Optos Versus Indirect Ophthalmoscopy for ROP Screening Examination (Optos vs BIO Study)

Retinal Detachment: Principles and Practice provides a historical review of current information on the diagnosis and treatment of retinal detachment. It is intended as both an introduction for graduate students in ophthalmology and a concise review or reference for practicing ophthalmologists. The volume defines the types of retinal detachments, their classifications and causes, and covers preoperative examination, preoperative management, prophylactic procedures, surgery, complications of surgery, and results of reattachment surgery. It also includes a historical introduction, suggested readings at the end of each chapter, and the classic article 'The Technique of Binocular Indirect Ophthalmoscopy,' by Morten L. Rosenthal.

Download Full-text

Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316401 ◽

2020 ◽

pp. bjophthalmol-2020-316401

Author(s):

Qian Yang ◽

Xiaohong Zhou ◽

Yingqin Ni ◽

Haidong Shan ◽

Wenjing Shi ◽

...

Keyword(s):

Cohort Study ◽

Retinopathy Of Prematurity ◽

Neonatal Intensive Care ◽

Predictive Performance ◽

Screening Guideline ◽

Postmenstrual Age ◽

The Mean ◽

Type 1 Rop ◽

Rop Screening

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.

Download Full-text

Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000626 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000626

Author(s):

May May Choo ◽

John Grigg ◽

Elizabeth H Barnes ◽

Nurliza Khaliddin ◽

Tengku Ain Kamalden ◽

...

Keyword(s):

Oxygen Saturation ◽

Real World ◽

Retinopathy Of Prematurity ◽

Screening Programme ◽

Intraventricular Haemorrhage ◽

Developing Nations ◽

Retrospective Comparative Study ◽

Treatment Mortality ◽

Fundoscopic Examination ◽

Rop Screening

ObjectiveAn ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival.Methods and analysisThis retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88–92%], epoch 2 targets [90–95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage.ResultsA total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively.ConclusionIncidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.

Download Full-text

Screening auf Frühgeborenenretinopathie – die wichtigsten Änderungen in der neuen deutschen Leitlinie 2020

Der Ophthalmologe ◽

10.1007/s00347-021-01393-6 ◽

2021 ◽

Author(s):

Jeany Q. Li ◽

Ulrich Kellner ◽

Birgit Lorenz ◽

Andreas Stahl ◽

Tim U. Krohne

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinopathy Of Prematurity ◽

Vascular Endothelial ◽

Anti Vegf ◽

Zone Ii ◽

Endothelial Growth Factor ◽

Rop Screening

Zusammenfassung Hintergrund Durch Verbesserungen in der neonatologischen Versorgung von Frühgeborenen und die Entwicklung neuer Behandlungsmöglichkeiten der Frühgeborenenretinopathie („retinopathy of prematurity“ [ROP]) haben sich die Anforderungen an das ROP-Screening seit der Veröffentlichung der letzten Fassung der deutschen Leitlinie zum ROP-Screening im Jahr 2008 verändert. Auf Grundlage aktueller Studiendaten wurde die Leitlinie in 2020 grundlegend überarbeitet und in einer aktualisierten Fassung veröffentlicht. Ziel Dieser Artikel fasst die wichtigsten Änderungen in der neuen Leitlinie zusammen. Ergebnisse Die Altersgrenze für einen Screeningeinschluss wurde für Kinder ohne zusätzliche Risikofaktoren auf ein Gestationsalter von unter 31 Wochen gesenkt. Die Mindestdauer für eine Sauerstoffsupplementation, die einen Einschluss in das Screening bei Frühgeborenen erforderlich macht, wurde auf über 5 Tage angehoben. Eine Behandlung bei ROP in Zone II kann nun schon bei jedem Stadium 3 mit Plus-Symptomatik unabhängig von der Anzahl der betroffenen Uhrzeiten erfolgen. Für die Nachkontrollen nach Anti-VEGF („vascular endothelial growth factor“)-Therapie wurden Kriterien zur Frequenz und Dauer definiert. Das verbindliche Dokument für diese und weitere neue Empfehlungen ist die Leitlinie selber. Schlussfolgerungen Die Empfehlungen der Leitlinie ermöglichen eine zuverlässige Identifikation von Kindern mit ROP-Risiko für den Einschluss in das Screening und eine rechtzeitige Erkennung fortgeschrittener Krankheitsstadien für die Therapieeinleitung, um so Erblindung durch ROP zu verhindern.

Download Full-text

Risk Factors for Retinopathy of Prematurity in the Netherlands: A Comparison of Two Cohorts

Neonatology ◽

10.1159/000517247 ◽

2021 ◽

pp. 1-8

Author(s):

Kasia Trzcionkowska ◽

Floris Groenendaal ◽

Peter Andriessen ◽

Peter H. Dijk ◽

Frank A.M. van den Dungen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

The Netherlands ◽

Retinopathy Of Prematurity ◽

Screening Guideline ◽

Potential Risk Factors ◽

Second Period ◽

Perinatal Database ◽

Rop Screening

Introduction: Retinopathy of prematurity (ROP) remains an important cause for preventable blindness. Aside from gestational age (GA) and birth weight, risk factor assessment can be important for determination of infants at risk of (severe) ROP. Methods: Prospective, multivariable risk-analysis study (NEDROP-2) was conducted, including all infants born in 2017 in the Netherlands considered eligible for ROP screening by pediatricians. Ophthalmologists provided data of screened infants, which were combined with risk factors from the national perinatal database (Perined). Clinical data and potential risk factors were compared to the first national ROP inventory (NEDROP-1, 2009). During the second period, more strict risk factor-based screening inclusion criteria were applied. Results: Of 1,287 eligible infants, 933 (72.5%) were screened for ROP and matched with the Perined data. Any ROP was found in 264 infants (28.3% of screened population, 2009: 21.9%) and severe ROP (sROP) (stage ≥3) in 41 infants (4.4%, 2009: 2.1%). The risk for any ROP is decreased with a higher GA (odds ratio [OR] 0.59 and 95% confidence interval [CI] 0.54–0.66) and increased for small for GA (SGA) (1.73, 1.11–2.62), mechanical ventilation >7 days (2.13, 1.35–3.37) and postnatal corticosteroids (2.57, 1.44–4.66). For sROP, significant factors were GA (OR 0.37 and CI 0.27–0.50), SGA (OR 5.65 and CI 2.17–14.92), postnatal corticosteroids (OR 3.81 and CI 1.72–8.40), and perforated necrotizing enterocolitis (OR 7.55 and CI 2.29–24.48). Conclusion: In the Netherlands, sROP was diagnosed more frequently since 2009. No new risk factors for ROP were determined in the present study, apart from those already included in the current screening guideline.

Download Full-text

Retinopathy of Prematurity—Using Electronic Medical Records to Efficiently Follow Patients at Multiple Hospitals

Journal of Neonatology ◽

10.1177/09732179211007600 ◽

2021 ◽

pp. 097321792110076

Author(s):

Gwendolyn Schultz ◽

Majida Gaffar

Keyword(s):

Retinopathy Of Prematurity ◽

Neonatal Intensive Care ◽

Transitional Period ◽

Neonatal Intensive Care Units ◽

American Academy Of Pediatrics ◽

Time Period ◽

Cost Efficient ◽

Delay Of Care ◽

Physician Scheduling ◽

Rop Screening

Purpose: To report the use of a centralized electronic medical record (EMR) to provide timely retinopathy of prematurity (ROP) screening in a previously fragmented monitoring system in a standalone children’s hospital in Connecticut. Methods: A chart review of 306 visits for ROP screening in 3 neonatal intensive care units (NICUs) over a time period of 24 months. Results: All infants born at <30 weeks gestational age or birth weight <1,500g (N = 107) at these NICUs were screened for ROP according to the American Academy of Pediatrics guidelines. Data was collected before the implementation of our centralized EMR list, during a transitional period, and once the list was established. Our analysis of the data found an improvement in delay of care from 16.85% to 10.83% of visits, and a decrease in number of visits done during off hours from 20.4% to 5% of visits. Conclusion: Our tool was a free and cost-efficient centralization of a once difficult-to-manage process for ROP screenings in Connecticut. The decrease in delay of care and improvement in physician scheduling will lead to better outcomes for our patients and better sustainability of practice for our providers.

Download Full-text