Retinal detachment of regressed retinopathy of prematurity in children aged 2 to 15 years

PURPOSE: To reveal the clinical features and surgical results of retinal detachment of regressed retinopathy of prematurity (ROP) that occur in the children aged 2 to 15 years. PATIENTS AND METHODS: The records of patient who had a retinal detachment of a regressed ROP were retrospectively reviewed. Sixteen eyes from 15 patients that required surgical treatments due to retinal detachment of a regressed ROP were included. RESULTS: After treatment of acute phase of ROP, eight eyes showed grade II of cicatricial change and eight eyes showed grade III. We did not find any evidence that the acute stages of ROP and its treatment affect the degree of the cicatricial changes. All eight eyes with grade III of cicatricial ROP showed tractional retinal detachment (TRD) and five of eight eyes (62.5%) with grade II showed rhegmatogenous retinal detachment (RRD). The mean interval between regressed ROP and development of late retinal detachment was 20.7 months (range, 12-61 months) in the TRD group and 85.8 months (range, 33-148) in the RRD group. The mean age at onset of late detachment was 34.1 months (range, 26-73 months) in the TRD group and 98.6 months (range, 45-162) in the RRD group. Anatomical success was achieved at one of five eyes (20%) with RRD and six of 11 eyes (54.5%) with TRD. Compared with the preoperative visual acuity, visual improvement, no change, and decreased visual acuity were achieved, respectively, in two eyes, three eyes, and no eyes in the RRD group and three eyes, six eyes, and two eyes in the TRD group. However, only two of 16 eyes with late retinal detachment achieved a visual acuity of 20/200 or better. CONCLUSION: Late retinal detachment is the main vision-threatening condition in patients with regressed ROP during childhood. The visual prognoses of these patients are poorer than those with late retinal detachments that occur in adult ROP patients. Therefore, a periodic fundus examination should be performed more frequently during childhood than in adulthood, particularly in nonverbal children.     

Threshold retinopathy of prematurity: ocular changes and sequelae following cryotherapy

PURPOSE: To determine ocular changes and sequelae following cryotherapy for threshold retinopathy of prematurity (ROP). METHODS: This is a retrospective study of 49 eyes of 26 premature babies with threshold ROP treated with cryotherapy between 1995 and 1998. All eyes included in the study had favourable structural outcome after cryotherapy. Follow-up examination of all babies was done 12 - 62 months (average 28 months) after cryotherapy. Visual axis, fixation pattern, anterior segment examination, cycloplegic refraction and dilated fundus examination with indirect ophthalmoscopy were undertaken in all eyes during follow-up. RESULTS: Posterior pole retinal residuae observed following cryotherapy were tortousity of blood vessels in 32 (65.3%), narrow temporal arcade in 22 (44.89%), temporal crescent in 17 (34.69%), disc drag in 13 (26.53%) and macular heterotopia in 7 (14.28%) eyes. Myopia was observed in 20 (40.82%) eyes and strabismus in 5 (19.23%) babies. The significant risk factor for ocular changes was ROP with more clock hours of involvement (p < 0.05). Higher period of gestation was associated with posterior pole changes (p< 0.05). CONCLUSIONS: All premature babies with threshold ROP treated with cryotherapy require frequent and long-term follow up to look for retinal residuae, refractive status, and ocular motility disorders.     

A population-based study of ocular abnormalities in premature children aged 5 to 10 years

We studied the prevalence of ocular abnormalities in 528 children born prematurely (less than 1,501-g birth weight, less than 33 weeks' gestational age, or both) in Stockholm County from 1976 to 1981. The control group consisted of 1,047 randomly selected full-term children. Through various searches of the ophthalmic records from the period of 1981 to 1986 of Stockholm County, we found that 134 of the 528 premature children (25.4%) and 121 of the 1,047 full-term children (11.5%) had needed ophthalmic care for different reasons. The prevalence of ocular abnormalities was much higher in premature children than in full-term children: reduced visual acuity of 20/33 or worse in the best eye (21 of 528 [4.0%] and one of 1,047 [0.1%]); myopia (33 of 528 [6.3%] and 18 of 1,047 [1.8%]); anisometropia of 1 diopter or greater (31 of 528 [5.9%] and 15 of 1,047 [1.5%]); strabismus (52 of 528 [9.9%] and 22 of 1,047 [2.1%]); and nystagmus (13 of 528 [2.4%] and one of 1,047 [0.1%]). Children with birth weight less than 1,000 g had the highest rates of ocular abnormalities. We conclude that visual and oculomotor development of premature children should be carefully examined.     

Subretinal organization in stage 5 retinopathy of prematurity

BACKGROUND: The subretinal organization (SRO) seen in patients who undergo vitrectomy for stage 5 retinopathy of prematurity has not previously been characterized. We report our observations of SRO and correlate its development with previous laser and cryotreatment for neovascular disease. METHODS: We surveyed data from 426 eyes in a retrospective chart review of 263 patients that underwent open-sky vitrectomy for stage 5 retinopathy of prematurity. RESULTS: Of 426 eyes evaluated, 130 eyes received laser, cryo, or a combination of both treatments. In 44 eyes (10.3%), SRO was observed and considered the cause of incomplete retinal attachment. Three forms of SRO were identified: subretinal bands (63.6%), subretinal plaques (15.9%), and diffuse SRO (18.2%). One patient had both a band and a plaque. SRO developed in 24 eyes after cryotreatment, 3 after laser, and 2 after combination cryo and laser treatment. Fewer untreated eyes than cryotreatment eyes developed SRO (15 of 296 eyes, 5.1%; ( P=0.0001). Eyes without laser or cryotreatment had a 5.1% frequency of developing SRO. CONCLUSION: Subretinal organization, a previously uncharacterized entity in retinopathy of prematurity, was most frequently identified in the form of subretinal band formation. SRO was identified in 10.3% of all stage 5 eyes evaluated, and was associated with incomplete retinal reattachment in all cases.     

Cataract surgery in children with and without retinopathy of prematurity

PURPOSE: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). SETTING: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients' preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. RESULTS: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First-eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second-eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow-up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. CONCLUSIONS: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.     

Stage 5 retinopathy of prematurity. Prognostic value of morphologic findings

Anterior and posterior segment findings were evaluated in 184 consecutive cases of stage 5 retinopathy of prematurity (ROP) (368 eyes). One hundred seventy patients had one or more examinations under anesthesia and 150 had open-sky vitrectomy (260 eyes) with or without additional surgery. Ocular findings were inspected and special attention was given to verify the morphology of the retinal detachment (RD) as predicted by ultrasonography. Immature iris and/or pupil, posteriorly or totally closed detachment funnels, vascularized epiretinal membranes, retinal folds, tractional retinoschisis, persistent hyaloid system, and subretinal blood and/or organization were the most significant indicators of bad prognosis. Evaluating stage 5 ROP eyes with these variables in mind is therefore essential.     

Outcome of prematurity and retinopathy of prematurity

Retinopathy of prematurity is a disease that manifests soon after birth in the premature infant and may lead to a lifelong disability. More infants at risk for developing the retinopathy are surviving, and the ophthalmologist must be aware of possible vision abnormalities, such as decreased acuity, strabismus, nystagmus, retinal scarring, and retinal detachment, that occur during childhood and in adult life. These abnormalities may occur in children who developed only mild forms of retinopathy of prematurity during early life.     

Electroencephalography in schoolchildren aged 10-12 years with myopia

Electroencephalography was performed in schoolchildren aged 10-12 years with emmetropia (n=38) and myopia of different degree (n=165), the goal was to study alpha-rhythm frequency, configuration and maximum amplitude. 16-channel device "Neuron-Spectr-3" (Russia) was used. Student criterion was counted with 95% confidence interval. Significant decrease of alpha-rhythm was found in children aged 10-12 years with myopia compared to control group (p < 0.05). Interhemisphere asymmetry of alpha-rhythm frequency and slowing of alpha-rhythm were revealed in schoolchildren with myopia only. Slowing and decrease of amplitude of alpha-rhythm are registered on the very early stages of myopization process before development of axial myopia.     

Decreased incidence of retinopathy of prematurity, 1995-1997.

PURPOSE: To report a significant decrease in the incidence of retinopathy of prematurity (ROP), both in our neonatal intensive care unit (NICU) and internationally, and review factors in patient care that may be contributory. METHODS: We retrospectively reviewed the records of all neonates weighing less than 1251 g admitted to our NICU from 1995 to 1997 and evaluated the incidence and stage of ROP. These data on 191 neonates were compared with an international NICU database of 9989 similar neonates, which represents all infants who received an ophthalmologic examination in the Vermont-Oxford Network Database (VOND) in 1997, except those from our institute (the University of Kentucky). In addition to investigating the incidence of ROP, we looked at the use of antenatal corticosteroids given 1 to 7 days prepartum, the use of oxygen at 36 weeks' postconceptional age, and the use of oxygen at home upon discharge. RESULTS: In our center, we had a 36.1% incidence of ROP compared with an international incidence of 57.2% for the VOND in 1997 (P <.0001). Antenatal corticosteroids were given to 62.6% of infants in our center compared with 48.6% in the VOND (P <.005). In addition, 48.5% of our infants weighing less than 1500 g received oxygen at 36 weeks' postconceptional age versus 29.5% of the VOND infants (P <.001). Upon discharge to home, 37.5% of our infants were on oxygen compared with 15.6% of infants from all VOND centers, excluding the University of Kentucky (P <.001). CONCLUSION: The incidence of ROP in our center from 1995 to 1997 and in the VOND in 1997 show a significant decrease from the 65.8% incidence from 1986 to 1987 reported by the Multicenter Trial of Cryotherapy for ROP.     

胰岛素样生长因子-1与早产儿视网膜病变

早产儿视网膜病变(ROP)是儿童主要的致盲眼病之一。氧调节和非氧调节生长因子均参与ROP的发生。血管内皮生长因子(VEGF)是一种重要的氧调节因子,其在新生血管形成中的重要作用已逐渐被认识,而非氧调节生长因子(胰岛素样生长因子-1,IGF-1)可能与早产儿脱离子宫内环境有关。本文主要讨论IGF-1和VEGF在ROPⅠ、Ⅱ期病变中的作用,以期能在早期评价个体的ROP发生倾向,及早进行干预,降低ROP发生率。     

Ocular growth and morbidity in preterm children without retinopathy of prematurity

Purpose  

To investigate ocular growth and morbidity in both preschool and school-aged children born prematurely without retinopathy of prematurity (ROP).