早产儿视网膜病变激光光凝治疗效果及预后影响因素分析

目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733～54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。     

Localized Structural and Functional Deficits in a Nonhuman Primate Model of Outer Retinal Atrophy

PurposeCell-based therapy development for geographic atrophy (GA) in age-related macular degeneration (AMD) is hampered by the paucity of models of localized photoreceptor and retinal pigment epithelium (RPE) degeneration. We aimed to characterize the structural and functional deficits in a laser-induced nonhuman primate model, including an analysis of the choroid.MethodsMacular laser photocoagulation was applied in four macaques. Fundus photography, optical coherence tomography (OCT), dye angiography, and OCT-angiography were conducted over 4.5 months, with histological correlation. Longitudinal changes in spatially resolved macular dysfunction were measured using multifocal electroretinography (MFERG).ResultsLesion features, depending on laser settings, included photoreceptor layer degeneration, inner retinal sparing, skip lesions, RPE elevation, and neovascularization. The intralesional choroid was degenerated. The normalized mean MFERG amplitude within lesions was consistently lower than control regions (0.94 ± 0.35 vs. 1.10 ± 0.27, P = 0.032 at month 1, 0.67 ± 0.22 vs. 0.83 ± 0.15, P = 0.0002 at month 2, and 0.97 ± 0.31 vs. 1.20 ± 0.21, P < 0.0001 at month 3.5). The intertest variation of mean MFERG amplitudes in rings 1 to 5 ranged from 13.0% to 26.0% in normal eyes.ConclusionsLaser application in this model caused localized outer retinal, RPE, and choriocapillaris loss. Localized dysfunction was apparent by MFERG in the first month after lesion induction. Correlative structure-function testing may be useful for research on the functional effects of stem cell–based therapy for GA. MFERG amplitude data should be interpreted in the context of relatively high intertest variability of the rings that correspond to the central macula. Sustained choroidal insufficiency may limit long-term subretinal graft viability in this model.     

The Effect of Pattern Scan Laser Photocoagulation on Peripapillary Retinal Nerve Fiber Layer Thickness and Optic Nerve Morphology in Diabetic Retinopathy

Purpose

To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy.

Methods

Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups.

Results

The average RNFL thickness had increased by 0.84 µm two months after and decreased by 0.4 µm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 µm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 µm (p = 0.11) at six months in the PASCAL group.

Conclusions

PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.     

Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

Purpose:To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG).Methods:This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures.Results:In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significantConclusion:AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.     

Correlation between systemic immune-inflammation index and routine hemogram-related inflammatory markers in the prognosis of retinopathy of prematurity

Purpose:To evaluate the prognostic potential of systemic inflammatory index in the course of retinopathy of prematurity (ROP).Methods:This is a retrospective case-control study. 303 infants with a gestational age of ≤35 weeks were screened with and without ROP at birth and 1 month after the birth of complete blood counts (CBC) were included in this study. Serum neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte (PLR), and systemic immune-inflammation index (SII) was calculated at birth and one month after. LMR was calculated by dividing the absolute lymphocyte count by the absolute monocyte count. NLR and PLR were determined by dividing the absolute neutrophil count or the absolute platelet count by the absolute lymphocyte count, respectively. The SII was calculated by the formula = neutrophilxplatelet/lymphocyte. All statistical analyses were performed using SPSS 22 (SPSS for Windows, version 22.0; SPSS, Inc. Chicago, IL, USA).Results:A total of 303 infants were included 145 with ROP and 158 without ROP. The NLR, LMR, PLR and SII values were 0.56 ± 1.17/0.51 ± 1.04 (P = 0.997), 13.7 ± 18/9.49 ± 13.1 (P = 0.014), 31.69 ± 68/24.1 ± 37.7 (P = 0.268), 131.42 ± 326/124.66 ± 267 (P = 0.935) in with ROP and without ROP infant at birth respectively. The NLR, LMR, PLR, and SII values were 0.68 ± 1.27/0.34 ± 0.99 (P = 0.001), 2.58 ± 6.01/2.46 ± 14.5 (P = 0.706), 47.5 ± 78.33/33.55 ± 42.4 (P = 0.035), and 253 ± 681/114 ± 345 (P = 0.001), respectively in with ROP and without ROP infant at 1 month after birth.Conclusion:The NLR, PLR, and SII seem an independent predictor of the development of ROP.     

Post laser-assisted in-situ keratomileusis dry eye disease and temporary punctal plugs

Purpose:The aim of this study was to compare the incidence of post laser in situ keratomileusis (LASIK) dry eye with and without intraoperative extended duration temporary punctal plug placement.Methods:This retrospective study included myopicastigmatic eyes without a preoperative diagnosis of dry eye disease that underwent LASIK surgery between January 2017, and March 2018. Patients who received punctal plugs during surgery in addition to usual postoperative care were compared to a control group who received usual postoperative care alone. Visual acuity, safety and efficacy indices, as well as predictability and presence of dry eye disease were assessed 3–6 months after surgery.Results:A total of 345 eyes of 345 patients were included, 172 eyes received punctal plugs and 173 did not. The mean age was 30.4 ± 10 years (range: 17–60 years) and 46.1% (N = 159) were female. Both groups were similar in terms of preoperative parameters, including age, gender, spherical equivalent, pachymetry or contact lens use. Patients treated with punctal plugs had significantly less postoperative dry eye complaints (N = 37 vs. 58, 21.5% vs. 34.1% respectively, P = 0.001). Patients treated with plugs that did develop dry eye disease did so later (51.2 ± 77.64 days'' vs. 20.78 ± 26.9 days, P = 0.009). Postoperative visual acuities were similar between groups (P > 0.05) at all postoperative follow-up visits as were safety (0.95 ± 0.16 vs. 0.99 ± 0.09, P = 0.30) and efficacy (1.01 ± 0.13 vs. 1.00 ± 0.11, P = 0.52) indices.Conclusion:Preventative temporary punctal plug placement during LASIK appears to reduce dry eye disease in the short term, without affecting visual acuity outcomes.     

Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity

Purpose:The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR).Methods:In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser.Results:63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: –1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002).Conclusion:Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.     

Should parents be present during screening examinations for retinopathy of prematurity?

Purpose:To investigate whether parents should be present during screening examinations for retinopathy of prematurity (ROP) by investigating the anxiety levels of parents using two different approaches.Methods:This cross-sectional and two-center study was carried out with the parents at the time of the first ROP screening examination of their premature infants. At one center, the parents accompanied the infants during the ROP examination (Group 1), and in the other center, they did not (Group 2). Anxiety levels were assessed with the State-Trait Anxiety Inventory (STAI), which consists of the State Anxiety (STAI-S) and Trait Anxiety (STAI-T) subscales and a visual analog scale (VAS).Results:A total of 147 parents of 127 infants were included in the study. STAI-T and -S levels were 40.5 ± 8 and 37.9 ± 7.5, respectively, in Group 1 and 39.6 ± 8.1 and 39.4 ± 9.1 in Group 2 before the examination. There were no statistically significant differences in terms of these values between the two groups (P > 0.05). The state anxiety levels increased by an average of 1.7 ± 8 in Group 1 and reached 39.6 ± 10.1 after the examination. In Group 2, these levels decreased by an average of − 2.7 ± 7.5 points to a score of 36.4 ± 10.3. This difference was found to be statistically significant (P = 0.001). A similar pattern was observed in the evaluation of the VAS data.Conclusion:As a preliminary opinion, it may be more appropriate for parents to not participate in screening examinations, but single-center controlled studies are required to confirm the results.     

Lower foetal haemoglobin levels at 31- and 34-weeks post menstrual age is associated with the development of retinopathy of prematurity: PacIFiHER Report No. 1 PacIFiHER Study Group (Preterm Infants and Fetal Haemoglobin in ROP)

Background/objectivesPrevious studies have suggested that lower mean foetal haemoglobin (HbF) levels is associated with an increased risk for developing retinopathy of prematurity (ROP). Lower HbF levels may lead to high oxygen exposure to the developing retina thereby increasing the risk of acute ROP. In this study, we characterize the temporal relationship of HbF levels and the development of ROP.Subjects/methodsThis is a single institution prospective observational cohort study. Preterm infants (born <31 weeks gestational age or <1500 g) with HbF measured at birth (cord blood), 31-, 34-, and 37-weeks post menstrual age (PMA); and at least one ROP exam, were enrolled.ResultsA total of 60 preterm infants (28 females, 47%) were enrolled. At 31-, 34-, 37-weeks PMA, infants with ROP (mild = Type 2 or less severe and severe = Type 1 ROP) had statistically lower percentages of HbF than infants with no ROP (28.2 ± 15 and 9.7 ± 2.9 vs 67.1 ± 29.6; p < 0.0001; 23.3 ± 14.7 and 32.5 vs 60.1 ± 25; p < 0.005; 31.9 ± 15.8 and 41.6 vs 60.2 ± 20.0; p < 0.0019). Infants with HbF levels in the lowest tercile at 31-weeks PMA were 7.6 times more likely to develop mild and severe ROP (95% CI 2.1–24.0, p value = 0.0006) and this risk increased to 12.3 times (95% CI: 2.6-59.0, p value = 0.0017) at 34-weeks PMA.ConclusionsLow HbF levels at 31- and 34-weeks PMA are associated with significantly increased risk of developing ROP. The decrease in HbF precedes the development of ROP and may be important in its pathogenesis.Subject terms: Retinal diseases, Biomarkers     

Combination of Intravitreal Ranibizumab and Laser Photocoagulation for Aggressive Posterior Retinopathy of Prematurity

Purpose

To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis^®) and laser photocoagulation.

Methods

Two premature females, born at 25 and 26 weeks’ gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulation and intravitreal ranibizumab (0.3 mg [30 µl]) to each eye. Structural outcomes were evaluated by indirect ophthalmoscopy and documented by retinography.

Results

An intravitreal injection was made at 34 weeks of postmenstrual age in the first case, followed by laser photocoagulation 1 week later. There was a partial regression of ROP with treatment. Five weeks later, neovascularization regrowth with bleeding in both eyes (intraretinal and subhyaloid) occurred and retreatment with combined therapy was performed. In the second case, single therapy with laser photocoagulation was made at 34 weeks of postmenstrual age. In spite of the confluent photocoagulation in the avascular area, progression to 4A ROP stage occurred 1 week later. Both eyes were retreated 1 week later with intravitreal ranibizumab and laser photocoagulation. Treatment resulted in ROP regression in both cases. There were no signs of systemic or ocular adverse side effects.

Conclusion

The cases presented show that combination therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP. Further investigation on anti-VEGF safety in premature infants is necessary. Additional studies are needed to define the role of anti-VEGF in ROP treatment.Key Words: Retinopathy of prematurity, Laser photocoagulation, Ranibizumab, Anti-VEGF therapy     

Peripapillary nerve fiber layer thickness changes after macular photocoagulation for clinically significant diabetic macular edema

Purpose

To evaluate the effect of macular photocoagulation (MPC) on peripapillary nerve fiber layer (PNFL) thickness measurement in patients with clinically significant diabetic macular edema (CSME).

Methods

This study was a prospective interventional case series. Patients with CSME underwent MPC. Optical coherence tomography (OCT) was used to measure the PNFL and central macular thicknesses before and 3 months after MPC.

Results

Thirty-three eyes of 25 patients with a mean age of 59.4 ± 7.2 years were included. There was no statistically significant difference between pre- and post-MPC mean best corrected visual acuity (0.35 ± 0.29 and 0.40 ± 0.23 LogMAR, respectively, P = 0.2). Mean baseline and 3 months central macular subfield thickness was 305.9 ± 90.7 and 317.5 ± 112.4 microns, respectively (P = 0.1). Peripapillary nerve fiber layer thickness was 105.7 ± 10.0 before and 106.1 ± 9.9 three months after MPC (P = 0.7). No significant differences were found between pre and post MPC measurements in temporal, nasal, inferior and superior nerve fiber layer thickness in each quadrant around optic nerve head (P > 0.05).

Conclusions

Macular photocoagulation has no statistically significant effect on PNFL thickness measurements in patients with CSME.     

Combined retinal vascular occlusion: Demography,clinical features,visual outcome,systemic co-morbidities,and literature review

Purpose:To document the clinical features, systemic association, and treatment outcome of patients with a combined retinal vein and artery occlusion (CRVAO) and review of literature.Methods:A retrospective chart review of patients diagnosed with CRVAO at a tertiary eye care center. Patient''s demographic details and associated ocular and systemic factors were recorded. Treatment included laser photocoagulation, anti-vascular endothelial growth factor (VEGF) intravitreal injection or transscleral cyclophotocoagulation (TSCPC), alone or in combination. At last, follow- up treatment response was measured in visual acuity status, regression of neovascularization, and control of intraocular pressure (IOP). All cases reported in the current decade were analyzed and compared with this study.Results:Seventeen eyes with CRVAO accounted for 0.3% of total vascular occlusion (total 5151 patients were seen in this period). The mean age was 48.12 ± 17.5 years (range: 12-87 years) and there were 9 females. Nine eyes had CRVO + CRAO; 6 eyes had BRVO + BRAO, and one patient each had CRVO + BRAO and CRAO + BRVO. Fluorescein angiography (FA) showed delayed ''arm to retina'' time (>20 seconds) in all 10 eyes and delayed arteriovenous transit time in 9 out of 10 eyes. Optical coherence tomography (OCT) showed hypereflective inner retinal layers (16 eyes) and neurosensory detachment (7 eyes). The most common systemic associations were hypertension and dyslipidemia (n = 7 people; 41.18%) each. Four patients (23.5%) had a plaque in carotid arteries with normal 2D echocardiography. Ten (59%) eyes were treated with intravitreal bevacizumab + laser; four (23.5%) eyes were treated with laser only, and three (17.6%) eyes were treated with laser + anti-VEGF + TSCPC. At last follow up, vision improved in 9 (52.9%) eyes; stable in 3 (17.7%) eyes, and reduced to perception of light in 5 (29.4%) eyes.Conclusion:Combined CRVAO is a rare emergency leading to acute vision loss. Early diagnosis and treatment for ocular complications and systemic evaluation for cardiovascular risk factors are needed.     

Morphology of the Trabecular Meshwork and Schlemm's Canal in Posner-Schlossman Syndrome

PurposeThe purpose of this study was to investigate trabecular meshwork (TM) and Schlemm''s canal (SC) morphology in Posner-Schlossman syndrome (PSS).MethodsForty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography.ResultsTM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm² vs. 5445.69 ± 1368.89 µm², P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm² vs. 5476.40 ± 1390.15 µm², P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05).ConclusionsTM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.     

Posture-Related Changes of Intraocular Pressure in Patients With Acute Primary Angle Closure

PurposeTo evaluate the posture-related change in intraocular pressure (IOP) of eyes with angle-closure disease and the associated factors.MethodsEyes were prospectively enrolled and divided into three groups: eyes with acute primary angle-closure (APAC), fellow eyes of acute primary angle-closure (FAPAC), and eyes with nonacute primary angle-closure disease (PACD). All of them had been treated with laser peripheral iridotomy. IOP was measured in the sitting, supine, and lateral decubitus positions (LDP) five minutes after posture change. Anterior chamber angle parameters and angle-closure mechanism were evaluated by anterior segment optical coherence tomography.ResultsForty-four eyes were enrolled into each group. APAC eyes showed more LDP-Sitting IOP increase than fellow eyes (5.7 ± 2.7 vs. 2.2 ± 1.4 mm Hg, P < 0.001) and nonacute PACD eyes (3.6 ± 2.0 mm Hg, P < 0.001). LDP-sitting IOP change was higher in eyes with exaggerated lens vault (having shallow anterior chamber and volcano-like iris-lens configuration) than in those without it (APAC: 6.3 ± 2.6 vs. 3.9 ± 2.1 mm Hg, P = 0.011). Linear regression revealed that LDP-sitting IOP change in the APAC group was negatively associated with angle opening distance (AOD), trabecular iris space area, scleral spur angle, and anterior chamber depth (ACD1000). With multivariable stepwise regression analysis, AOD750 remained statistically significant (beta-coefficient = −8.36, P = 0.014).ConclusionsAPAC eyes had significant posture-related IOP changes, associated with narrower angle structures and exaggerated lens vault.     

Early Postnatal Oxygen Exposure Predicts Choroidal Thinning in Neonates

PurposeTo evaluate whether choroidal thickness (CT) using arm-mounted optical coherence tomography (OCT) in infants screened for retinopathy of prematurity (ROP) correlates with oxygen exposure in neonates.MethodsOCT images were obtained in infants screened for ROP in a single level IV neonatal intensive care unit. CT was measured at three different locations: the subfoveal center and 1.5 mm from the fovea center in each direction. Correlation and regression analyses were performed to determine the relationship between clinical factors and CT. Clinical factors included gestational age, birth weight, presence of bronchopulmonary dysplasia (BPD), and fraction of inspired oxygen (FiO₂) at defined time points: 30 weeks postmenstrual age (PMA), 36 weeks PMA, and on day of imaging.ResultsMean subfoveal, nasal, and temporal choroidal thicknesses CT (SFCT, NCT, and TCT, respectively) were 228.0 ± 51.4 µm, 179.7 ± 50.3 µm, and 186.4 ± 43.8 µm, respectively. SFCT was found to be significantly thicker than NCT and TCT (P < 0.0001 and P = 0.0002, respectively), but no significant difference was found between NCT and TCT (P = 0.547). Compared with infants without BPD, infants with BPD had thinner SFCT and NCT (P = 0.01 and P = 0.0008, respectively). Birth weight was positively correlated with SFCT (r = 0.39, P = 0.01) and NCT (r = 0.33, P = 0.045) but not TCT. Gestational age and ROP stage were not significantly associated with CT. SFCT was found to be significantly thinner with higher average FiO₂ supplementation levels at 30 weeks PMA (r = –0.51, P = 0.01) but not at 36 weeks PMA. Regression analysis revealed that FiO₂ at 30 weeks PMA was an independent predictor of SFCT in infants screened for ROP (P = 0.01).ConclusionsEarly postnatal exposure (<32 weeks PMA) to higher oxygen supplementation in premature neonates statistically predicts choroidal thinning.     

Profile of patients receiving intravitreal anti-vascular endothelial growth factor injections during COVID-19-related lockdown

Purpose:The aim of this study was to analyze the impact on vision due to delay in presentation of patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, consequent to COVID-19-related travel restrictions.Methods:Data were collected retrospectively of patients who received anti-VEGF injections during four months of the COVID-19 pandemic. Visual acuities, indication for treatment were noted along with basic demographic characteristics.Results:Data were analyzed for 303 eyes of 263 patients. The indication for treatment was age-related macular degeneration (AMD) in 60 eyes (19.8%), while 162 eyes (53.5%) had Diabetic Macular Edema, 71 eyes (23.4%) had Retinal Vein Occlusion and 10 eyes (3.3%) had other diagnosis. The visual acuity in the treatment naïve eyes (Group A, n = 168) was significantly worse (P < 0.001) than those who presented for retreatment (Group B, n = 135). In Group B, there was a significant decline in vision for the entire cohort (P = 0.009) and those with AMD (P = 0.036). Those in Group B presented at a mean interval of 19.1 ± 10.6 (range, 4–64) weeks for retreatment.Conclusion:The COVID-19 pandemic has led to a delay in patients receiving anti-VEGF injections. The visual acuity is worse in both treatment naïve as well as those requiring retreatment. This could have long-term impact on vision of patients requiring this vision preserving treatment.     

Risk Factors for Retinopathy of Prematurity Requiring Photocoagulation

Purpose To analyze risk factors other than birthweight (BW) and gestational age for retinopathy of prematurity (ROP) requiring photocoagulation in infants (BW 1500g).Methods We divided 45 eyes with ROP into three groups (A, without photocoagulation; B, with 6 clock hours photocoagulation; C, with 6 clock hours photocoagulation) and analyzed maternal and neonatal factors by multiple logistic regression.Results Among 13 factors, the number of days of infection, defined as C-reactive protein (CRP) greater than 1.0mg/dl, was a significant risk between groups A and B+C [Odds ratio (OR), 1.549; 95% Confidence interval (CI), 1.008–2.381; P = 0.046]. Among six after-birth factors, the number of days of infection (OR, 1.404; 95% CI, 1.023–1.928; P = 0.036) was significant between groups A and B+C, and the number of blood transfusions (OR, 4.959; 95% CI, 1.002–24.54; P = 0.050) and use of rescue surfactant (OR, 413.9; 95% CI, 1.163–147306; P = 0.044) were significant between groups B and C.Conclusions CRP should be routinely monitored while observing the progress of preterm infants. The probability of requiring photocoagulation increased in infants who received a blood transfusion or rescue surfactant. Jpn J Ophthalmol 2004;48:68–71 © Japanese Ophthalmological Society 2004     

Transsklerale und transpupilläre Laserkoagulation bei proliferativer Sichelzellretinopathie

Background. Transscleral diode laser photocoagulation is a new method for treating proliferative sickle-cell retinopathy (PSR). Other treatments include transpupillary laser photocoagulation and transscleral cryocoagulation Case report. We report two patients with sickle-cell disease and PSR, one treated by transpupillary argon laser coagulation and the other by transscleral diode laser scatter photocoagulation. Conclusion. Transpupillary and transscleral laser photocoagulation are effective and safe in the treatment of PSR. Transscleral photocoagulation is an alternative treatment method in eyes with PSR and cloudy optical media or with poor mydriasis in which transpupillary coagulation cannot be performed.     

早产儿视网膜病变激光术后嵴前无血管区的临床观察

目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)激光光凝术后嵴前部分无血管化区的临床转归,为ROP的临床治疗提供依据.方法:前瞻性随访观察2014-06/2016-06由我院ROP筛查协作组在门诊以及NICU床旁筛查发现并进行视网膜激光光凝治疗的患儿186例372眼,激光光凝术后嵴前存在部分无血管区的患儿26例32眼,其中男17例18眼,女9例14眼,平均出生胎龄(29.4±0.4)周,平均出生体质量1222.8±70.3g,阈值前1型10例12眼,阈值期12例14眼、急性进展性后极部型4例6眼,分别于激光术后1、3、8、12 wk行Retcam眼底照相复查,观察病变嵴、嵴前无血管区以及附加病变的消退情况.随访中如发现病变嵴或附加病变加重,则给予补充视网膜激光光凝或行玻璃体腔抗VEGF治疗,直至病变嵴和附加病变完全消退,病情稳定.结果:患儿26例均在激光术后1 wk复查时发现病变嵴前无血管区,但附加病变减轻,病变嵴由3期向2期、1期消退,阈值前1型消退最明显;3 wk复查时27眼(84%)病变嵴为1期或不明显、无血管区逐渐缩小,视网膜血管向周边发育;5眼(16%)无血管区缩小不显著,附加病变(+~++),病变嵴3~4期、或伴有出血,其中3眼(9%)为阈值期病变患儿,2眼(6%)为急性进展性后极部型患儿,遂及时给予补充视网膜光凝;8 wk复查,未补充视网膜光凝的27眼嵴前无血管区已血管化,嵴及附加病变消退;补充光凝中3眼(9%)病情得到控制、稳定,其中阈值期2眼、急性进展性后极部型1眼,2眼(6%)嵴上新生血管消退不明显、附加病变依然存在,其中阈值期1眼、急性进展性后极部型1眼,故给予玻璃体腔抗VEGF治疗,12 wk复查时见附加病变、病变嵴消退,视网膜血管向颞侧走形稍僵直.结论:视网膜激光光凝是ROP治疗的有效方法,光凝术后嵴前部分无血管区多可自行发育完善.对于少数激光术后病情活动的阈值期及急性进展性后极部型嵴前部分无血管区需及时补充激光光凝治疗,必要时可联合玻璃体腔抗VEGF治疗.