Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a rapidly evolving area of pediatric ophthalmology. Over the past decade, a new understanding of the pathophysiology of ROP has emerged. Advances in clinical research have lead to modifications in screening criteria and treatment guidelines for ROP. With this knowledge, new treatment modalities such as anti-angiogenic agents are being investigated. This review will highlight some of the current concepts related to ROP.     

Risk Factors for Acute Retinopathy of Prematurity

We prospectively studied the risk factors and the incidence of retinopathy of prematurity (ROP) in 195 consecutive preterm infants. Birth weight and duration of mechanical ventilation were the only factors significantly associated with the incidence of ROP. While indomethacin increases the risk of developing ROP, maternal antenatal steroids have a protective effect against the development of severe stages of ROP. The presence of intraventricular hemorrhage increases the risk of severe ROP. Drs. Al-Amro and Thabit are from the Department of Opthalmalogy, and Drs. Al-Kharfi and Al-Mofado are from the Department of Pediatrics at the School of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices. The authors explore the effects of various factors on the incidence and severity of ROP and the effect of medications used for non-ophthalmic indications.     

早产儿视网膜病变的国际分类

早产儿视网膜病变的国际分类标准（ICROP）分为两部分。于1984年发表了第一部分，于1987年进行了扩展。早产儿视网膜病变的专家们就此达成了一致。最初的分类标准促进了大量多中心临床治疗试验的发展。也让我们更好的了解了这一潜在的致盲眼病。通过在托儿所更先进的图像技术我们能够提供更高质量的方法来描述ICROP。国际小儿眼科医师和视网膜专科医师一致意见修改了ICROP的某些方面，而有些改动应该是必需的。与最初的分类标准不同的方面包括了对以下内容的介绍：（1）在超低体重儿中观察到的恶性度更高的视网膜病变的概念（侵袭性，后极ROP）。（2）描述了附加病变的中间水平（附加病变前期）。介于正常后极部血管和完全附加病变之间，（3）评价Ⅰ区范围的一种实用临床工具。     

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     

Retinopathy of Prematurity: An Optimum Screening Strategy

OBJECTIVE: We sought to find out whether birth weight of less than 1251 g or gestational age less than 30 weeks could provide a safe and efficient screening criteria of detecting treatable retinopathy of prematurity (ROP). METHODS: Infants either with a birth weight less than 1500 g or gestational age less than 32 weeks were screened for ROP during an 8-year period. RESULTS: In our study, the incidence of ROP was 36 of 187 (19.3%) infants. Although there was a slight increase in the number of infants screened over the years, the incidence of ROP of any stage remained stable. The maximum stage of ROP reached was stage 1 in 10 of 187 (5.3%), stage 2 in 8 of 187 (4.3%), and stage 3 in 18 of 187 (9.6%) infants. Among those with stage 3 disease, threshold ROP was present in 16 of 18 (88.9%). All infants with threshold ROP had a BW less than 1100 g and gestational age less than or equal to 28 weeks. Significantly fewer babies (105/187, or 56%) would have been examined had inclusion criteria of a birth weight of less than 1251 g and gestational age less than 30 weeks been applied. In addition, 31% (134/437) of screening examinations could have been avoided. CONCLUSIONS: Our study suggests that a birth weight of less than 1251 g and gestational age less than 30 weeks can be safely and efficiently used to screen infants without missing a diagnosis of sight-threatening ROP in our catchment population.     

中国早产儿视网膜病变登记网的建设

早产儿视网膜病变（ROP）近年来在我国逐渐受到关注,成为研究热点.但由于民众欠缺相关知识及专业技术人员的匮乏,致使我国ROP的防治处于初级阶段,亟待ROP知识的普及以及专业防治的开展.＂中国早产儿视网膜病变登记网＂（http：//www.chinarop.com）的建设,旨在加强ROP的科普宣传和医务工作者的专业培训,建立国内的ROP病历注册登记制度及ROP数据库,为国内的ROP研究提供帮助.