Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study

Objective  To report on a 6-year experience with wide-field digital imaging based telemedicine (WFDI telemedicine) to reduce the risk for blindness from retinopathy of prematurity (ROP). Methods  Wide-angle digital fundus cameras (RetCam 120, Massie Lab, Pleasanton, CA, USA) were installed in five neonatal intensive care units (NICUs) in Germany. All prematures at risk were screened with WFDI, and the local ophthalmologists were asked to continue binocular indirect ophthalmoscopy (BIO) according to the German guidelines. Image data were coded and transferred to the Reading Centre in Regensburg. Image evaluation and additional BIO of infants with suspected treatment-requiring ROP (STR-ROP i.e. threshold ROP zone II, prethreshold ROP zone I (type-1 ROP according to ETROP), and ROP possibly requiring treatment but not reliably classifiable from the images) were performed by paediatric ophthalmologists at the Reading Centre. ROP was classified following ICROP, ETROP, and revised ICROP criteria. Outcome measures were incidence of clinically relevant ROP (CR-ROP, i.e. any ROP up to mid-peripheral zone III, ≤ stage 3+), sensitivity to detect STR-ROP, and positive predictive value to detect treatment-requiring ROP (TR-ROP). Results  In total, 1,222 prematures at risk were screened (mean BW 1395 g, SD ±507 g; mean GA 30 wks, SD ±3 wks). The overall incidence of CR-ROP was 27.6% (71.8% mild = stage 1 to 3 without plus disease, 15.7% prethreshold = type-1 ROP according to ETROP, 12.5% threshold according to ICROP). Zone I disease was present in 3.3%, zone II disease in 76.5%, and zone III disease in 20.2%. According to ETROP, 95 infants were type-1 or type-2 ROP; 67.4% type-1 ROP, and 32.6% type-2 ROP. Of all 1,222 infants, 3.5% received treatment. Following ETROP (not applied in the study), 5.3% would have been treated. The sensitivity for detecting STR-ROP was 100%, and the positive predictive value for TR-ROP 82.4% (28/34) at the time of the first referral (28 infants, ≤ stage 3+ in zone I or II). Conclusion  All TR-ROP was detected in time, showing the potential of our telemedical screening program. The overall incidence of CR-ROP was comparable to ROP incidences reported in other West European countries. Support: Bayerische Sparkassenstiftung, München, Germany; Bayerische Landesstiftung, München, Germany; Deutsche Forschungsgemeinschaft (DFG Lo 457/4-1,2), and Iris Medical, Mountain View, CA, USA The authors do not have any financial interest in the RetCam120 or Massie Laboratories, Pleasanton, CA 94588, USA or Clarity Medical Systems Inc, Pleasanton, CA 94588, USA C: (925)-519-6655, Parts of the contents were presented at the Annual Meetings 2003 and 2007 of the Association for Research in Vision and Ophthalmology ARVO, at the Annual Meeting of the European Paediatric Ophthalmological Society EPOS 2003, at the Annual Meeting 2004 of the German Ophthalmological Society DOG, and at the World Ophthalmology Congresses WOC 2006 and 2008     

Clinical features and treatment outcomes of intraocular lymphoma: a single-center experience in China

AIM:To investigate the clinical manifestations,diagnostic approaches,treatments,and outcomes of intraocular lymphoma.METHODS:In this retrospective study,16 patients(28 eyes)with intraocular lymphoma were recruited in the Department of Ophthalmology,Peking Union Medical College Hospital,from 2004 to 2019.All patients underwent comprehensive ophthalmic examinations.Vitreous specimens of 13 patients were sent for cytopathology examination and other adjunctive diagnostic procedures.Three patients were diagnosed with intraocular lymphoma according to analysis of the histopathological results of systemic lymphoma by one clinician.Twenty-three eyes were treated with intravitreal administration of methotrexate,4 eyes could not receive ocular treatment due to life-threatening lymphoma,and 1 eye did not require ocular treatment because the fundus lesions regressed after systematic chemotherapy.RESULTS:In 28 eyes,25 eyes were diagnosed with vitreoretinal lymphoma,and 3 eyes were diagnosed with ciliary body lymphoma,all of which were non-Hodgkin diffuse large B cell lymphomas.The final visual acuity improved in 15 eyes(54%),remained unchanged in 5 eyes(18%),and decreased in 8 eyes(29%).Anterior segment inflammation disappeared or reduced in 8 and 5 eyes,respectively;and 15 eyes had no anterior segment reaction.Twenty eyes had mild vitreous opacity,1 eye had mild vitritis,and 7 eyes had pars plana vitrectomy combinedwith silicone oil tamponade.Fundus lesions disappeared in 9 eyes and were relieved in 5 eyes;4 eyes showed no changes,and the remaining 10 eyes’fundus were normal.CONCLUSION:The clinical manifestations of intraocular lymphoma are diverse,and the misdiagnosis rate is high.Cytopathological analysis of vitreous is one of the gold standards for the diagnosis.Immunohistochemistry,gene rearrangement and flow cytometric immunophenotypic analysis can improve the diagnostic rate.Ocular chemotherapy or radiotherapy regimens may preserve visual acuity,and a multidisciplinary team can provide individualized treatment for the patients.     

Evaluation of retinopathy of prematurity incidence with telemedicine confirmation in Gansu,China: a pilot study

Purpose: To determine the incidence of retinopathy of prematurity (ROP) in Gansu, China by combining bedside examinations with remote RetCam (Clarity Medical Systems, Pleasanton, CA, USA) diagnosis.

Methods: ROP screening via indirect ophthalmoscopy followed by RetCam imaging was performed from 2014 to 2015. Three ROP-experienced ophthalmologists interpreted images remotely. Incidence of ROP was determined by combining bedside and telemedicine diagnoses.

Results: Of 139 examined infants and 137 complete records, 20 (14.6%) patients developed ROP, with 11 (8.0%) stage 1, six (4.4%) stage 2, and three (2.2%) stage 3 based on combined diagnoses. Perinatal asphyxia was significantly associated with ROP incidence (p = 0.01). ROP incidence by combined diagnosis (20/137 or 14.6%) versus clinician diagnosis alone (21/137 or 15.3%, p = 0.50) was similar. Telemedicine changed diagnoses in 4/21 (19.0%) ROP cases.

Conclusions: Telemedicine may be helpful in confirming ROP incidence and may serve as a training and support model for less experienced and professionally isolated ROP examiners.     

Weitwinkelfundusdokumentation bei Retinopathia praematurorum

Background. Fundus documentation in preterm infants has been improved by the advent of a new wide-angle fundus camera (RetCam 120). Patients and methods. In 30 preterm infants we used the RetCam 120 for retinopathy of prematurity (ROP) screening, before and after laser treatment of ROP and after regression of acute phase ROP for documentation of fundus findings. The RetCam 120 is a digital contact wide-angle fundus camera which is based on a 3-chip CCD video camera. Results. The RetCam 120 proved to be feasable for ROP documentation in preterm infants. Fundus documentation enhanced follow-up, teaching and cooperation between ophthalmologists and neonatologists. Conventional ophthalmoscopy is still necessary when using the RetCam 120 in ROP screening. Technical improvements of the camera itself and of the hardware and software is necessary before the RetCam 120 can be used routinely in ROP screening. Conclusion. The wide-angle fundus documentation using the RetCam 120 allows instant visualization and real-time documentation of intraocular findings. The RetCam 120 opens up new possibilities in clinical and scientific work, in teaching and in the new frontiers of ophthalmological telemedicine.     

Retinopathy of prematurity in the UK I: the organisation of services for screening and treatment

AIMS: To ascertain how closely services for the screening and treatment of retinopathy of prematurity (ROP) were organised on a national level in 1995. METHODS: Questionnaires about the local arrangements for the screening and treatment of retinopathy of prematurity (ROP) were sent to the entire consultant membership (n = 648) of the Royal College of Ophthalmologists (RCOphth) and to the clinical directors (n = 259) of neonatal units and other units caring for preterm babies in the UK in 1995. RESULTS: 568/648 of UK consultants (88%) and 15 non-consultant ophthalmologists and 210/259 paediatricians (81%) and 19% paediatricians in non-neonatal units responded. Thirty-one per cent responding ophthalmologists were involved in the ROP service: of these 64% screened babies, 34% screened and treated babies, while 1% ophthalmologists treated ROP but did not screen. Ninety-six per cent units caring for preterm babies had their babies screened for ROP and for almost 95% of the screening took place in the neonatal unit. About 8200 babies were screened in 1994; 277 developed stage 3, of whom 54% received treatment. Nine per cent (n = 14) and 5% (n = 8) treated babies became blind in one and both eyes respectively. A sessional commitment was identified for 9% ophthalmologists, but for less than half this was included in the contracted work programme. Sixty-five ophthalmologists treated babies with ROP, but only 10 treated more than five babies in 1994. Training needs were identified by 71 respondents. CONCLUSIONS: Several aspects of ROP screening and treatment services require improvement. Hopefully, reducing the number of identified screeners would increase skills, confidence and the ability to recognise severe disease requiring treatment, and also facilitate incorporation of this work into consultant work plans.     

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

AIM: To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. METHODS: A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. RESULTS: The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. CONCLUSION: IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.     

Screening for retinopathy of prematurity--a comparison between binocular indirect ophthalmoscopy and RetCam 120

AIM: To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard. SETTING AND DESIGN: Prospective, comparative study. MATERIALS AND METHODS: A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method. RESULTS: ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively. CONCLUSION: Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.     

Effects of congenital ptosis on the refractive development of eye and vision in children

AIM: To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children. METHODS: In this prospective observational study, 41 patients with unilateral congenital ptosis were enrolled (age range 3-15y). The blepharoptosis was divided into 3 subgroups according to the margin reflex distance-1 (MRD-1), including mild group (MRD-1 ≥2 mm), moderate group (0≤MRD-1<2 mm), and severe group (MRD-1<0 mm). The fellow eyes served as controls. All subjects underwent ocular examinations, including axial length, keratometry, and refractive error. RESULTS: The incidence of astigmatism and magnitude of cylindrical power differed significantly between the ptotic eyes and the fellow eyes. The spherical equivalent refraction (P=0.006), spherical power (P=0.01), cylindrical power (P=0.011), axial length-corneal radius (AL/CR) ratio (P=0.009), frequency of hyperopia (P=0.002) and astigmatism (P=0.004) were significantly different among the ptotic eye subgroups and the fellow eye group. In addition, in patients with congenital ptosis, the incidence of amblyopia is 43.9% and the incidence of anisometropia is 24.4%. More importantly, the ratio of AL/CR showed significantly positive correlation with the severity of ptosis. CONCLUSION: Congenital ptosis may lead to a delayed eyeball development in the aspect of AL/CR. The risk of amblyopia is also increased due to visual deprivation and aggravated anisometropia, particularly in severe ptosis case.     

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.     

Telephotoscreening to detect retinopathy of prematurity: preliminary study of the optimum time to employ digital fundus camera imaging to detect ROP.

PURPOSE: Labor-intensive screening of infants in the neonatal intensive care units is the only way presently to detect retinopathy of prematurity (ROP). Our purpose is to determine if RetCam 120 images (Massie Research Laboratories, Inc, Dublin, Calif), acquired by a neonatal nurse, can be used to screen for ROP by performing 2 screening sessions, at 32 to 34 weeks' (examination 1) and 38 to 40 weeks' (examination 2) postconceptional age. METHODS: RetCam examinations were performed by a nurse on infants at examination 1 and examination 2 intervals. At the same time, an examination was performed by an experienced ophthalmologist. Masked readers evaluated the digital images for the presence of ROP and, if ROP was present, estimated the risk of that eye progressing to prethreshold or threshold disease. The data were compared to the eye's clinical course. RESULTS: A total of 46 eyes were assessed at examination 1 and 50 eyes at examination 2 from July 1, 1999, to December 15, 1999. For detecting ROP, the sensitivity and specificity were 46% and 100% for examination 1 and 76% and 100% for examination 2. Sensitivity and specificity of predicting prethreshold was 64% and 97%, respectively, for examination 1 and 2. Sensitivity for predicting ROP threshold at examination 1 was 0% (only 1 photo was available for grading of sensitivity) and specificity for predicting ROP threshold at examination 1 was 95%. At examination 2, sensitivity and specificity were 100%. CONCLUSION: The RetCam examination had insufficient sensitivity to be recommended as a substitute for indirect ophthalmoscopy in screening for ROP. Reasons for low sensitivity are the technical limitation of the camera design itself, which creates difficulty in photographing the peripheral retina in small eyes, and the need for a lid speculum better adapted to the contact camera optical system design. Both of these issues are being addressed as part of an ongoing project to study the feasibility of employing telemetry of digital fundus images from remote, underserved neonatal intensive care units to ophthalmologists capable of diagnosing ROP.     

RetCam与BIO在ROP筛查中的应用效果对比

目的：比较广角数码视网膜成像系统(RetCam)与双目间接检眼镜(BIO)在早产儿视网膜病变(ROP)筛查中的应用效果。

方法：对2014-05/2017-05在我院出生的1 624例3 248眼早产儿进行RetCam与BIO检查，对比两种检查方法对ROP的筛查结果及不良事件发生情况。

结果：早产儿1 624例3 248眼中，RetCam检出ROP患儿196例392眼，BIO检出ROP患儿189例378眼，二者的分期结果与分区病变结果比较差异无统计学意义(P>0.05)； 以BIO检查结果为标准，RetCam检查的敏感性、特异性、假阳性率、阳性预测值分别为100.00%、99.51%、3.57%、96.43%； RetCam与BIO的不良事件发生率分别为0.18%、0.22%，差异无统计学意义(P>0.05)。

结论：RetCam与BIO筛查ROP具有较高一致性，RetCam可以替代BIO作为ROP的筛查方法。     

Assessment and management of retinopathy of prematurity in the era of anti-vascular endothelial growth factor (VEGF)

The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and improve ROP awareness. Advancements in imaging techniques, expansion of telemedicine services, and the potential for artificial intelligence-assisted ROP screening programs have created opportunities to improve ROP care in areas with a shortage of ophthalmologists trained in ROP. To address the gap in provider knowledge regarding ROP, the Global Education Network for Retinopathy of Prematurity (GEN-ROP) created a web-based tele-education training module that can be used to educate all providers involved in ROP, including non-physician ROP screeners. Over the past 50 years, the treatment of severe ROP has evolved from limited treatment modalities to cryotherapy and laser photocoagulation. More recently, there has been growing evidence to support the use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of severe ROP. However, VEGF is known to be important in organogenesis and microvascular maintenance, and given that intravitreal anti-VEGF treatment can result in systemic VEGF suppression over a period of at least 1–12 weeks, there are concerns regarding adverse effects and long-term ocular and systemic developmental consequences of anti-VEGF therapy.Future research in ophthalmology to address the growing burden of ROP should focus on cost-effective fundus imaging devices, implementation of artificial intelligence platforms, updated treatment algorithms with optimal use of anti-VEGF and careful investigation of its long-term effects, and surgical options in advanced ROP. Addressing these unmet needs will aid the global effort against the ROP epidemic and optimize our understanding and treatment of this blinding disease.     

广角数码儿童视网膜成像系统进行早产儿视网膜病变筛查研究

目的：探讨广角数码儿童视网膜成像系统( RetCamⅡ)进行早产儿视网膜病变( ROP)筛查的临床价值。
　　方法：选择2012-01/2015-12产科符合筛查标准的200例400眼早产儿采用RetCamⅡ进行ROP筛查,以双目间接眼底镜检查结果作为金标准,计算RetCamⅡ筛查早产儿ROP的价值。
　　结果：本次筛查200例400眼早产儿,双目间接眼底镜检查共检出ROP病变63眼,ROP患病率为15.8%,其中正常337眼、ROPⅠ期42眼、Ⅱ期14眼、Ⅲ期7眼、Ⅳ期0眼、Ⅴ期0眼;RetCamⅡ共计筛查出ROP病变64眼,其中误诊5眼、诊断级别降低6眼。 RetCam Ⅱ检出结果与双目间接眼底镜检查结果的一致性Kappa值为0.814( P<0.05)。 RetCam Ⅱ筛查早产儿 ROP 病变的灵敏度为93.7%、特异度为98.5%、漏诊率为6.4%、误诊率为1.5%、阳性预测值92.2%、阴性预测值98.8%。
　　结论：RetCam Ⅱ进行早产ROP筛查具有较高的临床实用价值。     

激光光凝及抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗早产儿视网膜病变的疗效观察

目的 观察激光光凝和抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）玻璃体腔注射治疗早产儿视网膜病变（ROP）的有效性及安全性。方法 经临床检查确诊的3期ROP患儿19例38只眼纳入研究。其中,1区病变9例18只眼;2区病变10例20只眼。所有患儿均采用间接检眼镜和二代广角数码视网膜成像系统（RetCam Ⅱ）行眼底检查及眼底摄像,双眼眼底病变相同。依据治疗方式分为激光光凝治疗组和注药治疗组。治疗时,随机选取1只眼行激光光凝治疗,另1只眼玻璃体腔注射25 mg/ml的bevacizumab 0.03 ml（含bevacizumab 0.75 mg）。治疗后随访12～66周,平均随访时间33周。比较两组嵴及附加病变（plus）消退时间。结果 1区病变18只眼中,嵴、plus消退时间注药治 疗组分别为（2.25±0.46）、（2.11±0.60）周;激光光凝治疗组均为（3.75±1.75）周。两组间嵴、plus消退时间比较,差异有统计学意义（F=18.29,15.56;P＜0.05）。2区病变20只眼中,嵴、plus消退时间注药治疗组分别为（3.1±1.72）、（2.1±0.56）周;激光光凝治疗组分别为（3.50±1.90）、（2.50±1.35）周。两组间嵴、plus消退时间比较,差异无统计学意义（F=0.38,2.62;P＞0.05）。治疗出现视网膜表面纤维膜增加8只眼。其中,激光光凝治疗组6只眼,注药治疗组2只眼。随访中未观察到与治疗相关的并发症发生。结论 激光光凝和抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗3期ROP有效、安全。     

早产儿眼病的两种筛查模式效果评价

目的：探讨并对比两种筛查模式在检查早产儿视网膜病变(retinopathy of prematurity,ROP)中的应用情况。

方法：回顾性分析2016-01/2017-01我院眼科行眼病筛查的600例1 200眼早产儿病例资料,均采用双眼间接检眼镜(binocular indirect ophthalmoscope,BIO)和第3代广角数码视网膜成像系统(RetCam Ⅲ)检查眼底病变,统计检查结果及操作过程中出现的不良事件。

结果：患者600例1 200眼中,BIO检出ROP的几率为10.92%,与RetCam Ⅲ(10.75%)比较,差异无统计学意义(P>0.05); 以BIO为“金标准”,RetCam Ⅲ检查ROP的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为98.67%、93.13%、99.35%、94.57%、99.16%。BIO、RetCam Ⅲ检查ROP分期结果比较,差异无统计学意义(P>0.05)。BIO检查眼底非ROP病变的几率为4.83%,与RetCam Ⅲ(4.58%)比较,差异无统计学意义(P>0.05); 以BIO为“金标准”,RetCam Ⅲ检查眼底非ROP病变的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为99.67%、94.83%、99.91%、98.21%、99.74%。BIO筛查过程中17例(2.83%)出现不良事件,与RetCam Ⅲ的7例(1.17%)比较,差异有统计学意义(P<0.05)。

结论：RetCam Ⅲ检查ROP及早产儿眼底非ROP病变结果与BIO基本一致,但在减少操作过程中的不良事件上RetCam Ⅲ更具优势。     

【In Press】Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

AIM: To assess the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. METHODS: Data was collected from ROP patients with Zone II Stage 3+ who had intravitreal ranibizumab injections between October 2014 and January 2017 at the department of Ophthalmology in our hospital. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Gestational age at birth, birth weight, sex, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up period were recorded. The final clinical status of the retina was noted for each patient. The primary outcome measures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization RESULTS: Eighty-six eyes of 46 premature infants with Zone II Stage 3+ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67wk (range: 25 to 33wk) and the mean birth weight was 1070.57±226.85 g (range: 720.00 to 1650.00 g). The mean PMA at treatment was 38.32±2.99wk (range: 32.29 to 46.00wk). Seventy-one eyes (82.56%) were treated successfully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22wk (range: 1.86 to 11.71wk). All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.1%) achieved complete vascularization. CONCLUSION: Intravitreal ranibizumab injection is an effective treatment in patients with zone II stage 3+ ROP. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment.     

Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?

Purpose: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP‐ROP). Methods: The medical charts of all infants with AP‐ROP at Uppsala University Hospital, Sweden, during a 2‐year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. Results: All infants (16 eyes) had AP‐ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first‐line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. Conclusions: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti‐vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long‐term ocular and systemic outcome is warranted before this drug becomes general clinical practice.     

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 twentynine 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 70 mo after the treatments.     

Binocularity outcomes following treatment for retinopathy of prematurity

ObjectiveRetinopathy of prematurity (ROP) is a leading cause of childhood visual impairment. Treatment options for severe ROP include laser and/or anti–vascular endothelial growth factor (anti-VEGF) injections. Previous studies have compared the 2 treatments for functional outcomes including visual acuity, amblyopia, and strabismus. The purpose of this study was to evaluate the influence of treatment on binocularity.MethodsIn this masked, cross-sectional study, binocularity was measured using Bagolini lenses and the Frisby stereotest in children aged 3–8 years with a history of ROP treatment in 2 Canadian centres. Events associated with disruption of binocularity including amblyopia, anisometropia, and strabismus, were recorded and analyzed as secondary outcomes.ResultsA total of 42 children were recruited: 19 were treated with laser and 23 with an anti-VEGF agent. The mean age at the time of assessment in the laser group was 81.2 (6.8 years) ± 16.2 months versus 63 (5.25 years) ± 15.7 months in the anti-VEGF group (p < 0.001). No statistically significant difference in rates of binocularity was detected (68% laser vs 82% anti-VEGF, p = 0.27). Laser-treated participants experienced a greater number of cumulative insults to binocularity (p = 0.01).ConclusionsPatients with a history of ROP treated with laser or anti-VEGF agents require long-term follow-up to address binocularity-disrupting factors. Although we did not detect a difference in rates and level of binocularity between treatment groups, we did find an increased rate of cumulative binocularity disrupting events in the laser-treated group.