Favorable outcomes in the treatment of aggressive posterior retinopathy of prematurity

Objectives: To report the results of intravitreal ranibizumab injection as primary therapy in aggressive posterior retinopathy of prematurity, the process of the disease, and the additive treatments performed. Methods: This retrospective case review included 15 eyes of 8 premature babies with aggressive posterior retinopathy of prematurity who were initially treated with intravitreal ranibizumab injection. The documented data were gestational age, birth weight, gender, postmenstrual age at intravitreal ranibizumab injection, zone of retinopathy of prematurity, reactivation time of disease, iris neovascularization, retinal hemorrhage, anatomical outcome, and additional treatment. Results: Median gestational age at birth was 26 (range, 23–27) weeks, birth weight was 730 (range, 550–970) g, and postconceptional age at aggressive posterior retinopathy of prematurity diagnosis and intravitreal ranibizumab injection was 35 (range, 33–35) weeks. Intravitreal ranibizumab injection was performed as primary treatment. Two eyes necessitated a second intravitreal ranibizumab injection. The reactivation of retinopathy of prematurity was 5 (range, 3–7) weeks after intravitreal ranibizumab injection. Recurrence of the disease in Zone II was treated with laser photocoagulation. A favorable outcome was obtained in all eyes (100%). Conclusion: Aggressive posterior retinopathy of prematurity is a serious, rapidly progressing form of retinopathy of prematurity that requires quick and proper management. This study indicates that primary treatment with ranibizumab and laser photocoagulation on recurrence provide favorable anatomical outcomes.

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Macular Development in Aggressive Posterior Retinopathy of Prematurity

BioMed Research International ◽

10.1155/2015/808639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Hemang K. Pandya ◽

Lisa J. Faia ◽

Joshua Robinson ◽

Kimberly A. Drenser

Keyword(s):

Birth Weight ◽

Laser Treatment ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Posterior Pole ◽

Close Proximity ◽

Postmenstrual Age ◽

The Mean ◽

Anterior Posterior

Purpose. To report anatomic outcomes after early and confluent laser photocoagulation of the entire avascular retina, including areas in close proximity to the fovea, in patients with APROP. We aspire to demonstrate fundoscopic evidence of transverse growth and macular development following laser treatment in APROP.Methods. Retrospective review of 6 eyes with APROP that underwent confluent laser photocoagulation of the entire avascular retina. Photographic fundoscopic imaging was performed using the RetCam to compare outcomes after treatment.Results. Mean birth weight and gestational age were 704.8 g and 24.33 weeks, respectively. There were 2 females and 1 male. The average time to laser was 9.3 weeks after birth, with the mean postmenstrual age of 34 weeks. Two eyes had zone 1 and 4 eyes had posterior zone 2 disease. Three eyes developed 4A detachments, which were successfully treated. All 6 eyes experienced transverse growth, with expansion of the posterior pole and anterior displacement of the laser treatment.Conclusion. Confluent photocoagulation of the entire avascular retina, regardless of foveal proximity, should be the mainstay for treating APROP. Examination should be conducted within 5–10 days to examine areas previously hidden by neovascularization to ensure prudent therapy. Macular development involves both transverse and anterior-posterior growth.

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Intravitreal ranibizumab versus laser photocoagulation for retinopathy of prematurity: efficacy, anatomical outcomes and safety

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312272 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1332-1336 ◽

Cited By ~ 2

Author(s):

Hyun Goo Kang ◽

Eun Young Choi ◽

Suk Ho Byeon ◽

Sung Soo Kim ◽

Hyoung Jun Koh ◽

...

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Case Series ◽

Therapeutic Effects ◽

Type I ◽

Intravitreal Ranibizumab ◽

Retrospective Case ◽

Major Complications ◽

Anatomical Outcomes

Background/AimsTo compare the efficacy, anatomical outcomes and complications of intravitreal ranibizumab with those of laser photocoagulation for retinopathy of prematurity (ROP).MethodsThis is a retrospective case series of 314 eyes from 165 infants diagnosed with type I ROP and treated with either laser photocoagulation (161 eyes) or intravitreal ranibizumab (0.25 mg/0.025 mL) injection (153 eyes) between January 2006 and December 2016 in a tertiary referral-based hospital. The main outcome was the rate of recurrence requiring additional treatment. Secondary outcomes included the incidence of major complications and final refractive error.ResultsThe mean follow-up was 36.3±31.9 months. Recurrences requiring further intervention were noted in 22 (13.7%) laser-treated and 15 (9.8%) ranibizumab-treated eyes (p=0.196). Retinal detachment (8 vs 1, p=0.037) and macular dragging (7 vs 1, p=0.039) were observed in the laser-treated and injection-treated groups, respectively, but no systemic or neurodevelopmental adverse events were reported. In the ranibizumab group, 95.6% showed fully vascularised retinas. Multivariate analyses revealed that birth weight (OR 0.993, p=0.023) and higher ROP stage (OR 11.222, p=0.008) influenced the incidence of major complications.ConclusionIntravitreal ranibizumab for ROP appears to achieve similar therapeutic effects than did laser photocoagulation, but with fewer surgical complications such as retinal detachment or macular dragging.

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Different retinopathy of prematurity severity and outcomes in triplets: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20944306 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2094430

Author(s):

Ashwaq Bin Amro ◽

Rawdha Alnuaimi ◽

Tin Chan ◽

Abeer Alali

Keyword(s):

Case Report ◽

Weight Gain ◽

Birth Weight ◽

Diode Laser ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Spherical Equivalent ◽

Intravitreal Ranibizumab ◽

The Right

In this case report, we discuss the presentation of retinopathy of prematurity in triplets born at 25 + 3 weeks gestational age of whom each had a different birth weight, weight gain and treatment requirements. Triplet A weighed 800 g and his retinopathy of prematurity had resolved with no intervention. Triplet B weighed 630 g at birth and he required bilateral intravitreal ranibizumab injection at 32 + 6 weeks. Triplet C weighed 520 g and required bilateral intravitreal ranibizumab injection at 36 weeks, but after 5 weeks he had recurrence which was treated with bilateral diode laser. Triplet C had the poorest weight gain. The main differences between the triplets are the birth weight and the weight gain. Furthermore, refraction was performed at 10 months; triplet A had a hyperopia of +1.25 spherical equivalent in both eyes, triplet B had mild myopia of −0.25 spherical equivalent and triplet C had a myopia of −3.00 spherical equivalent in the right eye and −2.75 spherical equivalent in the left eye.

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A Longitudinal Study of Retinopathy of Prematurity at Great Eastern Medical School and Hospital, Srikakulam

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/116 ◽

2021 ◽

Vol 8 (11) ◽

pp. 593-596

Author(s):

Lakshmi Sativada ◽

Dineshkanth Vudayana ◽

Tejapraveen P ◽

Jogendra Prasad Behra

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Medical School ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Anti Vegf ◽

Department Of Ophthalmology ◽

Indirect Ophthalmoscope ◽

Rop Screening

BACKGROUND Retinopathy of prematurity (ROP) is a vasculopathy affecting the premature retina. In India ROP is increasing due to the increased premature deliveries, well improved neonatal care and better neonatal survival rate. ROP screening by an experienced ophthalmologist plays an important role in screening, identifying and management of at-risk premature infants. Nowadays, the gold standard treatment is laser photocoagulation of avascular retina and anti-vascular endothelial growth factor (VEGF) depending on the severity of disease. METHODS This observational study included 152 babies who were referred to the Department of Ophthalmology at Great Eastern Medical School (GEMS), Srikakulam for ROP screening. The screening of eyes was done with a binocular indirect ophthalmoscope with 20 D lens. Eyes were examined by application of topical anaesthetic drops after applying topical tropicamide drops till full dilatation was noted. ROP was staged and treatment was given accordingly. RESULTS Totally 152 infants were screened for ROP in the Department of Ophthalmology. Babies with gestational age between 26 weeks and 36 weeks were included in the present study. Babies with birth weight between 900 gm and 2000 gm were also included in the study. Of the 152 babies which were included in the study, 54 babies presented with different stages of ROP. The incidence of ROP in the present study was found out to be 35.5 %. When incidence of ROP was noted with respect to birthweight, in extremely low birth weight (ELBW) babies, incidence was found out to be 71.4 %; in very low birth weight (VLBW) babies incidence rate was found to be 48.4 %. When incidence of ROP was noted with respect to gestational age ROP incidence was found to be 65.2 % in babies with gestational age of < 32 weeks. There was no association with gender in the incidence of ROP. When ROP incidence was noted in babies who received O2 therapy 59.2 % babies who received O2 therapy developed ROP. CONCLUSIONS In our study, at our institute the incidence of ROP was 35.5 %. With appropriate screening for the babies at risk we can prevent the development of ROP and further complications. According to study results our recommendations are that initial screening should to be done as early as 4 weeks of postnatal age or 34 - 35 weeks post conceptional age and to be followed till term gestation. In the present study we found that usage of anti VEGF came out with promising outcome results. The procedure of anti VEGF was relatively safe and easy with a smaller number of complications when compared to laser photocoagulation. KEYWORDS Retinopathy of Prematurity, Laser Photocoagulation, Indirect Ophthalmoscope, Tropicamide, Anti VEGF

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Combination of Intravitreal Ranibizumab and Laser Photocoagulation for Aggressive Posterior Retinopathy of Prematurity

Case Reports in Ophthalmology ◽

10.1159/000338623 ◽

2012 ◽

Vol 3 (1) ◽

pp. 136-141 ◽

Cited By ~ 26

Author(s):

Ágata Mota ◽

Ângela Carneiro ◽

Jorge Breda ◽

Vitor Rosas ◽

Augusto Magalhães ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Intravitreal Ranibizumab

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A study of risk factors and their correlation with severity of retinopathy of prematurity: a prospective study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204039 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1984

Author(s):

Bhuvaneshwari C. Yelameli ◽

Ramesh V. Neelannavar ◽

Kiruthika Das

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Survival Rates ◽

Wide Field ◽

Maternal Risk ◽

Medical College ◽

Stage 4 ◽

A Prospective Study

Background: Recent advances in neonatal care in the last decade and improved survival rates have resulted in an apparent increase in the incidence of retinopathy of prematurity (ROP), which is the most important cause of preventable blindness in infants. This study was done to identify the risk factors which predispose to ROP and to assess its correlation with severity of ROP.Methods: A total of 140 neonates with gestational age ≤34 weeks, birth weight ≤2000 grams who were admitted at NICU, S. N. Medical College and HSK Hospital, Bagalkot from December 2018 to May 2019 were considered. Babies were assessed and recorded for the risk factors of ROP in a predesigned proforma. ROP screening was performed using wide-field digital imaging on a retcam shuttle (Clarity MSI, USA).Results: A total of 140 babies were examined, and an overall incidence of ROP was 52 (37.1%). 17 (32.7%) had stage 3, 3 (5.8%) had stage 4, and 1 (1.9%) had stage 5. Among the 52 babies with ROP, 19 (51.3%) underwent laser photoablation. Risk factors like gestational age, birth weight, maternal risk factors, apnea, intrauterine growth restriction (IUGR), hypoglycaemia, respiratory distress syndrome (RDS), sepsis, coronary heart disease (CHD), blood transfusion and oxygen requirement duration were significantly associated with ROP. Delay in the establishment of feeds has been associated with ROP (p<0.001).Conclusions: Screening should be intensified in the presence of risk factors which can reduce the incidence of severe stages of ROP as highlighted by this study.

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Retinopathy of Prematurity in A Tertiary Care Hospital in Eastern Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.213 ◽

2008 ◽

Vol 47 (169) ◽

Author(s):

Srijana Adhikari ◽

B P Badhu ◽

N K Bhatta ◽

R S Rajbhandari ◽

B K Kalakheti

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Neonatal Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Screening Criteria

World Health Organization’s Vision 2020 program has recognized Retinopathy of Prematurity(ROP) as an important cause of childhood blindness in industrialized and developing countries. Inthe last few years, it has been identifi ed in many under developed countries as well, as a result ofimproved neonatal intensive care. In Nepal, ROP screening is carried out in a few tertiary hospitalsbut there is no published data on this disease. The purpose of this study was to fi nd out the incidence,severity and risk factors of ROP among infants screened in a tertiary care hospital in the EasternRegion of Nepal.A prospective cohort study was carried out in neonates with gestational age of 34 weeks or less and,or birth weight of 1700 gm or less born over the period of one year. Dilated fundus examination ofall babies was done by indirect ophthalmoscopy between 2-4 weeks after birth and followed up tillthe retinal vascularization was complete. Classifi cation of ROP was done according to internationalclassifi cation (ICROP). Maternal and neonatal risk factors were also noted.A total of 55 babies fulfi lled the screening criteria. ROP was present in 25.45% (n=14) of the babies.Threshold disease was noted in 5.45% (n=3) of the babies screened. Low birth weight (p<0.01)and low gestational age (p<0.01) was signifi cantly associated with the incidence of ROP. Oxygensupplementation (p=<0.01) was an independent risk factor.ROP screening should be performed in all preterm low birth weight infants where there is availabilityof good neonatal intensive care units. The examination should be intensifi ed in those having riskfactors like oxygen. Further studies in the other tertiary care hospitals in Nepal would help toestablish the screening criteria for Nepalese infants.Key words: Retinopathy of prematurity, Eastern Nepal, screening

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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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Retinopathy of prematurity: Prevalence and risk factors

Paediatrica Indonesiana ◽

10.14238/pi45.6.2005.270-4 ◽

2016 ◽

Vol 45 (6) ◽

pp. 270

Author(s):

Rinawati Rohsiswatmo

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Supplemental Oxygen ◽

Severe Illness ◽

Blood Transfusions ◽

Inclusion Criteria ◽

Cross Sectional ◽

Background Retinopathy ◽

Multiple Blood

Background Retinopathy of prematurity (ROP) is one of the ma-jor causes of infant blindness. There are several factors known asrisk factors for ROP. Recent studies show ROP as a disease ofmultifactorial origin.Objective To report the prevalence of ROP in Cipto MangunkusumoHospital, Jakarta and its relation to several risk factors.Methods A cross-sectional descriptive study was conducted fromDecember 2003-May 2005. All infants with birth weight 2500 gramsor less, or gestational age 37 weeks or less, were enrolled con-secutively and underwent the screening of ROP at 4 to 6 weeks ofchronological age or 31 to 33 weeks of postconceptional age.Result Of 73 infant who met the inclusion criteria, 26% (19 out of73 infant) had ROP in various degrees. About 36.8% (7 out of 19infants) were in stage III or more/threshold ROP. No ROP wasnoted in infants born >35 weeks of gestational age, and birth weight>2100 grams. No severe ROP was found in gestational age >34weeks and birth weight >1600 grams. None of full-term, small forgestational age infants experienced ROP. Birth weight, sepsis,apneu, asphyxia, multiple blood transfusions, and oxygen therapyfor more than 7 days were statistically significant with the develop-ment of ROP. However, using multivariate analysis, only asphyxia,multiple blood transfusions, and oxygen therapy for more than 7days were statistically significant with the development of ROP.Conclusion Screening of ROP should be performed in infantsborn 34 weeks of gestational age and/or birth weight <1600 grams.Infants with birth weight from 1600-<2100 grams need to bescreened only if supplemental oxygen is necessary or with clini-cally severe illness

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High-Dose Erythropoietin in Extremely Low Gestational Age Neonates Does Not Alter Risk of Retinopathy of Prematurity

Neonatology ◽

10.1159/000511262 ◽

2020 ◽

pp. 1-8

Author(s):

Dennis E. Mayock ◽

Zimeng Xie ◽

Bryan A. Comstock ◽

Patrick J. Heagerty ◽

Sandra E. Juul ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

High Frequency ◽

High Dose ◽

Heart Murmur ◽

Treatment Groups ◽

Increased Risk ◽

Gestational Age At Birth ◽

Age At Birth

Introduction: The Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial sought to determine the safety and efficacy of early high-dose Epo as a potential neuroprotective treatment. We hypothesized that Epo would not increase the incidence or severity of retinopathy of prematurity (ROP). Methods: A total of 941 infants born between 24–0/7 and 27–6/7 weeks’ gestation were randomized to 1,000 U/kg Epo or placebo intravenously for 6 doses, followed by subcutaneous or sham injections of 400 U/kg Epo 3 times a week through 32 weeks post-menstrual age. In this secondary analysis of PENUT trial data, survivors were evaluated for ROP. A modified intention-to-treat approach was used to compare treatment groups. In addition, risk factors for ROP were evaluated using regression methods that account for multiples and allow for adjustment for treatment and gestational age at birth. Results: Of 845 subjects who underwent ROP examination, 503 were diagnosed with ROP with similar incidence and severity between treatment groups. Gestational age at birth, birth weight, prenatal magnesium sulfate, maternal antibiotic exposure, and presence of heart murmur at 2 weeks predicted the development of any ROP, while being on high-frequency oscillator or high-frequency jet ventilation (HFOV/HFJV) at 2 weeks predicted severe ROP. Conclusion: Early high-dose Epo followed by maintenance dosing through 32 weeks does not increase the risk of any or severe ROP in extremely low gestational age neonates. Gestational age, birth weight, maternal treatment with magnesium sulfate, antibiotic use during pregnancy, and presence of a heart murmur at 2 weeks were associated with increased risk of any ROP. Treatment with HFOV/HFJV was associated with an increased risk of severe ROP.

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