Ambient light,ophthalmic artery blood flow velocities and retinopathy of prematurity

Exposure to bright light was recently proposed as a possible risk factor for the development of retinopathy of prematurity. A semi-longitudinal Doppler ultrasound study was conducted of ophthalmic artery flow velocities at normal and increased ambient light in 22 preterm infants, at post-menstrual ages from 28 to 37 weeks. The aim of this study was to obtain relationships between ophthalmic artery blood flow velocities at various post-menstrual ages and lighting conditions and the occurrence of retinopathy of prematurity. A gradual increase in average blood flow velocities was seen between 28 and 37 weeks. A stepwise increase in flow velocity was seen in all cases when ambient light was increased from moderate to intense. Five of the 22 infants developed retinopathy. No association could be established between ophthalmic artery flow velocities or light-induced changes in flow velocity and the occurrence of retinopathy.     

Severe retinopathy of prematurity in infants from the southern regions of Sweden

We studied children born in 1986–1989 with severe retinopathy of prematurity (ROP) defined as stage 3 "plus" or more. Sixteen children from the southern and central areas of Sweden were identified and 15 of these were referred to Orebro Medical Center Hospital for surgical treatment of ROP. The incidence of severe ROP was estimated as 0.8 per 10000 newborns per year. All children were born before 29 weeks' gestation and weighed less than 1310 g; they also needed ventilatory support for a long time. The overall neonatal morbidity was high. A model for eye examination in premature newborns is suggested.     

早产儿视网膜病的手术治疗

早产儿视网膜病(retinopathy of prematurity,ROP)是儿童重要的可预防的致盲性疾病,需早期发现、及时治疗,对于阈值期及阈值前1型病变首选激光光凝治疗,如果进展为视网膜脱离需进行巩膜扣带术或玻璃体手术,文章对ROP手术治疗的现状及进展进行评述。     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

切实加强对早产儿视网膜病的防治

早产儿视网膜病(ROP)是儿童致盲的重要原因之一,我国每年约有100万早产儿面临发生ROP的危险,目前对ROP的防治工作还不够规范和完善,切实加强对ROP的防治非常重要。以下3个方面是防治ROP的关键环节:通过积极预防,降低ROP发生率;通过早期诊断,及时发现ROP;通过及时治疗,降低ROP致盲率。     

早产儿视网膜病年度筛查报告

目的调查温州医学院附属育英儿童医院早产儿视网膜病变(ROP)的发生率及其发病高危因素,初步对2004年我国卫生部制定的ROP筛查标准进行评价。方法对2007年1月1日-12月31日入住该院新生儿科并符合筛查标准的254例早产儿进行ROP筛查,即出生体重<2000g的早产儿,在婴儿出生后4～6周或矫正胎龄32周开始进行检查,随诊至周边视网膜血管化。再分别按英国推荐的ROP筛查标准(体重≤1500g或孕周≤31周)和美国推荐的ROP筛查标准(体重≤1500g或孕周≤28周)对筛查结果进行比较。结果在接受筛查的254例早产儿中,发生ROP24例,发生率为9.4%。其中Ⅰ期病变18例,Ⅱ期病变4例,Ⅲ期病变2例,2例需激光治疗,无失明病例。若按美国推荐的ROP筛选标准统计,将遗漏21例,其中包括2例需要激光光凝治疗;若按英国推荐的标准筛选,将遗漏8例,其中1例同样需要激光光凝治疗。本研究将出生体重在1500～2000g的早产儿再细分为4组进行比较,发现发生ROP的患儿基本集中在出生体重1501～1600g组,与其余3组间两两比较差异均有统计学意义(P均<0.01),而在这组筛查患儿中出生体重在1601～2000g的患儿数远远多于1501～1600g患儿例数(165/30)。ROP相关因素的Logistic回归分析结果表明,孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。结论出生体重≤1600g的早产儿为ROP筛查标准更符合本地区的实际情况;对于出生体重>1600g的早产儿,根据患儿全身疾病情况有选择的进行筛查可减少漏诊率。孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。有必要根据更多的流行病学结果,制定出符合我国国情的ROP筛选标准。     

Pathogenesis of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a blinding disease, initiated by delayed retinal vascular growth after premature birth. There are both oxygen-regulated and non-oxygen-regulated factors, which contribute to both normal vascular development and retinal neovascularization. One important oxygen-regulated factor, critical to both phases of ROP, is vascular endothelial growth factor (VEGF). A critical non oxygen-regulated growth factor is insulin-like growth factor (IGF-1). In knockout mice, lack of IGF-1 prevents normal retinal vascular growth, despite the presence of VEGF, important to vessel development. In vitro , low IGF-1 prevents vascular endothelial growth factor-induced activation of Akt, a kinase critical for vascular endothelial cell survival. Premature infants who develop ROP have lower levels of serum IGF-1 than age-matched infants without disease.
Conclusion : IGF-1 is critical to normal vascular development. Low IGF-1 predicts ROP and restoration of IGF-1 to normal levels may prevent ROP.     

进一步完善早产儿视网膜病的筛查制度

早产儿视网膜病(ROP)是儿童致盲的重要原因,已成为发展中国家日益突出的医疗和社会问题。防治ROP的关键是建立科学的筛查制度。文章主要讲述筛查制度中所涉及的筛查对象、筛查时机、随访方案等,以及如何管理该制度,以期对所有符合标准的早产儿做到一个不漏地筛查和全程随访,从而做到早期诊断和及时治疗,以降低致盲率。     

Screening for retinopathy of prematurity in developing countries

Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.     

Patent ductus arteriosus and retinopathy of prematurity in infants below 27 weeks gestation

Retrospective study of infants who survived the neonatal period after delivery at 24–26 weeks gestation revealed patency of the ductus arteriosus (PDA) in 44%. The mean birthweight of infants who developed PDA was lower. Retinopathy of prematurity (ROP) was seen in 79% of survivors with 24% having grade III or IV involvement. All but one of the more severe grades of ROP occurred among infants with PDA. Infants with PDA required more prolonged ventilatory support. Perinatal factors did not have a significant role in the development of these complications.     

Reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity in infants of <33 weeks gestation

Background: The relationship between oxygen and retinopathy of prematurity (ROP) has been studied frequently, and a pulse oximeter has the potential to facilitate the control of oxygen fluctuation in neonates. The objective of the present study was to compare the incidence of threshold ROP (stage 3 requiring laser treatment and stage 4) in infants of <33 weeks gestation after implementing a new clinical O₂ management practice. Methods: A retrospective study of data from the Kyoto First Red Cross Hospital neonatal intensive care unit (NICU) from 1 July 2004 to 31 October 2007 (closed 1 December 2006–30 March 2007 for reconstruction). A reduced oxygen protocol was implemented to maintain oxygen saturation (SpO₂) values using a pulse oximeter between 88% and 92%. The incidence of threshold ROP in the earlier period (1 July 2004–31 December 2005) and the later period (1 January 2006–31 October 2007) were compared. Results: The incidence of threshold ROP significantly decreased from 32.2% to 16.7%, after changing to the reduced oxygen protocol (P < 0.05). Conclusion: A significant decrease in the rate of threshold ROP in infants of <33 weeks gestation was observed after implementation of the new clinical O₂ management practice.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%)). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Regressed retinopathy of prematurity: the relationship between clinical risk factors of the newborn period and regressed retinopathy of prematurity severity in a preterm born population of Stockholm county 1976-81

In a retrospective study, clinical risk factors of the neonatal period were correlated with the severity of regressed retinopathy of prematurity (ROP) in a population of preterm infants (bw less than 1500 g and or gestational age less than 33 weeks). At the age of 5-11 years 134 out of 528 preterm born infants (25.4%) were found to be under ophthalmic care. Reliable information on eye fundus status could be obtained in 105 of them. Regressed ROP was found in 61, the moderate form in 48 (9.1%) and the severe form in 13 (2.5%) patients. Twelve patients (2.3%) had visual acuity of less than 0.3 on the worst eye and two (0.4%) of these patients were blind from ROP. Twenty-four clinical factors of the newborn period were correlated with the severity of regressed ROP. The results suggest that long oxygen exposure in combination with other factors interfering with retinal vasotonus are associated with the degree of the disease developed.     

早产儿视网膜病经间接检眼镜激光治疗后视网膜脱离分析

目的分析严重早产儿视网膜病(ROP)经间接检眼镜激光治疗后出现视网膜脱离的特点。方法回顾性收集2006年1月至2008年2月经间接检眼镜激光治疗后出现视网膜脱离的ROP患儿,统计其性别、孕周、出生体重、ROP诊断、激光治疗参数、眼底随访情况、RetCam图片等临床资料,分析激光治疗后视网膜脱离的发生时间、部位和范围等特点。结果7例患儿(共12只眼)经间接检眼镜激光治疗后出现视网膜脱离,其平均孕周为29.9周(28～35周),平均出生体重1366g(1140～1810g)。激光治疗前诊断为阈值病变8只眼(占66.7%),阈值前病变1型4只眼(33.3%)。所有患眼激光治疗后平均5.8周出现视网膜脱离,其中11只眼(91.7%)在治疗后2～7周出现视网膜脱离,仅1只眼(8.3%)于激光治疗后24周出现4B期。所有患眼中,9只眼(75.0%)表现为颞侧、局限性的牵引性视网膜脱离,脱离范围<4个钟点,1只眼(8.3%)表现为鼻侧、局限性视网膜脱离,脱离范围4个钟点,另2只眼(16.7%)为累及各象限的完全性视网膜脱离。所有患儿激光治疗后平均随访27.2周。结论严重早产儿视网膜病经间接检眼镜激光治疗后7周内出现视网膜脱离的可能性比较大,主要表现为颞侧玻璃体增殖、牵引而导致的局限性视网膜脱离。     

急进型后极部早产儿视网膜病的研究进展

急进型后极部早产儿视网膜病（AP-ROP）是一种特殊类型的早产儿视网膜病,其眼底特征表现为视网膜后极部血管扩张迂曲严重,并累及所有象限,而且病情进展非常迅猛。随着越来越多的AP-ROP 病例被发现,并且治疗效果相对差,使AP-ROP 问题日益受到关注。哪些早产儿更易患病？如何做到早期诊断？是否有更好的治疗技术？国内外对此进行了一定的研究探索。该文对AP-ROP 的危险因素、筛查、临床诊断、治疗的临床研究最新进展做一综述。