Foveal structure changes in infants treated with anti-VEGF therapy or laser therapy guided by optical coherence tomography angiography for retinopathy of prematurity

AIM: To evaluate foveal vessel density (VD) and foveal thickness using optical coherence tomography angiography (OCTA) in retinopathy of prematurity (ROP) children treated with laser photocoagulation or anti-vascular endothelial growth factor (VEGF) injection. Additionally, we assessed the relationship between foveal microvascular anomalies and different therapies in ROP children. METHODS: This was a single-center, retrospective study of patients with a diagnosis of type 1 ROP. Twenty-three eyes (14 patients) treated with anti-VEGF injection and twenty-nine eyes (17 patients) treated with laser coagulation were included in this study. The foveal VD, inner thickness and full thickness were measured at the central 0°, 2° to 8°, and 8° of the retina (centered on the fovea) using OCTA and cross-sectional OCT, respectively. RESULTS: Foveal VD, inner thickness and full thickness were significantly smaller within the central 8° of the retina in ROP children treated with anti-VEGF injection than in those treated with laser photocoagulation (P=0.013, 0.009, 0.036, respectively). The full thickness was also smaller in the anti-VEGF group than in the laser group at the central 0° of the retina (P=0.010). The grade of foveal hypoplasia is lower in the anti-VEGF group than in the laser group (P=0.045). Multivariable analysis did not find any risk factors associated with visual acuity in our study. CONCLUSION: In children with type 1 ROP, the better structural development of fovea in those who were treated with anti-VEGF injection compared with laser photocoagulation are identified. However, visual acuity outcomes are similar 70mo after the treatments.

Pattern and risk factors of retinopathy of prematurity in tertiary care centre

Retinopathy of prematurity is one of the commonest cause of blindness in sick neonates exposed to excessive oxygen following NICU admissions. The present study was thus conducted to assess the pattern and risk factors associated with incidence of retinopathy of prematurity.A retrospective record based study was conducted at tertiary care centre between 1st July 2017 to 30thMay 2020 were screened for ROP. Baseline characteristics and risk factors for ROP were assessed. The zone and stage of ROP were categorized as per the International classification of ROP along with iris neovascularisation and plus disease as per the revised international classification of retinopathy of prematurity (ICROP) preplus disease criteria. Data was entered in excel sheet and analysed using SPSS software version 20.Majority of neonates belonged to gestational age of 28 to 31 weeks (58.8%) and 51.2% neonates had birthweight of 1.5 to 2 kg. Male preponderance was observed with male: female ratio of 1.75:1. Amongst the various risk factors, the occurrence of ROP was highly significantly associated with gestational age and birthweight (p<0.01). Subgroup analysis revealed that aggressive posterior ROP (APROP) contributed significantly to Type I ROP in 11.1% (3) cases. And the observed difference in gestational age and birthweight between APROP and other cases of ROP were statistically highly significant (p<0.01).Early and timely screening of ROP for all high risk neonates especially low birth weight and neonates with small gestational age should be mandatory as these are the most significant risk factors associated with ROP in present study.

Incidence and risk factors of retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India

To study the incidence and risk factors of Retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India. A prospective cohort study of all neonates born during January 1, 2015 to December 31, 2015, with birth weight less than 1000 grams. Demographic details, risk factors and incidence of ROP were studied. Sixty babies were enrolled for the study with mean birth weight of 892.983±112.933 (560 to 1000) grams and mean gestation age of 29.47±2.258 (25-35) weeks. The incidence of ROP in this cohort was 50% (30 infants), out of which 23% (7 infants) required treatment (laser photocoagulation). The statistical analysis of risk factors on univariate analysis revealed significant association for oxygen exposure, apnoea, surfactant use, anaemia, blood transfusion, intraventricular haemorrhage, sepsis and antibiotic use. On multivariate logistic regression analysis anemia and oxygen exposure > week were found to be independent risk factors for development of ROP. The incidence of ROP was although high in this exclusive cohort of babies born <1000g but there is substantial decrease in incidence as compared to that reported in earlier studies. Gestational age <30 wks, being appropriate for gestation rather than small for gestation, anemia and oxygen exposure>1 week were found to be independent risk factors for development of ROP in this cohort.

Ocular phenotype and genetical analysis in patients with retinopathy of prematurity

Background Retinopathy of prematurity (ROP) is a multifactorial retinal disease, involving both environmental and genetic factors; The purpose of this study is to evaluate the clinical presentations and genetic variants in Chinese patients with ROP. Methods A total of 36 patients diagnosed with ROP were enrolled in this study, their medical and ophthalmic histories were obtained, and comprehensive clinical examinations were performed. Genomic DNA was isolated from peripheral blood of ROP patients, polymerase chain reaction and direct sequencing of the associated pathogenic genes (FZD4, TSPAN12, and NDP) were performed. Results All patients exhibited the clinical manifestations of ROP. No mutations were detected in the TSPAN12 and NDP genes in all patients; Interestingly, three novel missense mutations were identified in the FZD4 gene (p.A2P, p.L79M, and p.Y378C) in four patients, for a detection rate of 11.1% (4/36). Conclusions This study expands the genotypic spectrum of FZD4 gene in ROP patients, and our findings underscore the importance of obtaining molecular analyses and comprehensive health screening for this retinal disease.

Oxygen care and treatment of retinopathy of prematurity in ocular and neurological prognosis

This retrospective cohort study aimed to investigate the effects of neonatal oxygen care and retinopathy of prematurity (ROP) treatment on ROP-related ocular and neurological prognoses. We included premature infants treated for ROP at a tertiary referral center between January 2006 and December 2019. Demographic and clinical data were collected from electronic medical records. Odds ratios (ORs) of oxygen care- and ROP treatment-related factors were calculated for ocular and neurological comorbidities 3 years after ROP treatment, after adjusting for potential confounders. ROP requiring treatment was detected in 171 eyes (88 infants). Laser treatment for ROP (OR = 4.73, 95% confidence interval [CI] 1.64–13.63) and duration of invasive ventilation (OR = 1.02, 95% CI 1.00–1.03) were associated with an increase in ocular comorbidities, along with a history of neonatal seizure (OR = 28.29, 95% CI 5.80–137.95) and chorioamnionitis (OR = 32.13, 95% CI 5.47–188.74). No oxygen care- or ROP treatment-related factors showed significant odds for neurological comorbidities. Shorter duration of invasive oxygen supply during neonatal care (less than 49 days) and anti-vascular endothelial growth factor injection as the primary treatment for ROP are less likely to cause ocular comorbidities. No association was identified between ROP treatment modalities and the risk of neurological comorbidities.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Swiss cohort

Background Currently used screening criteria for retinopathy of prematurity (ROP) show high sensitivity for predicting treatment-requiring ROP but low specificity; over 90% of examined infants do not develop ROP that requires treatment (type 1 ROP). A novel weight gain-based prediction model was developed by the G-ROP study group to increase the specificity of the screening criteria and keep the number of ophthalmic examinations as low as possible. This retrospective cohort study aimed to externally validate the G-ROP screening criteria in a Swiss cohort. Methods Data from 645 preterm infants in ROP screening at Inselspital Bern between January 2015 and December 2019 were retrospectively retrieved from the screening log and analysed. The G-ROP screening criteria, consisting of 6 trigger parameters, were applied in infants with complete data. To determine the performance of the G-ROP prediction model for treatment-requiring ROP, sensitivity and specificity were calculated. Results Complete data were available for 322 infants who were included in the analysis. None of the excluded infants had developed type 1 ROP. By applying the 6 criteria in the G-ROP model, 214 infants were flagged to undergo screening: among these, 14 developed type 1 ROP, 9 developed type 2 ROP, and 43 developed milder stages of ROP. The sensitivity for predicting treatment-requiring ROP was 100% (CI, 0.79–1.00), and the specificity was 41% (CI, 0.35 –0.47). Implementing the novel G-ROP screening criteria would reduce the number of infants entering ROP screening by approximately one third. Conclusions The overall prevalence of treatment-requiring ROP was low (2.15%). Previously published performance parameters for the G-ROP algorithm were reproducible in this Swiss cohort. Importantly, all treatment-requiring infants were correctly identified. By using these novel criteria, the burden of screening examinations could be significantly reduced.

G-ROP Criteria for Predicting Retinopathy of Prematurity Among Neonates with Different Birth Weight Percentiles

Purpose: To determine whether being small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) affected the sensitivity and specificity of Postnatal Growth and Retinopathy of Prematurity (G-ROP) model. Methods: We applied the G-ROP criteria, except hydrocephalus, for prematures retrospectively. The infants were divided into three subgroups according to birth weight percentiles (SGA, AGA, LGA), and the performance of the G-ROP criteria was tested for each group by calculating sensitivity and specificity for any stage retinopathy of prematurity (ROP) and severe ROP. Severe ROP was defined as ROP needing treatment. Results: Three hundred and ninety neonates screened for ROP were included. The gestational age and birth weight of the neonates were 29.3±2.9 weeks and 1302.9±416 g, respectively. There were 41 (10.5%) SGA, 312 (80%) AGA and 37 (9.5%) LGA neonates. The sensitivity of the model for any ROP was 67.8%, 66.7%, 73.2%, 55.6% for all of the patients in the study, SGA, AGA, and LGA neonates, respectively. The sensitivity of the model for severe ROP in all group and for each subgroup was 100%. The specificity of the model for any ROP was 65.9%, 70.6%, 87.7%, 90% for all of the patients, SGA, AGA, and LGA neonates, respectively. The specificity for severe ROP was 46.4%, 50%, 44%, 63.6% for all of the patients, SGA, AGA, and LGA neonates, respectively.Conclusion: The sensitivity and specificity of the G-ROP model in SGA infants were similar with the whole group, but was different between SGA, AGA and LGA neonates. Although the model did not miss any severe ROP, the specificity of the model for severe ROP was found low.