklist for quality assessment used for bias assessment, summary and random-effects meta-analysis for treatment costs. Included studies were further searched to identify eligible references and citations. RESULTS In total, 15 studies reported ROP screening costs, and 13 reported lifetime costs (either treatment and/or follow-up costs) for infants with ROP. The range for screening costs (10 studies) was US$5-US$253 per visit, or US$324-US$1072 per screened child (5 studies). Costs for treatment (11 studies) ranged from US$38 to US$6500 per child. Four studies reported healthcare follow-up costs (lifetime costs ranging from US$64 to US$2420, and 10-year costs of US$1695, respectively), and of these, three also reported lifetime costs for blindness (range US$26 686-US$224 295) using secondary cost data. Included papers largely followed the quality assessment checklist items, thus indicating a low risk of bias. CONCLUSION The costs of screening for and treating ROP are small compared with the societal costs of resulting blindness. However, little evidence is available for predicting the effects of changes in patient population, screening schedule or ROP treatments. PROSPERO REGISTRATION NUMBER CRD42020208213.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
| | - Jhangir Humayun
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
| | - Ulrika Sjöbom
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Chatarina Löfqvist
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Goteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
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Neamah GT, Al Nwuaini MQ, Abd KA, Nasrawi AJM, Hussein SRM. Retinopathy of prematurity, a two-year experience at the ROP screening unit from AL-Zahraa Teaching Hospital, AL-Najaf, Iraq. J Med Life 2022; 15:1431-1436. [PMID: 36567829 PMCID: PMC9762363 DOI: 10.25122/jml-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/25/2022] [Indexed: 12/27/2022] Open
Abstract
This study aimed to assess the incidence of retinopathy of prematurity (ROP) in Al Najaf city, define the risk factors of ROP, and assess the performance of the newly implemented ROP screening. This retrospective study was performed in the ROP screening clinic in Al Najaf city between January 2018 and December 2019. 247 neonates were examined at the ROP screening clinic, with gestational age ≤30 weeks, weight ≤1500 g, other fetal and maternal risk factors, and older or heavier newborns with a complicated course. Out of all the neonates, 90 were enrolled in this study because all others lost contact with the ROP clinic. 62 out of 90 enrolled neonates (69%) were diagnosed with ROP. Of them, 82% had stage 1-2 ROP, and 18% had stage 3-4. We found that the higher gestational age was protective for ROP (P-value=0.012, OR=0.434, CI=0.227-0.829). CPAP carried a higher risk of ROP (P-value=0.072, OR=7.276, CI=0.834-63.441). The P-value was significant for maternal age and premature rupture of membranes (PROM) (P-value=0.028 and 0.01, respectively). This study showed the incidence of ROP in the accepted range compared to other countries with similar resources. Furthermore, there was a strong association between ROP and the following factors: decreased gestational age, CPAP, maternal age, and PROM.
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Affiliation(s)
| | | | | | - Alaa Jumaah Manji Nasrawi
- Department of Pediatrics, College of Medicine, University of Kufa, Kufa, Iraq,Corresponding Author: Alaa Jumaah Manji Nasrawi, Department of Pediatrics, College of Medicine, University of Kufa, Kufa, Iraq. E-mail:
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Tan Z, Isaacs M, Zhu Z, Simkin S, He M, Dai S. Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic support systems. Saudi J Ophthalmol 2022; 36:283-295. [PMID: 36276257 PMCID: PMC9583350 DOI: 10.4103/sjopt.sjopt_220_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Neonatal care in middle-income countries has improved over the last decade, leading to a "third epidemic" of retinopathy of prematurity (ROP). Without concomitant improvements in ROP screening infrastructure, reduction of ROP-associated visual loss remains a challenge worldwide. The emergence of teleophthalmology screening programs and artificial intelligence (AI) technologies represents promising methods to address this growing unmet demand in ROP screening. An improved understanding of current ROP screening programs may inform the adoption of these novel technologies in ROP care. METHODS A critical narrative review of the literature was carried out. Publications that were representative of established or emerging ROP screening programs in high-, middle-, and low-income countries were selected for review. Screening programs were reviewed for inclusion criteria, screening frequency and duration, modality, and published sensitivity and specificity. RESULTS Screening inclusion criteria, including age and birth weight cutoffs, showed significant heterogeneity globally. Countries of similar income tend to have similar criteria. Three primary screening modalities including binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology were identified and reviewed. BIO has documented limitations in reduced interoperator agreement, scalability, and geographical access barriers, which are mitigated in part by WFDRI. Teleophthalmology screening may address limitations in ROP screening workforce distribution and training. Opportunities for AI technologies were identified in the context of these limitations, including interoperator reliability and possibilities for point-of-care diagnosis. CONCLUSION Limitations in the current ROP screening include scalability, geographical access, and high screening burden with low treatment yield. These may be addressable through increased adoption of teleophthalmology and AI technologies. As the global incidence of ROP continues to increase, implementation of these novel modalities requires greater consideration.
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Affiliation(s)
- Zachary Tan
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia,Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michael Isaacs
- Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia
| | - Samantha Simkin
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Mingguang He
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia
| | - Shuan Dai
- Department of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia,Address for correspondence: Dr. Shuan Dai, Assoc. Prof. Shuan Dai, Faculty of Medicine, The University of Queensland, Brisbane, Australia. E-mail:
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Aly H, Othman HF, Munster C, Das A, Sears J. The U.S. National Trend for Retinopathy of Prematurity. Am J Perinatol 2022; 29:1569-1576. [PMID: 33592666 DOI: 10.1055/s-0041-1723830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS). STUDY DESIGN We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere-Terpstra test. RESULTS A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively). CONCLUSION There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC. KEY POINTS · Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.. · The prevalence of NEC did not change over the same time period.. · Increased ROP and severe ROP were consistent in all three GA and BW subgroups..
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Affiliation(s)
- Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hasan F Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
| | - Chelsea Munster
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Anirudha Das
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
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Kıran Yenice E, Kara C. Development of myopia in laser-treated ROP infants: prematurity or laser photocoagulation? Int Ophthalmol 2022; 43:1453-1458. [PMID: 36149616 DOI: 10.1007/s10792-022-02540-x] [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: 06/10/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the relationship between the development of corrected 1-year-old refraction values and risk factors in preterm infants who underwent laser photocoagulation (LPC) therapy for retinopathy of prematurity (ROP). METHODS The ophthalmic examination findings of preterm neonates who had developed Type I ROP and received LPC therapy were evaluated retrospectively. The association between spherical equivalent (SE) values and clinical findings were analyzed by using multivariable linear regression analysis. RESULTS The study included 157 eyes of 80 neonates with a mean birth week of 27.1 ± 2.2 weeks (23 to 32 weeks) and a mean birth weight of 995 ± 273 g (565 to 1760 g). The treatments were administered on an average of 36.8 ± 2.7 (32 to 45 weeks) postmenstrual age. LPC treatment was applied bilaterally to 77 of the 80 neonates included in the study, and unilaterally to 3 of them. The mean ± standard deviation of the SE value was 0.31 ± 1.89 diopters (D) (- 8.00 to 4.63 D) according to the results of the 1-year corrected age refraction examination. In univariate analysis, no significant association between GA, BW, and ROP zone and SE value, while the number of laser spots (ß = - 0.27 ± 0.00 D, p = 0.00) and stage 3 ROP (ß = - 0.29 ± 0.37 D, p = 0.00) were significantly associated with the SE value. In multivariable linear regression analysis, a significant association between number of laser spot, stage 3 ROP and SE value (ß = - 0.25 ± 0.00 D, p = 0.01 for number of laser spot, ß = - 0.28 ± 0.36 D, p = 0.00 for stage 3 ROP). CONCLUSION In conclusion, this study supports that stage of ROP and the number of laser spots count applied in photocoagulation treatment for ROP is significantly correlated with degree of myopia (p < 0.05).
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Affiliation(s)
- Eşay Kıran Yenice
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, University of Health Sciences, Varlık Mahallesi Etlik Caddesi, No: 55 Keçiören/ Yenimahalle, Ankara, Turkey.
| | - Caner Kara
- Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, University of Health Sciences, Varlık Mahallesi Etlik Caddesi, No: 55 Keçiören/ Yenimahalle, Ankara, Turkey
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Sun L, Yan W, Huang L, Li S, Liu J, Lu Y, Su M, Li Z, Ding X. ROP-like retinopathy in full/near-term newborns: A etiology, risk factors, clinical and genetic characteristics, prognosis and management. Front Med (Lausanne) 2022; 9:914207. [PMID: 36035399 PMCID: PMC9399493 DOI: 10.3389/fmed.2022.914207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeRetinopathy of prematurity (ROP) like retinopathy (ROPLR) could occur in full/near-term newborns. The causes and clinical features are still largely elusive. This study focused on the risk factors, clinical and genetic characteristics, treatment and outcome, and prognosis of ROPLR.MethodsA total of 47 consecutive full/near-term newborns during 2016–2017 with ROPLR were included. The clinical and genetic characteristics, treatment and outcome, prognosis, and potential underlying etiology of ROPLR were were analyzed.Results91 eyes of 47 infants were found to have ROPLR. The ROPLR regressed completely in 65.9% and partially in 20.9% of eyes without any interventions. Retinal changes of family exudative vitreoretinopathy (FEVR) were allocated in 12 neonates (group A), perinatal hypoxia-ischemia were categorized in 17 neonates (group B), and the other 18 neonates were categorized in group C. Compared to those in group B/C, infants in group A had significantly more severe retinopathy (stage 4/5, p < 0.001) and more treatments (p < 0.00 risk factor 1).ConclusionsPerinatal hypoxia-ischemia might be a major risk factor for ROPLR, in which spontaneous regression was common. FEVR, confirmed by positive family findings and genetic testing, might be the second risk factor of ROPLR, in which retinopathy is more severe and treatment is needed.
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Affiliation(s)
- Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenjia Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jia Liu
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Yamei Lu
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Manxiang Su
- Zhuhai Maternity and Child Health Hospital, Zhuhai, China
| | - Zhan Li
- Zhuhai Maternity and Child Health Hospital, Zhuhai, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiaoyan Ding
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Rasoulinejad SA, Sarreshtehdari N, Mafi AR. The crosstalk between VEGF signaling pathway and long non-coding RNAs in neovascular retinal diseases: Implications for anti-VEGF therapy. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang Y, Wang Y, Wang X, Ma Y, Li Z, Di Y. LncRNA TUG1 Promotes Apoptosis, Invasion, and Angiogenesis of Retinal Endothelial Cells in Retinopathy of Prematurity via MiR-145-5p. Front Med (Lausanne) 2022; 9:803214. [PMID: 35445044 PMCID: PMC9014803 DOI: 10.3389/fmed.2022.803214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is a common retinal vascular disease in premature neonates. In recent years, there is increasing evidence that the long non-coding RNA taurine upregulated gene 1 (TUG1) plays a regulatory role in vascular diseases, suggesting a potential role for TUG1 in vascular endothelial cells. We hypothesized that TUG1 may be associated with ROP. Our aim, therefore, was to explore the biological functions of TUG1 in aberrant retinal development. Methods We used the mouse oxygen-induced retinopathy (OIR) model to simulate the pathological changes of retinal in ROP. Quantitative real-time polymerase chain reaction was used to detect the expression of TUG1, miR-145-5p and cellular communication network factor 1 (CCN1). Human retinal endothelial cells (HRECs) were treated with CoCl2 to mimic hypoxia conditions. Cellular functional changes were observed after transfection with RNA interference (RNAi)-TUG1 and miR-145-5p mimics. The apoptosis of HRECs was detected by flow cytometry, the migration ability was detected by wound healing and transwell migration assays, and the ability of angiogenesis was detected by tube formation assay. The potential binding sites between TUG1, miR-145-5p, and CCN1 were verified by dual-luciferase reporter assays. The degree of retinopathy was evaluated by staining retinal sections with hematoxylin and eosin, and the expression of CCN1, HIF-1α, VEGF, caspase-3, Bcl-2, IL-1β, and TNF-α protein was analyzed by Western blotting and immunohistochemistry. Results In the retina tissue of OIR mice, TUG1, miR-145-5p, and CCN1 were differentially expressed. Knocking down TUG1 attenuated apoptosis, migration, and angiogenesis induced by hypoxia on HRECs, as did miR-145-5p overexpression. Results from reporter assays indicate direct interactions between TUG1, miR-145-5p, and CCN1. Intravitreal injection of miR-145-5p mimics reduced the degree of retinopathy. Conclusion TUG1 acts as a molecular sponge of miR-145-5p to regulate CCN1 expression and thus regulate the development of retinal neovascularization. This regulatory mechanism may provide a new theoretical basis for the prevention and treatment of ROP.
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Affiliation(s)
- Yuexia Wang
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Wang
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Wang
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuan Ma
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaojin Li
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Di
- Shengjing Hospital of China Medical University, Shenyang, China
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Boskabadi H, Abrishami M, shoeibi N, sanei Z, Moradi A, Zakerihamidi M. Comparison of Vitamin D Levels in Premature Infants with and without Retinopathy of Prematurity. ARCHIVES OF IRANIAN MEDICINE 2022; 25:209-213. [PMID: 35942992 PMCID: PMC11897870 DOI: 10.34172/aim.2022.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/28/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP. METHODS This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016-2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants' first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool. RESULTS Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP. CONCLUSION The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Majid Abrishami
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Nasser shoeibi
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Zahra sanei
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ali Moradi
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Islamic Azad University, Tonekabon, Iran
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Liu YL, Ying GS, Quinn GE, Zhou XH, Chen Y. Extending Hui-Walter framework to correlated outcomes with application to diagnosis tests of an eye disease among premature infants. Stat Med 2022; 41:433-448. [PMID: 34859902 PMCID: PMC8884176 DOI: 10.1002/sim.9269] [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: 09/22/2019] [Revised: 08/28/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
Diagnostic accuracy, a measure of diagnostic tests for correctly identifying patients with or without a target disease, plays an important role in evidence-based medicine. Diagnostic accuracy of a new test ideally should be evaluated by comparing to a gold standard; however, in many medical applications it may be invasive, costly, or even unethical to obtain a gold standard for particular diseases. When the accuracy of a new candidate test under evaluation is assessed by comparison to an imperfect reference test, bias is expected to occur and result in either overestimates or underestimates of its true accuracy. In addition, diagnostic test studies often involve repeated measurements of the same patient, such as the paired eyes or multiple teeth, and generally lead to correlated and clustered data. Using the conventional statistical methods to estimate diagnostic accuracy can be biased by ignoring the within-cluster correlations. Despite numerous statistical approaches have been proposed to tackle this problem, the methodology to deal with correlated and clustered data in the absence of a gold standard is limited. In this article, we propose a method based on the composite likelihood function to derive simple and intuitive closed-form solutions for estimates of diagnostic accuracy, in terms of sensitivity and specificity. Through simulation studies, we illustrate the relative advantages of the proposed method over the existing methods that simply treat an imperfect reference test as a gold standard in correlated and clustered data. Compared with the existing methods, the proposed method can reduce not only substantial bias, but also the computational burden. Moreover, to demonstrate the utility of this approach, we apply the proposed method to the study of National-Eye-Institute-funded Telemedicine Approaches to Evaluating of Acute-Phase Retinopathy of Prematurity (e-ROP), for estimating accuracies of both the ophthalmologist examination and the image evaluation.
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Affiliation(s)
- Yu-Lun Liu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Correspondence to: Yong Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA or Yu-Lun Liu, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. or
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Graham E. Quinn
- Division of Pediatric Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, PA 19104, USA
| | - Xiao-Hua Zhou
- Department of Biostatistics, School of Public Health, Peking University, China.,Beijing International Center for Mathematical Research, Peking University, China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA.,Correspondence to: Yong Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA or Yu-Lun Liu, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. or
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Abstract
Retinopathy of prematurity (ROP) is an alteration in the development of the immature retina vascularization that frequently occurs in premature infants and is one of the leading causes of childhood blindness worldwide. In threshold stage retinopathy, laser photocoagulation is the standard treatment, particularly in those located in zone II. However, this therapy destroys parts of the retina and can lead to significant eye complications later in life. For this reason, in the last few years, antivascular endothelial growth factor agents are being used as monotherapy or as coadjuvant with laser, especially in retinopathy located in zone I. More recently, the administration of oral propranolol has been used as prevention and/or treatment of prethreshold retinopathy with encouraging results. This review provides an overview of the current evidence on newer treatment strategies for ROP. KEY POINTS: · Laser is the standard treatment in threshold retinopathy of prematurity (ROP).. · Prethreshold stages of the ROP have no treatment.. · Propranolol may prevent the progression of ROP..
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Affiliation(s)
- Aldo Bancalari
- Department of Pediatrics, Faculty of Medicine, University of Concepcion, Concepcion, Chile
| | - Ricardo Schade
- Ophthalmology Service, Guillermo Grant Benavente Hospital, Concepcion, Chile
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Tawfik S, Mansour A, Selim NL, Habib AM, Fouad YA, Tawfik MA, Al-Feky M. Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt. BMC Ophthalmol 2021; 21:445. [PMID: 34961497 PMCID: PMC8711162 DOI: 10.1186/s12886-021-02193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking. METHODS Retrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions. RESULTS Of the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30-34) weeks, and the median (IQR) BW was 1600 (1350-2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample. CONCLUSION The incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.
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Affiliation(s)
- Sara Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed Mansour
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Norhan Lotfy Selim
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed M Habib
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Yousef A Fouad
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt.
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.
| | - Mohamed A Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Memorial Institute for Ophthalmic Research, Giza, Egypt
| | - Mariam Al-Feky
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
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Plastino F, Pesce NA, André H. MicroRNAs and the HIF/VEGF axis in ocular neovascular diseases. Acta Ophthalmol 2021; 99:e1255-e1262. [PMID: 33729690 DOI: 10.1111/aos.14845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022]
Abstract
Ocular neovascular diseases, such as proliferative diabetic retinopathy, retinopathy of prematurity and neovascular age-related macular degeneration, are the leading causes of visual impairment worldwide. The hypoxia-inducible factors and vascular endothelial growth factors are key molecular promoters of ocular neovascularization. Moreover, the role of microRNAs as regulators of angiogenesis has been expanding, particularly hypoxia-associated microRNA; hypoxamiRs. This review provides a summary of hypoxamiRs that directly and specifically target HIF1A and VEGF mRNAs, thus critically involved in the regulation of ocular neovascular pathologies. The discussed microRNAs highlight putative diagnostic markers and therapeutic agents in choroidal and retinal angiogenic diseases, including proliferative diabetic retinopathy, retinopathy of prematurity and neovascular age-related macular degeneration.
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Affiliation(s)
- Flavia Plastino
- Department of Clinical Neurosciences Division of Eye and Vision St. Erik Eye Hospital Karolinska Institutet Stockholm Sweden
| | - Noemi Anna Pesce
- Department of Clinical Neurosciences Division of Eye and Vision St. Erik Eye Hospital Karolinska Institutet Stockholm Sweden
| | - Helder André
- Department of Clinical Neurosciences Division of Eye and Vision St. Erik Eye Hospital Karolinska Institutet Stockholm Sweden
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Mantena S, Burke TF. Oxygen Blending is Urgently Needed in Resource-Limited Settings. J Pediatr 2021; 237:288-291. [PMID: 33940015 DOI: 10.1016/j.jpeds.2021.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Sreekar Mantena
- Departments of Statistics and Molecular and Cellular Biology, Harvard University, Cambridge, MA.
| | - Thomas F Burke
- Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
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Özdek Ş, Özmen MC, Yalınbaş D, Atalay HT, Coşkun D. Immediate Sequential Bilateral Vitrectomy Surgery for Retinopathy of Prematurity: A Single Surgeon Experience. Turk J Ophthalmol 2021; 51:225-230. [PMID: 34461709 PMCID: PMC8411288 DOI: 10.4274/tjo.galenos.2020.07377] [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: 12/01/2022] Open
Abstract
Objectives: We report the safety and efficacy of simultaneous bilateral vitrectomy for stage 4 and stage 5 retinopathy of prematurity (ROP). Materials and Methods: Babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were included in this retrospective study. Clinical history, demographic characteristics of the patients, surgical procedure details, perioperative and postoperative ophthalmic and systemic complications, and postoperative anatomical success rates were evaluated. General anesthesia features were also recorded. Results: Seventy eyes of 35 babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were reviewed. At the time of surgery, the mean age was 41.4±4.9 weeks. There was preoperative plus disease in 58.6% of the eyes. The mean surgery/eye ratio was 1.2. Mean anesthesia time was 95±64 minutes. The mean follow-up was 28.1 months (3 to 84 months). Anatomical success was 95.7% for stage 4A (44/46 eyes), 83.3% for stage 4B (15/18 eyes), and 50% for stage 5 (3/6 eyes) ROP. Patients with stage 5 ROP had significantly less anatomical success than stage 4A and 4B (p=0.004). None of the patients had endophthalmitis and anesthesiarelated severe complications. Conclusion: Immediate sequential bilateral vitrectomy surgery can be considered an option for patients with active bilateral stage 4 and stage 5 ROP. The risk of endophthalmitis should be weighed against the risks of disease progression and anesthesia-related complications.
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Affiliation(s)
- Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Mehmet Cüneyt Özmen
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Duygu Yalınbaş
- Cumhuriyet University Faculty of Medicine, Department of Ophthalmology, Sivas, Turkey
| | - Hatice Tuba Atalay
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Demet Coşkun
- Gazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
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