Retinopathy of prematurity: postmenstrual age at threshold in a transitional economy is similar to that in developed countries

PurposesTo develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW).MethodsA multicentre retrospective cohort study was conducted based on data from four tertiary neonatal intensive care units in Shanghai, China. The medical records of enrolled infants, born from 2012 to 2016 who underwent ROP examinations, were collected and analysed. The incidence and risk factors for ROP were analysed in all infants. Postnatal age (PNA) and postmenstrual age (PMA) of infants, detected to diagnose ROP for the first time, were compared with the present examination schedule. The predictive performance of screening models was evaluated by internally validating sensitivity and specificity.ResultsOf the 5606 eligible infants, ROP was diagnosed in 892 (15.9%) infants; 63 (1.1%) of them received treatment. The mean GA of ROP patients was 29.4±2.4 weeks, and the mean BW was 1260±330 g. Greater prematurity was associated with an older PNA at which ROP developed. The minimum PMA and PNA at which diagnosis of treatable ROP occurred were 32.43 and 3 weeks, respectively. The optimised criteria (GA <32 weeks or BW <1600 g) correctly predicted 98.4% type 1 ROP infants, reducing the infants requiring examinations by 43.2% when internally validated.ConclusionsThe incidence of type 1 ROP and the mean GA and BW of ROP infants have decreased in China. The suggested screening threshold and schedule may be reliably used to guide the modification of ROP screening guideline and decrease medical costs.

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Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311662 ◽

2018 ◽

Vol 103 (4) ◽

pp. 494-498 ◽

Cited By ~ 4

Author(s):

Yichen Bai ◽

Huanjie Nie ◽

Shiyu Wei ◽

Xiaohe Lu ◽

Xiaoyun Ke ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Primary Outcome ◽

Safety And Efficacy ◽

Postmenstrual Age ◽

Zone Ii ◽

The Mean ◽

Secondary Outcomes ◽

Number Of Injections

BackgroundTo evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP).MethodsPatients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease.ResultsA total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up.ConclusionIVC injection is an effective treatment for ROP.

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New modifications of Swedish ROP guidelines based on 10-year data from the SWEDROP register

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314874 ◽

2019 ◽

Vol 104 (7) ◽

pp. 943-949 ◽

Cited By ~ 3

Author(s):

Gerd Holmström ◽

Ann Hellström ◽

Lotta Gränse ◽

Marie Saric ◽

Birgitta Sunnqvist ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Neonatal Care ◽

Coverage Rate ◽

Natural Course ◽

Web Based ◽

Postmenstrual Age ◽

Over Time

Background/aimsDuring the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified.MethodsIn Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008–2017.ResultsOf 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed.ConclusionModification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26–29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.

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Lens-sparing vitrectomy for stage 4A retinopathy of prematurity in infants with aggressive-posterior ROP: Anatomic and functional results

European Journal of Ophthalmology ◽

10.1177/1120672120946938 ◽

2020 ◽

pp. 112067212094693

Author(s):

Sara Macor ◽

Silvia Pignatto ◽

Antonio Capone Jr ◽

Stefano Piermarocchi ◽

Paolo Lanzetta

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Functional Outcomes ◽

Vitreous Hemorrhage ◽

Functional Results ◽

Postmenstrual Age ◽

Refractive Correction ◽

Anatomic Success

Aim: To assess long-term anatomic and functional outcomes of early lens-sparing vitrectomy (LSV) for stage 4A retinopathy of prematurity (ROP) in infants with aggressive-posterior ROP (AP-ROP) which progressed to retinal detachment despite laser treatment. Methods: Chart review of infants who underwent early 25-gage LSV for stage 4A ROP. Outcomes were anatomic success, mean visual acuity (VA), development of postoperative complications, and refractive changes. Follow-up examinations were performed at 1, 3, 6, 12, and then every 6 months. Results: Ten eyes of seven preterm infants who underwent LSV were included. Mean follow-up was 36 ± 13.4 months and mean postmenstrual age (PMA) at last follow-up was 37 ± 13.7 months. Mean gestational age (GA) and weight at birth was 26 ± 1.4 weeks and 639 ± 180 g. Two eyes had vitreous hemorrhage 4 and 14 days after surgery, respectively. At last follow-up anatomic success was 100%, mean VA was 20/80 and eight eyes (80%) had high myopic refractive correction (mean spherical equivalent –11.25 D). Conclusion: Early LSV for stage 4A ROP with AP-ROP and progression to retinal detachment is efficacious in terms of anatomic and functional outcomes. Anatomic success is associated with visual improvement despite possible myopic refraction changes during follow-up.

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Incidence of retinopathy of prematurity (ROP) and ROP treatment in Switzerland 2006–2015: a population-based analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313574 ◽

2017 ◽

Vol 103 (4) ◽

pp. F337-F342 ◽

Cited By ~ 11

Author(s):

Roland Gerull ◽

Viviane Brauer ◽

Dirk Bassler ◽

Bernard Laubscher ◽

Riccardo E Pfister ◽

...

Keyword(s):

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Cohort Analysis ◽

Survival Rates ◽

Patient Characteristics ◽

Developed Countries ◽

Population Based ◽

Screening Criteria ◽

Very Preterm Infants ◽

Very Preterm

BackgroundRetinopathy of prematurity (ROP) is a severe complication of preterm birth and can lead to severe visual impairment or even blindness if untreated. The incidence of ROP requiring treatment is increasing in some developed countries in conjunction with higher survival rates at the lower end of gestational age (GA).Material and methodsThe incidence of ROP and severe ROP (sROP) requiring treatment in Switzerland was analysed using the SwissNeoNet registry. We conducted a retrospective cohort analysis of very preterm infants with a GA below 32 weeks who were born between 2006 and 2015 in Switzerland. Patient characteristics were stratified according to GA.Results9.3% and 1.8% of very preterm infants in Switzerland developed ROP of any stage and sROP, respectively. The incidence of ROP treatment was 1.2%. Patients with 24 and 25 weeks GA had the highest proportion of ROP treatment at 14.5% and 7.3%, respectively, whereas the proportion of treated infants at or above a GA of 29 weeks was 0.06%. Similarly, the risk of sROP declined strongly with increasing GA. During the observation period of 10 years, the incidence of ROP treatment ranged between 0.8% and 2.0%. Incidences of sROP or ROP treatment did not increase over time.ConclusionThe incidence of ROP treatment in Switzerland is low and was stable over the analysed period. The low incidence of sROP in patients with a GA of 29 weeks or more leaves room for a redefinition of ROP screening criteria.

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Bilateral Coats’ Disease Combined with Retinopathy of Prematurity

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/364395 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Huseyin Gursoy ◽

Nazmiye Erol ◽

Mustafa Deger Bilgec ◽

Hikmet Basmak ◽

Ozden Kutlay ◽

...

Keyword(s):

Diode Laser ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Intravitreal Bevacizumab ◽

Retinal Hemorrhages ◽

First Report ◽

Postmenstrual Age ◽

Coats Disease ◽

The Right ◽

Additional Therapy

Purpose. To report a case of bilateral Coats’ disease combined with retinopathy of prematurity (ROP).Case. Retinal vascularization was complete in the right eye, whereas zone III, stage 3 ROP and preplus disease were observed in the left eye at 43 weeks of postmenstrual age (PMA) in a 31-week premature, 1200-g neonate. Intraretinal exudates developed and retinal hemorrhages increased in the left eye at 51 weeks of PMA. Diode laser photocoagulation (LP) was applied to the left eye. Exudates involved the macula, and telangiectatic changes developed one month following LP. Additional LP was applied to the left eye combined with intravitreal bevacizumab (IVB) injection at 55 weeks of PMA. Disease regressed one month after the additional therapy. At the 14-month examination of the baby, telangiectatic changes and intraretinal exudates were observed in the right eye. Diode LP was applied to the right eye combined with IVB injection. Exudates did not resolve completely, and cryotherapy was applied one month following LP. Retinal findings regressed three months following the cryotherapy.Conclusion. This is the first report of presumed bilateral Coats’ disease combined with ROP. If Coats’ disease could be diagnosed at early stages, it would be a disease associated with better prognosis.

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Towards Sustainable Entrepreneurial Ecosystems in a Transitional Economy: An Analysis of Two Romanian City-Regions through the Lens of Entrepreneurs

Sustainability ◽

10.3390/su12156061 ◽

2020 ◽

Vol 12 (15) ◽

pp. 6061 ◽

Cited By ~ 1

Author(s):

Ana-Maria Grigore ◽

Irina-Maria Dragan

Keyword(s):

Phenomenological Approach ◽

Developed Countries ◽

Transitional Economy ◽

Entrepreneurial Activity ◽

Specific Context ◽

Entrepreneurial Ecosystems ◽

City Regions ◽

Point Of No Return ◽

Political Entrepreneurs ◽

The Impact

The entrepreneurial ecosystem, one of the latest trends for researchers and practitioners, has the potential to increase our understanding of entrepreneurship. Existing research was conducted mostly in developed countries. The purpose of this paper is to bring to light the particularities of entrepreneurial ecosystems in two important city-regions of Romania, which should result in a better understanding of the specific context of this transitional economy. Starting from the models of entrepreneurial ecosystems proposed in the literature, we added an element specific to most post-communist states: political entrepreneurs, underlying the impact of their presence for the evolution and sustainability of entrepreneurial ecosystems. The research design was a qualitative exploratory study. The study focused on a sample of 21 entrepreneurs from two city-regions in Romania: Bucharest and Cluj-Napoca. The interviews were based on open-ended questions prompting the respondents to engage in a storytelling approach to describe their experiences as entrepreneurs in a volatile environment, along with their perceptions. The data were analyzed based on a descriptive phenomenological approach using thematic analysis. The main findings, resulting from the qualitative interview data, are that although entrepreneurship, both in results and mentality, is well-established, seemingly over the “point of no return”, the particular context is still making things rough for entrepreneurial activity. The results suggest a strong need for coherent policies at local and national levels.

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Incidence of retinopathy of prematurity in Germany: evaluation of current screening criteria

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319767 ◽

2020 ◽

pp. fetalneonatal-2020-319767

Author(s):

Petra P Larsen ◽

Andreas Müller ◽

Wolf A Lagrèze ◽

Frank G Holz ◽

Andreas Stahl ◽

...

Keyword(s):

Risk Factors ◽

Retinopathy Of Prematurity ◽

Screening Programme ◽

University Hospitals ◽

Quality Assurance Procedure ◽

Screening Criteria ◽

Additional Risk ◽

Postmenstrual Age ◽

Current Screening ◽

Rop Screening

ObjectiveTo evaluate current screening criteria for retinopathy of prematurity (ROP) by investigating the incidence of ROP requiring treatment in infants with gestational age (GA) ≥30 weeks or postmenstrual age (PMA) <32 weeks in Germany.MethodsThree patient databases were analysed, that is, the German Quality Assurance Procedure in Neonatology (years 2011–2017; n=52 461 infants screened for ROP, 1505 infants treated for ROP), the German Retina.net ROP Registry (years 2011–2018; n=281 treated infants) and the ROP screening programme of two German university hospitals (years 2012–2016; n=837 screened infants).ResultsIn the analysed cohorts, infants with GA ≥30 weeks represented 33.1%–38.5% of the screening populations but only 1.40%–1.42% of the cases requiring ROP treatment. In a cohort of 281 infants treated for ROP, all 4 infants with GA ≥30 weeks had additional risk factors for ROP including prolonged oxygen supplementation and/or significant comorbidities. Five infants (1.8%) were treated at 32 weeks PMA and none at PMA <32 weeks.ConclusionsIn the investigated cohorts, preterm infants with GA ≥30 weeks carried a very low or no risk for developing treatment-requiring ROP unless additional risk factors were present, and no treatment was performed earlier than 32 weeks PMA. These findings are of relevance for the ongoing re-evaluation of ROP screening criteria.

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Do extremely preterm infants need retinopathy of prematurity screening earlier than 31 weeks postmenstrual age?

Journal of Perinatology ◽

10.1038/s41372-020-0681-6 ◽

2020 ◽

Author(s):

Amy J. Sloane ◽

Elizabeth A. O’Donnell ◽

Amy B. Mackley ◽

Julia E. Reid ◽

Jay S. Greenspan ◽

...

Keyword(s):

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Postmenstrual Age

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Progressive retinal vessel malformation in a premature infant with Sturge-Weber syndrome: a case report and a literature review of ocular manifestations in Sturge-Weber syndrome

BMC Ophthalmology ◽

10.1186/s12886-021-01815-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhengping Hu ◽

Jian Cao ◽

Eun Young Choi ◽

Yun Li

Keyword(s):

Retinopathy Of Prematurity ◽

Retinal Vessel ◽

Male Infant ◽

Clinical Findings ◽

Choroidal Hemangioma ◽

Ocular Manifestations ◽

Weber Syndrome ◽

Postmenstrual Age ◽

Sturge Weber Syndrome ◽

Endothelial Growth Factor

Abstract Background Sturge-Weber syndrome is a disorder marked by a distinctive facial capillary malformation, neurological abnormalities, and ocular abnormalities such as glaucoma and choroidal hemangioma. Case presentation We report a case of progressively formed retinal vessel malformation in a premature male infant with Sturge-Weber syndrome and retinopathy of prematurity, after treatment with intravitreal anti-vascular endothelial growth factor (VEGF). The baby was born at 30 weeks gestation with a nevus flammeus involving his left eyelids and maxillary area. On postmenstrual age week 39, he received intravitreal anti-VEGF. Diffuse choroidal hemangioma became evident at 40 weeks, with the classic “tomato catsup fundus” appearance. These clinical findings characterized Sturge-weber syndrome. He presented with posterior retinal vessel tortuosity and vein-to-vein anastomoses at 44 weeks. Conclusion This is a rare case of documented progression of retinal vessel malformations in a patient with Sturge-Weber syndrome and retinopathy of prematurity.

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