Retinopathy of prematurity (ROP): Optimal timing of clinical evaluation and standard procedures

The authors present the protocol currently used in their institution for initial and follow-up evaluation of infants at high risk for developing retinopathy of prematurity (ROP). After topical anesthesia and lid speculum insertion, the examination is carried out using an indirect binocular ophthalmoscope with a +20 or +28-diopter lens. Mydriasis is achieved by instilling one drop of 1% tropicamide, followed by one drop of 0.5% tropicamide + 2.5% phenylephrine 15 minutes later and after an additional 15 minute interval, another drop of 1% tropicamide. If mydriasis is insufficient after one hour, one drop of a 0.5% tropicamide-5.0% phenylephrine solution may be instilled. The initial examination is performed between the third and fourth weeks of life. If any areas of retinal immaturity are found, the examination is repeated every other week and, later, every three to four weeks, until vascularization has reached the ora serrata. Should any sign of ROP be present during the first examination, the patient is examined weekly or every other week depending on the severity of clinical findings.     

低体重早产儿使用地塞米松与视网膜病变发展进程的相关性

目的：评价地塞米松疗法对早产儿视网膜病变（ retinopathy of prematurity,ROP ）的发生率和严重程度的影响。 ROP是导致婴幼儿视力损害的重要原因之一,甚至导致失明。近年来,由于新生儿护理技术的提高,能够存活的（极）低出生体重儿不断增加,导致发生ROP高危人群的产生。产前和产后类固醇（ postnatal steroids,PNS）的使用对ROP发生率的影响尚有争议,并且该制剂与ROP严重程度的相关性尚未评估。
　　方法：选取儿童医院2012－04／2013－06出生体重不足1500克并胎龄不足29周的115例新生儿进行双盲对照研究。随机分为病例组和对照组,病例组内给予8～14 d的新生儿静脉滴注地塞米松,对照组不予注射。从出生后
　　6 wk开始进行眼科检查并持续至病症消退。结果：收入新生儿重症监护室、出生体重不足1500克的新生儿的存活率为69％（80／115）。新生儿胎龄越低（≤25周和26～28周） ROP发生率越高。参加此项研究的58例婴幼儿中,ROP （二期或二期以上）的发生率为8．6％。在接受PNS的28例新生儿中,2例（7．4％）发生严重的早产儿视网膜病变。而在没有接受PNS的30例新生儿中,有3例（9．7％）确诊为ROP。接受PNS婴幼儿与对照组婴幼儿ROP的发生率无显著差异（ P＝0．35）。此外,病例组（7．4％）和对照组（9．7％）比较,严重ROP（二期以上）发生率也无显著差异（P＝0．36）。
　　结论：此研究表明,接受地塞米松静脉滴注的新生儿与未接受地塞米松滴注的新生儿在早产儿视网膜病变的发生率和严重程度上无显著差异。因此,注射地塞米松治疗早产儿慢性肺病通常不会增加ROP发生的危险性。     

Changes of the peripapillary vascular parameters in premature infants without retinopathy of prematurity using U-net segmentation

AIM: To quantitatively assess the changes in mean vascular tortuosity (mVT) and mean vascular width (mVW) around the optic disc and their correlation with gestational age (GA) and birth weight (BW) in premature infants without retinopathy of prematurity (ROP). METHODS: A single-center retrospective study included a total of 133 (133 eyes) premature infants [mean corrected gestational age (CGA) 43.6wk] without ROP as the premature group and 130 (130 eyes) CGA-matched full-term infants as the control group. The peripapillary mVT and mVW were quantitatively measured using computer-assisted techniques. RESULTS: Premature infants had significantly higher mVT (P=0.0032) and lower mVW (P=0.0086) by 2.68 (104 cm-3) and 1.85 μm, respectively. Subgroup analysis with GA showed significant differences (P=0.0244) in mVT between the early preterm and middle to late preterm groups, but the differences between mVW were not significant (P=0.6652). The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA (P=0.0211 and P=0.0006, respectively). For each day increase in GA at birth, mVT decreased by 0.1281 (104 cm-3) and for each 1 g increase in BW, mVT decreased by 0.006 (104 cm-3). However, GA (P=0.9402) and BW (P=0.7275) were not significantly correlated with mVW. CONCLUSION: Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP. Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.     

早产儿视网膜病变的筛查结果分析

目的:总结早产儿视网膜病变(retinopathy of prematurity,ROP)发生发展特点及相关危险因素,探讨其合理的筛查标准和治疗模式。方法:对胎龄≤35wk,体质量≤2500g的1626例早产儿进行ROP筛查,并对其临床特点进行总结。结果:发现ROP173例(10.64%);出生体质量≤1000g组,1001~1500g组,1501~2000g组,2001~2500g组患病百分比有显著性差异(分别为89.64%,29.71%,7·82%,1.29%,P<0.05);出生胎龄≤30wk组,30wk<出生胎龄≤32wk组,32wk<出生胎龄≤35wk组间ROP患病百分比有显著性差异(分别为31.11%,12.24%,4.04%,P<0.05);单生子与多生子患病率有显著性差异(分别为6.99%,34.12%,P<0.05);少数全身病情严重者可在32wk前发生ROP;患儿行冷凝术36例,手术效果满意。结论:体质量<1500g,胎龄<31wk,多生子中发病率高;及早行冷冻术病情控制满意。     

极低出生体质量早产儿视网膜病变临床分析

目的：分析极低出生体质量早产儿视网膜病变(ROP)的临床特点。

方法：回顾分析2009-12/2018-06在我院眼科门诊及新生儿科住院并接受眼底检查的早产儿3 121例,男1 862例,女1 259例,其中出生体质量低于1 500g的极低出生体质量早产儿400例,男191例,女209例; 出生体质量≥1 500g的早产儿2 721例,男1 671例,女1 050例。比较不同出生体质量早产儿中ROP的检出率、出生胎龄、性别比例、ROP的诊断时间、ROP的严重程度及其他眼病的患病率。

结果：本研究筛查3 121例早产儿,ROP检出率8.2%(255/3 121),出生体质量小于1 500g的极低出生体质量早产儿400例,ROP检出率23.8%(95/400),其中无需治疗的1～2期病变93.7%(89/95),阈值前及阈值病变3.2%(3/95),4～5期病变3.2%(3/95)。出生体质量<1 000,1 000～1 499,≥1 500g,ROP检出率分别为25.0%、23.7%、5.9%。不同体质量组男女性别比例、ROP检出率、出生胎龄、ROP诊断时间、ROP严重程度均有差异(P<0.001)。出生体质量<1 000g组与出生体质量1 000～1 499g组,以及出生体质量<1 000g组与出生体质量≥1 500g组的ROP严重程度比较有差异(χ²=28.90,P<0.01; χ²=34.64,P<0.01),但是出生体质量1 000～1 499g组与出生体质量≥1 500g组的ROP严重程度无差异(P>0.05)。不同出生体质量组其他眼病的发生率无差异(P>0.05)。

结论：出生体质量越低,ROP的发生率越高。出生体质量<1 000g的ROP严重程度明显高于出生体质量≥1 000g的早产儿。眼科应联合产科、新生儿科,降低极低出生体质量早产儿ROP的发生率,提高极低体质量ROP筛查、随访的依从性,是降低ROP致盲的重要手段。     

早产儿视网膜病变的冷冻治疗

目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)阈值前病变I型及阈值病变的冷冻治疗疗效,探讨其合理的治疗时机及模式。方法:对胎龄≤35wk,质量≤2000g患儿进行ROP筛查,对阈值前病变I型及阈值病变进行冷冻治疗。结果:(1)共筛查829例符合条件的早产儿,发现早产儿视网膜病变患儿86例(172眼,占10.4%),如按照中华眼科学会制定的ROP筛查标准(出生胎龄≤35wk,质量≤2000g)则患病率为20.6%;其中4期6眼(3.5%),3期44眼(25.6%),发展快的2期14眼(8.1%),稳定或退行2期56眼(32.6%),1期52眼(30.2%);24眼有后部plus现象,58眼周边视网膜出血;50眼2区发病,122眼3区发病;32wk及以内发病的16眼,32~36wk发病的60眼,36wk及以后发病的96眼;(2)行冷冻手术32例(64眼),其中阈值前病变I型12例,阈值病变20例;24眼有后部plus现象;40眼周边视网膜出血;50眼2区发病,14眼3区发病;32wk及以内发病的16眼,32~36wk发病的36眼,36wk及以后发病的12眼;单生子21例,双生子10例,三生子1例;(3)30例病情控制满意;1例发展为后极部视网膜皱襞,周边视网膜脱离,最后行玻璃体切割手术;2例玻璃体出血,其中1例出血吸收,1例最后牵引性视网膜脱离;(4)3例术后短期角膜水肿,5例眼睑冻伤,2例玻璃体出血。结论:(1)后部plus现象、周边视网膜出血、2区发病、32wk内发病的ROP是高风险病变,病情发展迅速,往往需要行手术治疗;(2)对阈值前病变及阈值病变及时行视网膜冷冻术效果较满意且安全。     

母亲缺铁性贫血与早产儿或低出生体重儿发生ROP的相关分析

目的:探讨母亲缺铁性贫血与早产儿或低出生体重儿发生早产儿视网膜病变(ROP)的关联,进而为本病的预防和控制其病变程度提供可能科学依据。方法:病例对照研究。分析2019-01/2021-07因首次(出生30d左右)ROP筛查就诊于我院并且确诊为ROP的317例早产儿或低出生体重儿及其母亲的临床资料。观察母亲缺铁性贫血与ROP发病、ROP分期的关系,母亲缺铁性贫血Hb及血值特征、母亲缺铁性贫血平均孕龄、孕周及婴儿出生体质量与ROP分期的关系。结果:存在缺铁性贫血的母亲235例(74.1%),82例(25.9%)母亲无铁缺乏。其中轻度贫血母亲194例(82.6%),其ROP患儿Ⅰ期119例和Ⅱ期75例;中度贫血母亲39例(16.6%),其ROP患儿Ⅱ期8例、Ⅲ期22例和Ⅳ期9例;重度贫血母亲2例(0.9%),其ROP患儿均为Ⅳ期;本次未发现Ⅴ期及阈值病变ROP患儿和极重度贫血母亲。与缺铁性贫血母亲相比,铁水平正常母亲的早产儿或低出生体重儿更易发生Ⅰ期ROP,但是Ⅱ期ROP在缺铁性贫血母亲中表现更为突出(均P<0.05);Ⅲ期和Ⅳ期早产儿或低出生体重儿ROP在血铁值正常的母亲中未观察到,...     

Retinopathy of prematurity and other ocular problems in premature infants weighing less than 1500 g at birth

PURPOSE: To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. METHODS: This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992-2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. RESULTS: The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. CONCLUSIONS: Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.     

极低出生体重早产儿视网膜病变的相关危险因素及近期转归

目的 探讨极低出生体重早产儿视网膜病变(ROP)的检出率及危险因素.方法 回顾性分析2017年4月至2019年5月在新生儿重症监护室住院的极低出生体重儿208例为研究对象.以是否发生ROP分为ROP组(98例192眼)与非ROP组(110例220眼),其中ROP组患儿根据是否需要治疗分为重症组(6例12眼)与非重症组(...     

A predictive score for retinopathy of prematurity in very low birth weight preterm infants

Aims

This study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP.

Methods

A prospective cohort of preterm infants with BW⩽1500 g and/or GA⩽32 weeks was studied. The score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. The score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions.

Results

The sample included 474 patients. The area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately.

Conclusions

ROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. The scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP.     

Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: ten year data from a tertiary care center in a developing country

BACKGROUND: Retinopathy of prematurity (ROP) is an important cause of childhood blindness in developing countries. AIM: To report the spectrum of ROP and associated risk factors in babies weighing > 1250 g at birth in a developing country. SETTING AND DESIGN: Institutional, retrospective, non-randomized, observational clinical case series. MATERIALS AND METHODS : Retrospective analysis (10 years) of 275 eyes (138 babies) with ROP. STATISTICAL ANALYSIS: Qualitative data with the Chi-square test. Quantitative data using the unpaired t test or the ANOVA and further tested using multivariate logistic regression. RESULTS: The mean birth weight was 1533.9 g (range 1251 to 2750 g) and the mean period of gestation was 30.9 weeks (range 26 to 35). One hundred and twenty-four of 275 eyes (45.1%) had threshold or worse ROP. Risk factors for threshold or worse disease were, 'outborn babies' ( P P = 0.007) and exchange transfusion ( P = 0.003). The sensitivity of the American and British screening guidelines to pick up threshold or worse ROP in our study group was 82.4% and 77.4% respectively. CONCLUSIONS : Severe ROP is often encountered in babies weighing greater than 1250 g at birth in developing countries. Western screening guidelines may require modifications before application in developing countries.     

出生体质量超过1500g早产儿严重ROP的发病特点及治疗预后

目的研究出生体质量超过1500g早产儿严重早产儿视网膜病变(retinopathy of prematurity,ROP)发病特点及其治疗预后。方法收集2006年1月至2009年6月在我院进行激光光凝治疗的阈值、阈值前1型或急进型后部ROP(aggressive posterior ROP,AP-ROP)患儿中,选择出生体质量>1500g患儿,对其性别、胎龄、出生体质量、母体和患儿全身疾病情况等危险因素进行分析,并对其治疗效果进行评价。结果共收集患儿33例,男26例,女7例;胎龄28.0～34.3周,平均31.0周;出生体质量为1500～2000g,平均1700g;剖宫产19例,顺产14例。所有患儿均有吸氧史,母体合并全身疾病者27例;术前诊断13例26眼为阈值前1型ROP,3例6眼为AP-ROP,17例34眼为阈值ROP。26例52眼患儿一次光凝成功,5例10眼补充光凝成功,1例2眼经Avastin玻璃体腔注射后病变稳定,1例2眼病变发展至4期和5期行玻璃体手术后病情控制、稳定。结论出生体质量超过1500g早产儿患严重ROP现象反映本地区ROP防治水平低,早产儿出生前母体全身情况不稳定是造成ROP发病的重要原因之一,该类型ROP病变一般较轻,治疗预后较好。     

马来西亚一个三级保健医院早产儿视网膜病变的筛查

目的:本研究旨在确定马来西亚一个三级保健医院早产儿视网膜病变的发病率及发病趋势。方法:回顾分析在2003-2005年之间出生并进行ROP筛查的婴儿,记录每个患儿ROP的最严重分期。结果:我们对188名婴儿进行了筛查,平均出生体重1105.3±300.6g,平均妊娠期为29.2 ±2.6wk。这些婴儿整体的ROP发病率为29.18 % (55/188)。出生体重在750g及以下的婴儿发病率为76.2%。3a以来,低体重儿的数量及重型ROP病例数量呈现一个增长的趋势(P<0.05)。出生体重与婴儿受检数量之间存在负相关关系(P=0.000)。结论:随着低体重和小月分婴儿比例的增加,患ROP的患儿比例随之增加。     

Incidence of retinopathy of prematurity in extremely premature infants over an 18-year period

Background: To report the incidence of retinopathy of prematurity (ROP) in a subgroup of extremely premature infants admitted to an Australian tertiary centre over an 18‐year period. Design: Retrospective study. Royal Brisbane and Women's Hospital Neonatal Intensive Care Unit. Participants: Five hundred and fifty‐four infants admitted between 23 and 25.6 weeks gestational age (GA). Methods: The 18‐year study was divided into three 6‐year periods for analysis: period 1 (1992–1997), period 2 (1998–2003) and period 3 (2004–2009). Infants were compared based on their week of GA and by the study period in which they were born. Main Outcome Measures: GA, birthweight, incidence and severity of ROP. Results: Three hundred seventy‐three (67.3%) infants survived until ROP screening, and 351 (63.4%) survived until discharge. ROP incidence increased from 78.2% in period 1 to 86.1% in period 3. Over the entire study, 90.5% of 23‐week GA infants had ROP compared with 89.7% of 24‐week GA infants and 76.1% of 25‐week GA infants. Mean birthweight was significantly lower in infants with any ROP (725.1 g) and ROP of at least stage 3 (720.8 g) compared with infants without ROP (806.5 g) (P < 0.0001). Twenty‐three–week GA infants had more severe ROP (28.6%) than 24 weeks (18.3%) and 25 weeks GA (11.9%). Conclusions: There has been increased survival and incidence of ROP in extremely premature infants over the past 20 years. Lower birthweight and GA are both associated with higher incidence and more severe ROP.     

超未成熟儿视网膜病变术后屈光状态分析

目的　研究出生体质量＜１０００ｇ的早产儿视网膜病变患儿经过抗血管内皮生长因子玻璃体内注射后矫正胎龄６个月大时的眼位、注视功能及屈光状态情况。方法　横断面研究,回顾性队列研究。出生体质量＜１０００ｇ、因早产儿视网膜病变接受抗血管内皮生长因子玻璃体内注射的３２例（６４眼）患儿,于矫正胎龄６个月大时检查其注视功能、眼位,并散瞳验光。按治疗前眼底有无纤维增殖进行分组,观察两组屈光性弱视发生风险有无统计学差异。结果　矫正胎龄６个月大时,３２例６４眼中近视眼者２９眼（４５．３％）,近视度数为－０．７５～－４．００（－２．０３±０．７１）ＤＳ;远视眼３２眼（５０．０％）,远视度数为＋１．００～＋４．００（＋１．７８±０．７６）ＤＳ;存在或合并散光者２８眼（４３．８％）,散光度数为１．００～６．００（２．３９±１．１３）ＤＣ。所有患儿均为正位眼且中心注视,无注视抑制;治疗前眼底纤维增殖组中,有屈光性弱视风险的比例为７５．０％（１２／１６）;无纤维增殖组中,有屈光性弱视风险的比例为２５．０％（４／１６）,两者相比差异具有统计学意义（Ｐ＝０．０３２）。结论　出生体质量＜１０００ｇ早产儿接受抗血管内皮生长因子玻璃体内注射术后矫正胎龄６个月大时,表现出中心注视及正位眼,无注视抑制。治疗前眼底纤维增殖组发生屈光性弱视的风险大于无纤维增殖组。     

Dopamine use is an indicator for the development of threshold retinopathy of prematurity

AIM: To assess whether treatment of premature infants with dopamine is a risk factor for development of retinopathy of prematurity (ROP). METHODS: A retrospective case series analysis of two groups was utilised with a minimum follow up of 6 months. Clinical profiles and patient risk factors were identified along with an evaluation of ROP progression and an analysis of clinical outcome. All infants were seen in a single community neonatal intensive care unit (NICU). 41 consecutive high risk infants were identified during a 36 month period whose birth weight was less than 1000 grams and who remained in the NICU without transfer until at least 28 days of age. Dilated indirect ophthalmoscopy fundus examinations were performed on all infants to identify the degree of and progression to threshold ROP. RESULTS: 18 of 41 infants were treated with dopamine for hypotension. The group of infants requiring dopamine differed statistically from the non-dopamine treated group by having a slightly higher birth weight, a greater incidence of hypotension and colloid treatment, and in manifesting more advanced respiratory disease. Within the dopamine treated group, 12 of 18 infants (67%) reached prethreshold ROP and seven infants (39%) reached threshold ROP requiring laser treatment. In contrast, only three of the infants (13%) who did not require dopamine for hypotension progressed to prethreshold (p = 0.001) and only one of these infants (4%) progressed to threshold ROP (p = 0.02). Logistic regression analysis among other variables demonstrated that dopamine use and gestational age are important factors in this low birthweight population for predicting the development of threshold ROP (dopamine use: adjusted odds ratio = 119.88, p = 0.0061; gestational age: adjusted odds ratio = 0.061, p = 0.0043). CONCLUSIONS: Dopamine use in low birthweight infants may therefore be a risk factor for the development of threshold ROP. More vigilant screening of high risk infants requiring dopamine therapy for systemic hypotension may be warranted.     

375例早产儿中早产儿视网膜病变的患病状况

目的了解厦门地区早产儿视网膜病变（ROP）的患病情况。设计回顾性病例系列。研究对象2004—2008年厦门市第一医院入院筛查的375例出生体重2500g,或胎龄≤32周的早产儿。方法用双目间接眼底镜进行眼底检查,明确是否有ROP及其分期,统计不同出生体重、不同胎龄患儿的ROP患病率。主要指标ROP患病率。结果375例早产儿发现有ROP者41例,患病率10.93％;其中ROP1期9例,2期14例,2期10例,3期1例,急性进展性后部ROP1例。出生体重≤1000g、1001-1500g、1501～2000g的早产儿ROP患病率分别为45．00％、17．07％、7．01％;出生胎龄≤28周、29～30周、31～32周、33～34周的患病率分别为34．48％、12．07％、12．71％、8．25％。结论出生体重≤2000g、胎龄434周ROP患病风险高,早期进行ROP的筛查是防治ROP的关键所在。     

Retinopathy of prematurity: approaches to surgical therapy

Retinopathy of prematurity (ROP) is a vaso-proliferative disease with infiltration of the vitreous gel. Contraction of the infiltrate results in traction detachment with typical peripheral trough formation. Cryotherapy inhibits proliferation in the active stages of the disease (Stage 3, 'plus'). With development of traction detachment involving the macula (Stage 48) encircling buckling procedures should first be tried. Closed vitrectomy is considered when high retinal detachment and opacification by vitreous strands occur. The surgical technique is described. Anatomical (64%) and functional (43%) successes are reasonably high for Stage 4 cases, but disappointing (anatomical 40%, functional 16%) for Stage 5 ROP. Open funnels of detached retina fare better than closed ones. It is probably best to perform surgery not before the cicatricial stage, i.e. six months after birth.