Prevalence of retinopathy of prematurity: a 3-year retrospective study

Background: Retinopathy of prematurity (ROP) is a vasoproliferative disease of premature infants which leads to permanent blindness. Early screening is needed to diagnose ROP and prevent blindness.Methods: Retrospective study was conducted in 225 neonates from January 2018 to December 2020. All neonates with birth weight <2000 gm and/or gestational age <38 weeks were included. History of oxygen given to neonates and presence of sepsis in neonates was noted. The infant’s pupil were dilated. Fundus examination was done. All the data was entered in MS-Excel 2016 and analyzed by SPSS (version 19). Chi-square test was done to calculate p value.Results: Out of total of 225 neonates, 137 (60.88%) were males and 88 (39.12%) were females. The gestation age of neonates (in weeks) ranged from 25 to 40 (mean: 32.35). The birth weight of neonates (in grams) ranged from 570 to 2500 (mean: 1460). 21 (9.33%) were found to have ROP. The male neonates found with ROP were 16 (11.67%) while females were 5 (5.68%) (p>0.05). Out of 148 neonates who were given oxygen 19 (12.83%) developed ROP (odds ratio: 5.52). Out of 42 neonates who had sepsis, 2 (4.76%) developed ROP (odds ratio: 0.43).Conclusions: The prevalence of ROP was 9.33%. The prevalence is showing a decreasing trend. ROP is not affected by gender. Oxygen given to neonates is associated with greater ROP. But sepsis in neonates is not associated with development of ROP.

Association between FVL G1691A, MTHFR C677T and A1298C Polymorphisms with Risk for Retinopathy of PrematurityAssociation between FVL G1691A, MTHFR C677T and A1298C Polymorphisms with Risk for Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is an important cause of preventable blindness in children. The aim of this study was to examine the association of the polymorphisms at Factor V Leiden (FVL) and methylene tetrahydrofolate reductase (MTHFR) gene with risk of ROP. Methods: A total of 106 neonates with ROP and 110 healthy neonates were enrolled. The FVL G1691A and MTHFR C677T and A1298C polymorphisms were genotyped by PCR-RFLP assay. Results: There was a significant association between FVL G1691A polymorphism and an increased risk of ROP. However, the MTHFR C677T and A1298C polymorphisms were not associated with risk of ROP. Conclusion: FVL G1691A polymorphism may be risk factor for development of ROP in neonates. However, there was no significant association between MTHFR C677T and A1298C polymorphisms and risk of ROP. However, it is critical that larger and well-designed studies in different ethnicities are needed to confirm our conclusions.

Evaluation of SpO2, PaO2, FiO2 levels in developing retinopathy of prematurity

Background: Retinopathy of prematurity (ROP) is a potentially blinding disease affecting the retinas in premature infants. In the treatment procedure of ROP, oxygen inhalation as well as the SpO2, PaO2, FiO2 levels analysis are some major concerns.Methods: This was a prospective COHORT study which was conducted at the special care baby unit (SCABU) and intensive care unit (ICU) of Dhaka shishu (children) hospital, Dhaka, Bangladesh from July 2012 to December 2014. Total one hundred (100) neonates of both sexes were finalized as the study population. Data were processed and analyzed using statistical software SPSS version 17, EPI info 7.Results: We found statistically significant risk for ROP, RR 3.48 (2.61-4.64) but there was no risk associated with FiO2 (24-32) % or 33-40 % in inhaled air. SpO2 (95-99) % was present in 25 (78.13%) of ROP (positive) neonates and 16 (23.53%) in ROP (negative) neonates. The difference was statistically significant (p<0.05) between the groups and RR 4.8 (2.51-9.28) for saturation of 95-99%. Partial pressure of oxygen >150 mm of Hg present in 12 (37.50%) cases of ROP (positive) neonates and 6 (8.82%) in ROP (negative) neonates. The difference was statistically significant (p<0.05) between the groups and RR 2.90 (1.83-4.5) for partial pressure of oxygen (>150) but there was no risk for partial pressure of 70-99 and 100-150 mm of Hg.Conclusions: During oxygen therapy FiO2 value, SpO2 value and more precisely the PaO2 value on neonate should be maintained within a target range.

Clinical profile on incidence and course of Retinopathy of Prematurity in a tertiary care hospital of Northern India

Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disorder of retina of preterm infants. It remains the leading cause of childhood blindness worldwide. Aggressive posterior retinopathy of prematurity (APROP) is rapidly progressive severe form of ROP. Aims and Objectives: The present study was done to assess incidence and evaluate course of ROP in preterm babies born before 34 weeks and birth weight <1750 grams. Material and Methods: The current study was a two year prospective observational study. Screening of all neonates born with gestational age ≤34 weeks and birth weight <1750 grams was done for ROP at 4 weeks of their postnatal age by indirect ophthalmoscopy and followed up till vascularization was complete. All neonates identified with APROP and ROP with plus disease was treated with double-frequency Nd YAG laser. Results: Of 318 neonates screened, 34.9% neonates (111) were observed to have ROP. 2.5% (8/318) neonates diagnosed with APROP and 4.4% neonates (14/318) having ROP with plus disease including pre-threshold and threshold ROP were treated with double frequency Nd Yag laser. All 14 treatment requiring ROP babies and 6 APROP babies showed total regression while one neonate with APROP succumbed to septicaemia during follow up and one APROP baby had to be referred to higher centre after he developed partial retinal detachment (RD) (Stage 4a). Conclusion: 34.9% had ROP, only 6.28% needed intervention. Laser monotherapy even when administered early has lesser favorable structural and functional outcome in APROP as compared to classical ROP.

Nigerian neonatologists perception and experience with retinopathy of prematurity

Background: Retinopathy of Prematurity (ROP) is an avoidable condition that affects premature infants exposed to oxygen stresses at or soon after birth. In low- and middle-income countries, like Nigeria, neonatal mortality rates are high and very few infants live to develop ROP. With recent better care, ROP is now being diagnosed. Objective: This study aimed to characterize what Nigerian neonatologists understand about ROP. Methods: At a joint meeting of Nigerian pediatric ophthalmologists and neonatologists in Kebbi State held 26-29 July 2018, questionnaires collected attendees’ perspective and experience with ROP including causes, risk factors and experiences. Results: Fifty-one neonatologists out of 71 returned a completed questionnaire (response rate: 71.8%). The male:female ratio was 1:1.8, and approximately 40% were aged 41-50 years (n=20, 39.22%). Only 3 (6.39%) had experience managing infants below 500g that survived. A majority managed babies with a mean weight of 913g ± 300.37 and age of 27.87 weeks ±2.37. Most had no access to oxygen monitors (n=39,78%). Most had 10 babies to one monitor and used average settings of 90- 95%. One third had seen a case of ROP (n=15,29.41%). Only 5.88% (n=3) were unaware of uncontrolled oxygen use as a risk factor. Only 4 (8.89%) had a functional screening team. None were aware of local screening guidelines. Conclusions: Regular educational programs, collaborative clinical presentations and webinars about ROP targeted at the neonatologists and parents, including establishment of screening programs across country will likely help reduce the burden of ROP blindness in Nigeria.

Comparison of Ocular Lens Thickness of Type-2 Diabetic Retinopathy Patients with Non-diabetic Control, Measured by High Resolution Ultrasonography

Background & objective: The aim of this study was to verify whether the ocular lens of type-2 diabetic retinopathy patients was thicker (measured by high resolution Ultrasonography) than those of non-diabetic individuals.The study also evaluated the differences in lens thickness (LT) between right and left eyes of diabetic retinopathy patients, and the differences in LT between proliferative and background retinopathy cases. Methods: This case-control study was conducted on 68 subjects (34 cases and 34 controls) aged 20-60 years in the Department of Radiology and Imaging, BIRDEM Hospital from March 2015 to February 2016. Adult patients suffering from type-2 diabetic retinopathy confirmed by slit-lamp examination were selected as cases, while apparently healthy subjects were taken as control. Patients with history of heart failure, ocular surgery, acute eye conditions, such as, conjunctivitis, scleritis, cataract or any other co-morbidities were excluded. Ocular mean lens thickness was measured by high resolution ultrasonography and was compared between case and control groups by Un-paired t-Test. Results: The study showed that type 2 diabetic patients had significantly thicker lenses than their non-diabetic counterparts (in right eye:case 4.1 ± 0.3 mm versus control 3.7±0.1 mm, p<0.001 and in left eye:case 4.2 ± 0.3 mm vs. control 3.7±0.1 mm, p<0.001). The study also revealed that proliferative retinopathy cases had thicker lenses than any other diabetic retinopathy groups (p < 0.05) and there was also statistically significant difference of HbA1c level between proliferative and background type II diabetic retinopathy cases (p<0.05) Conclusion: The study concluded that lens thickness is increased in type-2 diabetic retinopathy patients than that in non-diabetic healthy controls.The proliferative diabetic retinopathy cases possess thicker lens than the background retinopathy cases. Ibrahim Card Med J 2020; 10 (1&2): 40-44

Optic Neuritis in Patients with Type 2 Diabetes Mellitus: A Case Series

Diabetes mellitus is a group of metabolic disorders characterised by a high blood sugar level over a prolonged period of time. Ocular associations of diabetes include diabetic retinopathy, cataract, diabetic papillopathy, ocular movement disorders and optic neuritis. Optic neuritis is a clinical condition causing inflammation of the myelin sheet of optic nerve. This leads to alteration in the nerve conduction towards the brain. Diabetics are more commonly affected with anterior ischaemic optic neuropathy compared to papillitis or optic neuritis. The present case series is of diabetes associated papillitis. The patients were in the age range of 35-60 years. All the patients had poor visual acuity at presentation, mild disc oedema and disc elevation with no peripapillary haemorrhage, suggestive of papillitis. The patients had minimum background retinopathy and were hyperglycaemic at the time of presentation. The response to Intravenous (IV) methyl prednisolone, at a dose of 1 gm IV in 100 mL of normal saline, was good. Improvement to vision was seen within 3-5 days and improvement in colour vision was seen at the end of 11-15 days. Papillitis can be a manifestation of diabetes and should be kept as a differential diagnosis to non-arteritic ishaemic optic neuropathy. Optic neuropathies and background retinopathy may not co-exist. Poor systemic control of glycaemic level may directly co-relate to papillitis manifestation.

Association of -634 C/G Polymorphism at Vascular Endothelial Growth Factor Gene with Risk Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants worldwide. It is well known that neovascularization of the retina is prominent in the proliferative stages of ROP. It is suggested that vascular endothelial growth factor (VEGF) may play a role in the development of ROP. The aim of this study was to evaluate the association of the VEGF -634C/G polymorphism at VEGF with risk of ROP. Methods: In the study 54 neonates diagnosed with ROP and 55 healthy neonates served as controls. The VEGF -634 C/G polymorphism was genotyped by restriction fragment length polymorphism (PCR-RFLP) technique. Results: The CC, CG, and GG genotypes of VEGF -634C/G polymorphism were found in 33.3%, 38.9%, and 27.8% of neonates with ROP, respectively. In controls, CC, CG, and GG genotypes were seen in 43.6%, 45.4%, and 10.9%, respectively. Frequency of mutant allele (C) was 52.8% in neonates with ROP and 66.4% in healthy neonates. There was a significant difference in the distribution of VEGF -634C/G polymorphisms between cases and controls. Moreover, there was a significant association between VEGF -634C/G polymorphisms and ROP risk (OR = 3.141, 95% CI 1.115-8.851, P = 0.030). Conclusion: This study results revealed that VEGF -634C/G polymorphism might serve as a risk factor for development of ROP. Thus, clinicians should be aware of the ROP risk in infant with the VEGF -634C/G polymorphism and ROP risk in infants. However, large sample size and well-designed studies are necessary to validate our findings.

Artificial Reproductive Technology – A Risk Factor for Retinopathy of Prematurity

BACKGROUND: Retinopathy of Prematurity (ROP) is a potentially blinding vasoproliferative disease in premature babies. The presentation and course of ROP are determined by a complex interaction of a series of risk factors, including artificial reproductive technology (ART). AIM: To analyse and combine the information relating ART as an independent risk factor for retinopathy of prematurity. METHODS AND MATERIAL: The article is systematic review and meta-analysis using RevMan 5. Pubmed, Scopus and Medline were searched for articles from 1990 to 2018. RESULTS: Studies suggest that ROP is observed more frequently in ART children. They are more likely to be premature and of low birth weight than those conceived naturally. Results vary from just a tendency to a five-fold increase in risk to develop ROP in ART babies. At the same time, they might develop ROP later, and more mature newborns might be affected. CONCLUSION: The data relating ART as a risk factor for ROP is inconclusive, but most studies show at least a tendency. The ART newborns need to be considered as a risk group for ROP and observed with greater suspicion. Even more mature ART newborns might need to be screened in order not to miss any significant pathology.