Modification of screening criteria for retinopathy of prematurity in India and other middle-income countries

PURPOSE: To determine the gestational age and birth weight of premature babies who developed vision-threatening severe retinopathy of prematurity. DESIGN: Prospective observational study of babies at risk of blindness due to retinopathy of prematurity. METHODS: Data pertaining to all babies who underwent laser treatment or surgery for acute retinopathy of prematurity and those who had cicatricial retinopathy of prematurity were prospectively collected. The gestational age and birth weight were evaluated to establish screening criteria. RESULTS: In 120 babies, the mean gestational age was 29.6 weeks (range 26 to 36 weeks). The birth weight of 115 babies ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight was not available for five babies. Only one baby had a gestational age of >35 weeks. CONCLUSIONS: Ocular morbidity related to retinopathy of prematurity was seen in bigger and more mature babies. This study provides a scientific basis for establishing screening criteria for retinopathy of prematurity in South India and other middle-income countries.     

Retinopathy of prematurity in a South Australian neonatal intensive care unit

Purpose: To establish the incidence and severity of retinopathy of prematurity (ROP) in an Australian population of premature infants, and define risk factors for this population.
Methods: A survey of neonates born weighing less than 1501 g and/or with gestational age below 33 weeks, was undertaken at a neonatal intensive care unit in South Australia.
Results: ROP was diagnosed in 16.0% of the 94 neonates who were screened until retinal vascularisation was complete. Threshold disease occurred in 4.2%. Logistic regression identified three significant risk factors for the development of ROP: days of mechanical ventilation, multiple birth and female sex.
Conclusions: The incidence of ROP was relatively low when compared with figures recently published for two large populations studied in the United States and England. This difference was due to a lower incidence of mild forms of the disease. Days of mechanical ventilation, multiple birth and female sex were independently predictive of the occurrence of ROP. As small numbers of infants with ROP are managed at individual Australian centres each year, a national ROP register is recommended to facilitate the study of the disease in this country.     

Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes

PURPOSE: To examine the anatomical and refractive outcomes of infrared diode laser photocoagulation (DLPC) for the treatment of threshold retinopathy of prematurity (ROP). METHODS: The charts of all consecutive premature neonates with ROP treated by DLPC at our tertiary center from December 1, 1996, to December 31, 2004, were reviewed. RESULTS: The group included 100 neonates (194 eyes) with a mean birth weight +/- SD of 833.9 +/- 250.3 g and a mean gestational age +/- SD of 26 +/- 1.9 weeks. Sixty-two percent of neonates had zone I or posterior zone II ROP. Each eye received a mean +/- SD of 1,740 +/- 990 laser applications, and 21% of eyes received an additional 1 to 2 rows posterior to the ridge. Neonates treated after December 2003 (cutoff date of the Early Treatment of Retinopathy of Prematurity study) underwent a significantly greater number of laser applications (mean +/- SD, 2,286 +/- 1,087) than did neonates treated earlier. Anatomical results of laser treatment were favorable for 179 eyes (92.3%) at a mean follow-up +/- SD of 33.6 +/- 27.2 months. After vitreoretinal surgery, partial or total retinal detachment was documented for 2.5% of patients who received posterior-to-the-ridge laser treatment and 3.8% of patients treated only on the avascular retina. Refractive data were available for 134 eyes: 55.2% had myopia of -5 diopters (31.3%) or greater (23.9%). Strabismus was found in 21 (28.8%) of 73 neonates tested. Gestational age was correlated with corrected age at treatment, zone of ROP, number of laser applications, and spherical equivalent. Snellen visual acuity of 6/12 or more occurred in 17 of 24 patients who complied with testing. CONCLUSION: DLPC is a safe and effective treatment for ROP. Neonates of lower gestational age and birth weight require earlier and more aggressive laser treatment and may have a higher refractive error.     

A comparison of macular structure imaged by optical coherence tomography in preterm and full-term children

PURPOSE: Macular anatomic abnormalities were examined by optical coherence tomography (OCT) imaging in premature children and compared with those of full-term children. METHODS: In a prospective case-control study, premature patients 7 to 14 years of age were divided into three groups (group I, laser-treated retinopathy of prematurity [ROP]; group II, spontaneously regressed ROP; group III, no ROP), and age-matched children (group IV). All the eligible 74 eyes had normal-appearing posterior pole, myopia < or =3 D, and best corrected visual acuity 1.0. When both eyes of a subject were eligible for the study, one eye was randomly selected (10 eyes of 10 children in each group). Retinal thicknesses of the macula measured by OCT3 were compared. The correlation between central foveal thickness and prematurity (gestational age at birth < or = 30 weeks; birth weight < or = 1250 g) or ROP was determined. RESULTS: The mean foveal and central retinal thicknesses decreased significantly in group I (laser-treated ROP) and group IV (term birth). Significant differences in central retinal thickness were found between the premature groups and full-term children (Mann-Whitney U test). The cutoff point of central retinal thickness, determined by receiver operating characteristic curve was 209 microm. The general estimating equation model statistics found a significant effect of ROP severity (P = 0.003), P value for the category of prematurity was 0.063. CONCLUSIONS: The central retinal thickness was significantly higher in the preterm groups than in the full-term group. This subtle macular modification may be related mainly to ROP. Prematurity had only a marginally significant role.     

Macular development in the premature infant

To classify the ophthalmoscopic appearance of the developing macula, I performed retinal examinations on 129 premature neonates. In normal infants, the classification ranged from 34 weeks of gestational age when pigment was first evident in the macula, through the development of the annular ring reflex of the macula and foveolar reflex, to a mature (adult-appearing) macula at 42 weeks. This sequence allowed the observer to estimate the gestational age of the older premature neonate from the appearance of the macular area. Babies who had, or subsequently developed, retinopathy of prematurity showed a statistically significant two-week delay in macular development in the later stages. This may be the first evidence of a direct macular insult in retinopathy of prematurity.     

Retinopathy of prematurity in extremely low birth weight infants: a Tokyo multicenter study

OBJECTIVE: To investigate how the increase in survival rate in extremely low birth weight (a birth weight of 1,000 g or less) infants had affected the incidence of retinopathy of prematurity (ROP) and the frequency of laser treatment. METHODS: We retrospectively reviewed the medical records of 122 surviving premature infants with birthweights less than 1,000 g to determine the severity of ROP observed at 16 neonatal intensive care units in Tokyo between April and October 2002. RESULTS: The survival rate was 85.6%. The mean gestational age was 26.74 weeks and the mean birth weight was 782.25 g. One-hundred-and-five infants (86.1%) developed ROP, fifty (41.0%) received laser treatment, and six (4.9%) had retinal detachment. The median postmenstrual age (gestational age at birth plus chronological age in weeks, PMA) at the onset of ROP was 32.5 weeks, and the first laser treatment was performed at the median PMA of 35.7 weeks. CONCLUSIONS: In these extremely low birth weight infants, there was an increase in the survival rate and in the incidence of severe ROP that progressed to the stage that required treatment.     

早产儿视网膜病变筛查及危险因素的临床研究

目的了解我院早产儿视网膜病变(retinopathy of prematurity,ROP)的发病状况,并对其相关危险因素进行分析探讨。方法对2007年1月至2008年11月在我院出生的124例(248只眼)早产儿(出生体重≤2500g或胎龄≤35周)进行ROP的筛查。所有患儿瞳孔散大后,通过巩膜外顶压详细检查患儿视网膜情况。按照ROP国际分类法的规定记录检查结果。将患儿全身状况及吸氧、母孕期吸氧、先兆子痫、胎盘早剥等因素进行统计。结果 124例患儿全部完成了眼底筛查,在周边视网膜血管化或病变退化后终止随访。9例(13只眼)出现ROP,发生率分别占患儿例数和眼数的7.26%和5.24%。其中6例(8只眼)ROP患儿未达到阈值前病变,3例(5只眼)为阈值前Ⅰ型病变,此3例ROP患儿给予间接检眼镜视网膜激光光凝术。所有激光治疗患儿术后随访观察,直至膜病变静止、消退,均未出现视网膜脱离。母孕期吸氧、先兆子痫、胎盘早剥等因素与ROP发病无关。结论低体重是ROP发生的最重要因素。对早产儿适时进行ROP筛查,并对发现的ROP早期进行有效视网膜激光光凝术,可控制病变,降低早产儿的致盲率。     

Adult retinopathy of prematurity: retinal complications from cataract surgery

PURPOSE: To describe the results and retinal complications of cataract surgery in adults with a history of premature birth from two separate retina services. DESIGN: Retrospective, noncomparative, interventional, consecutive case series. METHODS: A retrospective chart review was carried out of two cohorts of patients: Beaumont Hospital and Wills Eye Institute. Eyes of patients were selected who had a birth weight of less than 2200 g or a gestational age of fewer than 32 weeks, were 15 years of age or older at baseline visit, and who underwent cataract surgery in one or both eyes with at least one follow-up examination. A total of 66 eyes from 45 patients were selected and subject to analysis. RESULTS: Thirty-seven eyes (56%) had minimal cicatricial changes resulting from Retinopathy of Prematurity (ROP). The mean age of cataract surgery was 40.3 years. Twenty-five eyes (38%) had at least a one-line improvement in vision, 20 eyes (30%) had no change in vision, and 21 eyes (32%) had a decline in vision after cataract surgery. A postoperative complication of a retinal tear or retinal detachment developed in 15 (23%) of 66 eyes. The severity of the baseline fundus changes resulting from ROP did not correlate with the likelihood of developing a postcataract surgery complication. Results were similar between the two cohorts. CONCLUSIONS: In patients with a history of premature birth, cataract surgery tends to be performed at a young age, has a mixed range of visual results, and can be associated with a high rate of retinal complications.     

早产儿视网膜病变的筛查与高危因素分析

目的 研究早产儿视网膜病变(ROP)发病情况及相关的危险因素,探讨其合理的筛查标准.方法 对出生体重≤2500g,胎龄≤37周患儿进行ROP筛查,并行相关因素分析.结果 共筛查275例符合条件的早产儿,发现ROP38例(13.82%);出生体重≤1500g组,～2000g组,～2500g组患病百分比有显著性差异(P<0.05);出生胎龄≤30周组,～32周组,≥33周组间ROP患病百分比有显著性差异(P<0.05);ROP早产儿的吸氧时间明显高于无ROP组(Z=5.292,P=0.000),需要机械辅助呼吸的早产儿发生ROP者较多(x2=30.597,P=0.000),多胎与单胎间发生ROP的差异无统计学意义(x2=0.748,P=0.387),ROP发病与出生胎龄、出生体重、吸氧时间、机械辅助呼口等因素相关.结论 出生体重越低,出生胎龄越小,吸氧时间较长,需要机械辅助呼吸的早产儿,ROP患病率越高.早产儿应及时检查眼底,尽早发现ROP.     

Incidence of retinopathy of prematurity among infants weighing 2000 g or less at birth

A retrospective study was carried out to determine the incidence of retinopathy of prematurity (ROP) among 157 neonates who weighed 2000 g or less at birth and who were examined at a referral centre for critically ill newborns between January 1983 and December 1985. Overall, 24 cases (15%) of ROP were detected, 18 (75%) among neonates with a birth weight of 1000 g or less. The incidence of ROP was more than eight times higher among neonates in this birth weight category than among those who weighed between 1001 and 2000 g. Grade I ROP accounted for 16 cases (67%), grade II for 7 cases (29%). Only one case (4%) of grade IV ROP was diagnosed, in an infant who weighed 1020 g at birth.     

The results of diode laser treatment of retinopathy of prematurity

PURPOSE: To evaluate the results of diode laser treatment of active phase of retinopathy in prematurity. MATERIAL AND METHODS: We studied 240 premature infants since January 2003 to October 2004. In 60 premature infants (102 eyes--25%) ROP was found. 26 premature infants (52 eyes--43.3%) with threshold ROP (stage 3a) in II zone (12 eyes) and in II and III zone (40 eyes) were treated with an aid of diode laser. Birth weight varied from 650 to 990g (mean 799.23g) and gestational age from 23 to 28 weeks (mean Hbd 26.2). RESULTS: Good anatomical results were obtained in 25 cases (50 eyes--96.15%), in 1 case (2 eyes--3.85%) was total retinal detachment. In this case the progress of retinopathy was caused by small birth weight and other chronic disorders. CONCLUSIONS: Diode laser treatment of active phase of retinopathy in prematurity gives good anatomical results. The results of treatment depend on the other chronic diseases of premature infants.     

The analysis of failure diode laser treatment of active phase of retinopathy of prematurity

PURPOSE: The aim of this study was to analyze risk factors influencing diode laser treatment of active phase of retinopathy of prematurity. MATERIALS AND METHODS: 106 premature infants were treated with the use of diode laser at Department of Neonatology since 1.01.2003-30.11.2004. The mean gestational age was 27.3, mean birth weight 1022 g. The earliest age of laser therapy was 37th day of life and the latest one 104th day (mean 64.3 days). 18 neonates were excluded from the study because they were from other departments, and 2 because they died. The results of treatment of the rest 86 children were evaluated. The occurence of retinal detachment or macular ectopy was classified as unfavorable outcome. RESULTS: The complete remission was obtained in 143 eyes (83.2%),the macular ectopy was diagnosed in 10 eyes (5.8%), the retinal detachment in 19 eyes (11%). Children with unfavorable outcomes were divided in two groups. The first one included 6 extremely immature infants, born between 24 to 25th week of gestation. The ROP in this group was diagnosed in I zone with plus disease. The second group included children with gestation age from 28 to 32 Hbd. 9 of them had severe infection (sepsis, congenital pneumonia, urinary tract infection), 1 serious maternal history (R type of diabetes). The procedure of laser therapy was performed on average at 72th day of life at the first group, and at 50th day at the second one. CONCLUSIONS: (1) Important risk factors of treatment failure of active phase of retinopathy of prematurity, is low gestational age and infections which take place in perinatal period. (2) In the second group of infants (gestational age from 28-32 Hbd), with treatment failure the retinopathy of prematurity occured much more earlier then in the group with successful treatment. (3) When making decision of the patient treatment besides estimation of the eye fundus and the progress of changes, we should also consider risk factors which have influence on retinopathy of prematurity, after treatment.     

Onset of retinopathy of prematurity as related to postnatal and postconceptional age.

The hypothesis that both perinatal events and stage of retinal development are important factors in determining the age at onset of retinopathy of prematurity (ROP) was tested by comparing gestational age at birth with postnatal and postconceptional age when ROP (using ICROP) was first seen. The study population consisted of 207 infants (111 placebo (P) treated, 96 vitamin E (E) treated) who developed ROP among a group of 914 premature infants (460 P, 454 E) enrolled in a randomised clinical trial of the effect of prophylactic use of vitamin E at pharmacological serum levels on incidence and severity of retinopathy. The mean postnatal age at onset of retinopathy was delayed in E treated infants compared with P treated infants by 1.4 weeks (t = 4.004, p < 0.0001). For both P and E treated infants postnatal age at onset of ROP (which reflects the state of retinal development at which birth insults occur) and postconceptional age at onset of ROP which defines state of maturity) were correlated with gestational age at birth. This suggests that both the event of premature birth and the extent of retinal development are important in determining when ROP will first be observed.     

Retinal and intraventricular cerebral hemorrhages in the preterm infant born at or before 30 weeks' gestation.

PURPOSE: To determine the prevalence of retinal hemorrhages and their association with cerebral intraventricular hemorrhages (IVH) in low-birth-weight preterm neonates born at or before 32 weeks' gestation. METHODS: We prospectively studied a consecutive series of 22 neonates (24-30 weeks' gestation; mean gestational age, 27 weeks; mean weight, 1065 g) admitted to the neonatal intensive care unit. Anterior segment and indirect ophthalmoscopic examination, as well as cranial ultrasonographic examination, were performed on day 1 and day 10 of life. The prevalence of retinal and intraventricular hemorrhage was tested statistically for association with obstetric and neonatal clinical variables. RESULTS: The prevalence of retinal hemorrhage was 9% (2/22; 95% CI, 3%-21%) on day 1 and 2% (1/22) on day 10. The prevalence of IVH was 27% (6/22; 95% CI, 9%-46%): 14% (3/22) on day 1 and 23% (5/22) on day 10. Retinal hemorrhages occurred with greater frequency in neonates born to women who had intrauterine infection (chorioamnionitis, P =.043) and low umbilical cord pH levels (P =.027). No association was found between the presence of retinal hemorrhage and IVH (P = 1.000), mode of delivery (ie, vaginal vs cesarean section, P = 1.000), birth weight (P =.476), or gestational age (P = 1.000). The presence of subconjunctival hemorrhage was associated with IVH (P =.046). CONCLUSIONS: Retinal hemorrhages occur in less than 10% of low-birth-weight neonates, ie, a prevalence one half that observed in term neonates (22%). The hemorrhages tend to resolve without sequelae in the first 10 days of life and occur more commonly in infants born to women with uterine infection. Retinal hemorrhages in very premature neonates are not predictive of IVH-related brain damage.     

未成熟儿视网膜病变危险因素分析

目的分析未成熟儿视网膜病变(retinopathy of     

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。     

The natural history of active retinopathy of prematurity

Two hundred twenty-one premature infants were examined in the premature nursery. Thirty-seven of the 221 (16.2%) had retinopathy of prematurity (ROP). Eight patients (21.5%) went blind and three other infants lost sight in one eye for a total of 19 sightless eyes (25.7%). The remaining 55 eyes (74.3%) retained vision. Birth weight was the most critical prognostic factor. Of eight babies who became blind all were under 1000 grams at birth, while babies who showed little change from active ROP were generally over 1300 grams. Nine of 14 eyes with only peripheral shunts (64%) resolved without dragging of the retina in the posterior pole. Sixteen eyes developed peripheral retinal detachment, and six of the sixteen (37.4%) had associated dilation and tortuosity of vessels in the posterior pole. Only one of these eyes resolved with minimal sequelae, suggesting that peripheral retinal detachment with dilated tortuous vessels was the most significant indicator of serious consequences.     

Retinopathy of prematurity. Results of fundus examination performed in 94 preterm infants

PURPOSE: The purpose of this study was to evaluate the incidence and severity of retinopathy of prematurity (ROP) in infants of birth weight less than 1.500 g and/or under 32 weeks'gestation. METHODS: Ninety-four preterm infants were examined following the Royal College of Ophthalmologists guidelines and retinopathy was graded using the International Classification of ROP. Screening limits were 1 500 g birth weight or 32 weeks'gestational age. Fundus examinations for ROP were performed at 5 weeks'chronological age from birth. Pupil dilation was obtained with instillation of 1% tropicamide three times at 15-minute intervals. RESULTS: The 94 infants examined for ROP had a median gestational age of 292.3 weeks and a median birth weight of 1 110340 g. ROP was diagnosed in 21 of 94 subjects (22.3%) by fundus examination. ROP stage 3 developed in one preterm infant, ROP stage 2 developed in five preterm infants, and ROP stage 1 developed in 15 preterm infants. No premature babies developed stage 4 or stage 5 ROP. The disease regressed spontaneously in all cases and none of the infants required cryo/laser therapy. In the most premature infants, 23-26 weeks'gestation, 57% developed ROP and one developed severe ROP (stage 3). No disease more posterior to peripheral zone 2 was observed. The incidence of ROP was higher in infants exposed to greater than 21% oxygen (24.2%) than in infants who did not receive oxygen (17.8%). Oxygen, blood transfusion, and cardiopathy appear to be associated with an increased incidence of retinopathy of prematurity. CONCLUSIONS: ROP continues to be a common problem associated with prematurity in France. This study found a similar incidence of prethreshold ROP when compared to recent studies. The data showed that blood transfusion and cardiopathy may play a role in the development of ROP in premature infants.     

新生儿视网膜出血的发生隋况及其影响因素

目的应用广角数码视网膜图像采集系统（RetCamⅡ）研究新生儿视网膜出血的发生情况,并分析视网膜出血的影响因素。方法横断面研究。2010年8月至2011年8月在昆明市妇幼保健院出生的3646例新生儿,在出生3d内采用RetCamⅡ拍摄眼底照片,观察新生儿视网膜出血的发生情况。根据不同的分娩方式,将新生儿分为经阴道分娩组（1833例）和剖宫产组（1813例）,使用卡方检验比较不同分娩方式的视网膜出血发生率。并对经阴道分娩组和剖宫产组的胎儿性别、胎儿体重、产程、产妇年龄、孕周以及是否发生胎儿宫内窘迫进行计数。使用卡方检验分析经阴道分娩和剖宫产新生儿发生视网膜出血的相关因素。结果新生儿视网膜出血总体发生率为20．50％（747／3646）,6．80％（248／3646）单眼发病,13．69％（499／3646）双眼发病。其中经阴道分娩的新生儿发生率为36．66％（672／1833）,高于剖宫产组的4．14％（75／1813）（X^2=591．800,P〈O．01）。在经阴道分娩的新生儿中,产程短者（〈6h）的发生率为39．0％（337／864）,高于产程长者（≥6h）的34．6％（335／969）（X^2=4．055,P=O．044）;胎儿宫内窘迫者发生率为61．0％（100／1641,高于非胎儿宫内窘迫者新生儿视网膜出血的发生率（34．3％,572／1669）（X^2=45．856,P〈O．01）。而经阴道分娩组和剖宫产组新生儿性别、体重、产妇年龄、孕周差异无统计学意义。结论RetCamⅡ可以很好地记录新生儿视网膜出血。新生儿视网膜出血与分娩方式有关,经阴道产中与是否发生胎儿宫内窘迫及产程长短有关,而与新生儿性别、体重、产妇年龄、孕周无明显关系。