Management of Type 2 Retinopathy of Prematurity or Less in Infants Aged 45 Weeks Postmenstrual Age or Older

Introduction This study aimed to evaluate the validity of using real-time video indirect ophthalmoscopy for telemedicine consultations for paediatric retinal findings, using retinopathy of prematurity (ROP) as a model disease. Methods An ophthalmologist simultaneously performed and recorded routine ROP screenings on enrolled premature infants (aged ≤30 weeks and weighing <1500 g) using the Keeler digital indirect ophthalmoscope. Examinations were graded as no ROP, mild, type 1 or type 2. Masked to clinical findings, another ophthalmologist reviewed and graded streamed video feed transmitted at 4096 kbps. We compared the sensitivity and specificity of diagnosing ROP via streamed and stored-and-forwarded video clips to the gold-standard in-person examination. Results A total of 150 examinations of individual eyes from 34 babies were included. The median postmenstrual age (PMA) at delivery was 24 weeks (range 23–34 weeks), the median birth weight was 630 g (range 455–1530 g) and the median PMA at examination was 37 weeks (range 31–54 weeks). Of those infants with any ROP, the sensitivity and specificity of streamed examinations were 100% and 70.6%, respectively. For type 2 or worse ROP, the sensitivity and specificity were 92.5% and 86.1%, respectively. For type 1 ROP, the sensitivity and specificity were 100% and 99.3%, respectively. Sensitivities (unless already 100%) and specificities were slightly higher for store-and-forward evaluations. Discussion Streamed video feed from the digital indirect ophthalmoscope can be utilised to diagnose clinically significant ROP accurately, though store-and-forward video review yielded slightly better results.

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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.

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

Clinical and Experimental Ophthalmology ◽

10.1111/j.1442-9071.2008.01682.x ◽

2008 ◽

Vol 36 (2) ◽

pp. 159-161 ◽

Cited By ~ 9

Author(s):

Susan Mary Carden ◽

Lan Ngoc Luu ◽

Tinh Xuan Nguyen ◽

Tess Huynh ◽

William Vance Good

Keyword(s):

Retinopathy Of Prematurity ◽

Developed Countries ◽

Transitional Economy ◽

Postmenstrual Age

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Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

Frontiers in Pediatrics ◽

10.3389/fped.2021.679546 ◽

2021 ◽

Vol 9 ◽

Author(s):

Marie Altendahl ◽

Myung Shin Sim ◽

Artemiy Kokhanov ◽

Bradley Gundlach ◽

Irena Tsui ◽

...

Keyword(s):

Health Insurance ◽

Retinopathy Of Prematurity ◽

Preterm Neonates ◽

Neurodevelopmental Outcomes ◽

Age Cohort ◽

Male Sex ◽

The Relationship ◽

Type 1 Rop

Purpose: To evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes in premature neonates at 0–36 months corrected age.Methods: A retrospective chart review was performed on 228 neonates screened for ROP at the UCLA Mattel Children's Hospital between 2011 and 2018. Demographic information, clinical outcomes, ROP severity (no ROP, type 1 ROP, type 2 ROP), and Bayley-III neurodevelopmental scores were collected. Infants were grouped into corrected age cohorts (0–12, 12–24, and 24–36 months) to assess neurodevelopmental outcomes with increasing age. Within each age cohort, ANOVA and Chi-Square testing were used to detect differences in birth characteristics and neurodevelopmental scores between infants with type 1 ROP, type 2 ROP, or no ROP. Univariable analyses assessed the relationship between ROP severity and neurodevelopmental outcomes within each age cohort. A multivariable analysis was then performed to determine if ROP severity remained significantly associated with worse neurodevelopmental scores after controlling for birth weight (BW), intraventricular hemorrhage grade (IVH), health insurance type, male sex, and age at Bayley testing.Results: Without controlling for factors associated with prematurity, neonates with type 1 ROP had poorer cognition (p = 0.001) and motor (p = 0.006) scores at ages 0–12 months and poorer cognition (p = 0.01), language (p = 0.04) and motor (p = 0.04) scores at ages 12–24 months than infants without ROP, but no significant differences were detected at ages 24–36 months. After adjusting for BW, IVH, insurance type, male sex, and age at Bayley testing, ROP severity was no longer associated with worse neurodevelopmental scores in any domain.Conclusion: This study emphasizes that poorer neurodevelopmental outcomes in preterm neonates are most likely related to lower birthweight, associated co-morbidities of prematurity, and socioeconomic factors such as health insurance, not severity of ROP itself.

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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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