An Update on Retinopathy of Prematurity (ROP)

DDR2 alleviates retinal vaso-obliteration and pathological neovascularization by modulating microglia M1/M2 phenotypic polarization in a mouse model of proliferative retinopathy

Retinopathy of prematurity (ROP), a leading cause of blindness in premature infants, is characterized by retinal vaso-obliteration during hyperoxia and pathological neovascularization (NV) in relative hypoxia phase. Current treatments, which focus on the late stages of pathological neovascularization, are associated with numerous side effects. Studies demonstrated that discoidin domain receptor 2 (DDR2), a collagen-binding receptor tyrosine kinase, inhibits the experimental choroidal neovascularization and participates in tumor angiogenesis. However, the role of DDR2 in ROP and underlying mechanisms is unclear. In this study, we initially found that DDR2 expressed during mouse physiological retinal vascular development and significantly decreased in vaso-obliteration phase followed by increase during pathological neovascularization phase in mouse oxygen-induced retinopathy (OIR) model. Early upregulation of DDR2 before hyperoxia attenuates oxygen-induced vaso-obliteration, reduces pathological neovascularization, and promotes retinal vascular maturation. Additionally, DDR2 upregulation increased the number of microglia around retinal blood vessels and induced anti-inflammatory M2 polarization. Furthermore, the STAT6/TGF-β signaling pathway suppressed during hyperoxia was activated after DDR2 upregulation. In conclusion, DDR2 attenuated vaso-obliteration and inhibited pathological neovascularization by switching the microglia polarization from M1 to M2 phenotype via the STAT6/TGF-β signaling pathway in OIR. This suggests that DDR2 could be a novel target for the early treatment of ROP.

Retinopathy of Prematurity (ROP): An Overview of Biomarkers in Various Samples for Prediction, Diagnosis, and Prognosis

Retinopathy of Prematurity (ROP) is a proliferative retinal vascular disease marked by abnormal development of retinal vessels in low birth weight preterm infants. It is one of the leading causes of blindness in preterm infants. Current ROP screening methods impose high demands on both the equipment and the expertise of ophthalmologists, which limits their widespread application, particularly in secondary hospitals and remote areas. Thus, the identification of relevant biomarkers and the development of simpler detection methods are important and promising. Non-invasive or minimally invasive sampling methods, along with biomarkers possessing high sensitivity and specificity, could greatly enhance neonatal screening, facilitate early diagnosis, and improve prevention of blindness in preterm infants. This review provides relevant medical insights for clinical practice. This review explored, compares and analyzes various sampling sources. It compares and analyzes research on ROP-related biomarkers derived from these samples.

SREBF1 facilitates pathological retinal neovascularization by reprogramming the fatty acid metabolism of endothelial cells

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder that critically affects the visual development of premature infants, potentially leading to irreversible vision loss or even blindness. Despite its significance, the underlying mechanisms of this disease remain insufficiently understood. In this study, we utilized the oxygen-induced retinopathy (OIR) mouse model and conducted endothelial functional assays to explore the role of Sterol Regulatory Element-Binding Protein 1 (SREBF1) in ROP pathogenesis. SREBF1 expression levels, along with its downstream targets, were investigated through Western blotting, RT-qPCR, and immunofluorescence staining techniques. Furthermore, Co-Immunoprecipitation (Co-IP) was employed to examine the molecular mechanisms involved. Our results demonstrated a significant increase in SREBF1 expression in both the OIR mouse model and hypoxic primary human retinal microvascular endothelial cells (HRMECs). Interventions conducted both in vivo and in vitro showed notable efficacy in reducing pathological neovascularization. Importantly, we discovered that SREBF1 plays a key role in modulating lipid metabolism in HRMECs by regulating the expression of ACC1 and FASN, leading to cellular reprogramming. This reprogramming influences HRMEC proliferation, migration, and tube formation through the HIF-1α/TGF-β signaling pathway, ultimately contributing to pathological retinal neovascularization. These findings provide new insights into the role of SREBF1 in angiogenesis within the context of ROP, offering potential therapeutic targets for the management and treatment of this disease.

Endothelial activating transcription factor 3 promotes angiogenesis and vascular repair in the mouse retina

Ischemia and pathological angiogenesis in retinal vascular diseases cause serious vision-related problems. However, the transcriptional regulators of vascular repair remain unidentified. Thus, the factors and mechanisms involved in angiogenesis must be elucidated to develop approaches for restoring normal blood vessels. Here, we investigated the effects of the stress response activating transcription factor 3 (ATF3) on angiogenesis and vascular regeneration in vitro and in vivo. ATF3 was expressed specifically in retinal vascular endothelial cells (ECs) during vascular development. Vascular endothelial growth factor stimulation upregulated ATF3 expression in cultured ECs. The downregulated ATF3 expression in ECs caused the deterioration of vascular network formation in vitro and in vivo. Moreover, ATF3 deletion in a model of oxygen-induced retinopathy inhibited retinal vascular repair but not pathological neovascularization. Transcriptome analysis confirmed that high ATF3 expression upregulated the expression of angiogenesis-related genes in ECs. ATF3 may aid vascular repair therapy in retinal vascular diseases.

Update on Management of Retinopathy of Prematurity: A Review

Retinopathy of prematurity (ROP) remains a significant health care concern in neonatal care as advances in neonatal intensive practices have improved the survival rates of premature infants. The management and screening of ROP have evolved significantly, with notable trends and advancements aimed at improving outcomes. The use of intravitreal antivascular endothelial growth factor injections has emerged as a prominent initial treatment for ROP in addition to laser photocoagulation. Screening practices have also seen enhancements, with a shift toward efficiency and tele-screening to optimize ROP management. This review aims to discuss available treatment and screening methods and explore new potential therapeutic tools for ROP.

The Ability of Large Language Models to Generate Patient Information Materials for Retinopathy of Prematurity: Evaluation of Readability, Accuracy, and Comprehensiveness

Objectives

This study compared the readability of patient education materials from the Turkish Ophthalmological Association (TOA) retinopathy of prematurity (ROP) guidelines with those generated by large language models (LLMs). The ability of GPT-4.0, GPT-4o mini, and Gemini to produce patient education materials was evaluated in terms of accuracy and comprehensiveness.

Materials and Methods

Thirty questions from the TOA ROP guidelines were posed to GPT-4.0, GPT-4o mini, and Gemini. Their responses were then reformulated using the prompts "Can you revise this text to be understandable at a 6th-grade reading level?" (P1 format) and "Can you make this text easier to understand?" (P2 format). The readability of the TOA ROP guidelines and the LLM-generated responses was analyzed using the Ateşman and Bezirci-Yılmaz formulas. Additionally, ROP specialists evaluated the comprehensiveness and accuracy of the responses.

Results

The TOA brochure was found to have a reading level above the 6th-grade level recommended in the literature. Materials generated by GPT-4.0 and Gemini had significantly greater readability than the TOA brochure (p<0.05). Adjustments made in the P1 and P2 formats improved readability for GPT-4.0, while no significant change was observed for GPT-4o mini and Gemini. GPT-4.0 had the highest scores for accuracy and comprehensiveness, while Gemini had the lowest.

Conclusion

GPT-4.0 appeared to have greater potential for generating more readable, accurate, and comprehensive patient education materials. However, when integrating LLMs into the healthcare field, regional medical differences and the accuracy of the provided information must be carefully assessed.

Evaluation of a Risk Screening Tool for Retinopathy of Prematurity (ROP) in a German Cohort

PURPOSE

To assess the efficacy of the DIGIROP-Birth algorithm in identifying infants at risk for developing retinopathy of prematurity (ROP).

METHODS

In a retrospective study, we included preterm infants over 11 years, 2010-2020, meeting the inclusion criteria for the DIGIROP-Birth calculator (24 + 0/7 to 30 + 6/7 weeks of gestational age). We assessed the validity of DIGIROP-Birth using receiver-operating characteristic (ROC) curves and calculated area-under-curve (AUC), sensitivity, specificity, and positive and negative predictive values.

RESULTS

897 infants were included in the analysis. The median age of the first ophthalmological examination was 40 days (IQR 32-50), the median gestational age was 198 days (IQR 185-209; corresponding to 28 + 2/7 gestational weeks), median birth weight was 1000 g (IQR 790-1300). Of 897 screened children, 458 (51.1%) were diagnosed with ROP, and 34 of 897 (3.8%) required treatment.Analysis of ROP requiring treatment predicted by DIGIROP showed an AUC of 0.860 [95%-CI 0.795-0.925]. An equilibrium of sensitivity and specificity existed at a probability of 4.12%. The positive predictive value was 10.95%, and the negative predictive value was 99.36%. Independent significant peri- and postnatal risk factors were emergency cesarean section and mass blood transfusions.

CONCLUSIONS

The DIGIROP-Birth calculator showed good predictive power in our studied population, with an incidence of 3.79% for therapy-requiring ROP. Peri- and postnatal risk factors should be included in ROP screening.

The analysis of foveal microvascular anomalies in retinopathy of prematurity after anti-vascular endothelial growth factor therapy using optical coherence tomography angiography

BACKGROUND

To investigate the quantitative vascular and structural differences in the foveal region of the eyes in retinopathy of prematurity children with or without anti-vascular endothelial growth factor (VEGF) therapy and healthy children using optical coherence tomography angiography (OCTA).

METHODS

This cross-sectional study analyzed 75 eyes from 44 subjects, categorized into four groups: ROP children treated with Conbercept or Ranibizumab, spontaneously regressed ROP, and healthy age-matched children. Using spectral-domain OCT and OCTA, we assessed parameters like central foveal thickness (CFT), foveal avascular zone (FAZ), superficial/deep capillary plexus (SCP/DCP), and choroidal vessel density (VD) at the fovea. Correlations between foveal microvasculature, preterm status and visual acuity were evaluated.

RESULTS

Significant differences were found in FAZ area, CFT, and VD-SCP (parafoveal) among the groups. The FAZ area was smaller in ROP children (with/without treatment) than in healthy counterparts(p = 0.009). CFT was higher in the Ranibizumab and spontaneously regressed groups compared to healthy ones (p = 0.043, p = 0.037), while Conbercept-treated children showed no significant difference (p = 0.886). Foveal VD trends were higher in groups A, B, and C compared to group D. FAZ area correlated negatively with CFT, VD-SCP (foveal), and VD-DCP (foveal) (p < 0.001, p < 0.001, p = 0.001), and positively with choroidal VD (p = 0.012). CFT showed positive correlations with VD-SCP (foveal) and VD-DCP (foveal) (p = 0.003, p = 0.001).

CONCLUSION

ROP children exhibit a smaller FAZ area compared to healthy group, with no significant difference noted when comparing the use of different anti-VEGF agents. ROP children have a thicker CFT than healthy children, except for those treated with Conbercept. Furthermore, microvascular irregularities were correlated with central foveal thickness.

Lower Hemoglobin Levels as a Risk Factor for the Development of Retinopathy of Prematurity

BACKGROUND

Retinopathy of prematurity (ROP) is an important cause of visual morbidity among preterm infants. The objective of the study was to assess the relationship between the initial hematological parameters of the complete blood count (CBC) and ROP development in preterm neonates.

METHOD

This retrospective cohort study was conducted in a neonatal intensive care unit in Odisha. The hematological parameters of the CBC conducted within the first 48 hours of age, demographic characteristics, neonatal morbidities, and ROP screening findings of preterm neonates (gestational age <34 weeks) were analyzed. Independent risk factors associated with ROP development were identified in a multivariate logistic regression model.

RESULT

A total of 43 (29.1%) out of 148 neonates had any of the ROP stages (stage 1-26, 2-08, and 3-09). Birth weight (aOR 0.003; 95% CI 0.00, 0.11);hemoglobin (Hb) level (aOR 0.70; 95% CI 0.54, 0.90); presence of respiratory distress syndrome (RDS) (aOR 7.61; 95% CI 1.5, 36.39); and need for packed red blood cell (PRBC) transfusion (aOR 4.26; 95% CI 1.1, 16.44) were independently associated with ROP development. The odds of ROP were higher among the neonates with initial Hb 10.5-15.4 g/dL (OR (95% CI) 3.7(1.5, 8.9), p=0.003) and for neonates with Hb 15.4-17.3 g/dL (OR (95% CI) 2.5(1.01, 6.16), p=0.047) in comparison to neonates with initial Hb >17.3 g/dL.

CONCLUSION

Preterm neonates with a lower level of Hb during the early postnatal days are at higher risk for ROP development and need to be prioritized for screening.

Vision on wheels: Technician-assisted retinopathy of prematurity screening in rural Tamil Nadu and Andhra Pradesh: 2018-2021 Project Report

AIM

To analyze the incidence of sight-threatening retinopathy of prematurity (ROP) in premature infants in rural Tamil Nadu and Andhra Pradesh from 2018 to 2021, and to analyze its association with birthweight (BW), gestational age (GA), and postconceptional age (PCA).

METHODS

Project Vision on Wheels is a free ROP screening and treatment program initiated by a tertiary eye care center in South India in June 2018 to screen preterm infants in rural areas in 11 centers in Tamil Nadu and Andhra Pradesh by trained technicians. Infants with sight-threatening ROP were immediately shifted for vision-preserving laser.

RESULTS

Of the 18,117 infants screened from 2018 to 2021, 1046 infants underwent laser, with the majority being bigger and more mature when compared to Western data. There was a yearly increase in the number of infants with sight-threatening ROP in the lower BW, GA, and PCA categories. The timely detection of the condition by committed screening led to salvage of vision by timely laser in 100% of the treated babies in all the years. The incidence of sight-threatening ROP had a yearly decrease in higher BW, GA, and PCA categories. These trends were statistically significant ( P = 0.001 for ROP and BW, P = 0.037 for ROP and GA, and P = 0.001 for ROP and PCA).

CONCLUSION

The statistically significant trend of decreasing sight-threatening ROP in babies with higher BW, GA, and PCA and increasing treatable ROP in younger and smaller babies (with lower BWs, GAs, and PCAs) in rural India, over time, is a hitherto unreported finding. This is the first such study in rural Tamil Nadu and Andhra Pradesh combined, with the largest data to date (as per MEDLINE search) to document this healthier trend.

Profile and risk factors of sight-threatening retinopathy of prematurity: Experience from SNCU in North India

BACKGROUND

This research aimed to identify the clinical profile and risk factors of retinopathy of prematurity (ROP) among "at-risk" newborns treated at a sick newborn care unit (SNCU) located at high altitude in North India, with the intention of contributing to formulate regional and national ROP screening guidelines.

MATERIALS AND METHODS

In a prospective observational study from 2021 to 2022, outborn and inborn babies eligible for ROP screening were screened.

RESULTS

Total 39/122 screened neonates had laser for Type 1 ROP, and 22/39 (56.4%) had aggressive ROP (AROP). The average birth weight (BW) was 1803.87 g, and the average gestational age was 34 weeks. Respiratory distress, bronchopulmonary dysplasia, sepsis, and apnea were present in 57.3%, 13%, 52.5%, and 25.4%, respectively. Sight-threatening ROP was present in 50% below 28+6 weeks, 27% between 29 and 30+6 weeks, 52% between 31 and 33+6 weeks, and 15% with gestation >34 weeks. Two babies with Type 1 ROP weighed >2 kg and one had AROP. Upon regression analysis, BW <1500 g, gestation <32 weeks, oxygen >48 h, clinical sepsis, total SNCU stay >14 days, continuous positive airway pressure support with oxygen >50%, and >10 days to achieve full feeds were associated with severe ROP. Caffeine to treat apnea and kangaroo mother care reduced ROP. None had short-term unfavorable outcome.

CONCLUSION

With similar infrastructure and work force shortage in most SNCUs, these findings can be generalized. The burden of Type 1 and AROP is increasing, as seen in higher gestation and BWs. This needs revision of ROP screening criteria at local and national level. It is crucial to emphasize on the importance of pediatrician and ophthalmologist collaboration, early ROP screening, diagnosis, and treatment to stop disease progression to severe ROP.

Human lens epithelial-secreted exosomes attenuate ocular angiogenesis via inhibiting microglial activation

The lens is an avascular tissue, where epithelial cells (LECs) are the primary living cells. The role of LECs-derived exosomes (LEC-exos) is largely unknown. In our study, we determined the anti-angiogenic role of LEC-exos, manifested as regressed retinal neovascularization (NV) using the oxygen-induced retinopathy (OIR), and reduced choroidal NV size and pathological vascular leakage using the laser-induced choroidal neovascularization (laser-induced CNV). Furthermore, the activation and accumulation of microglia were also restricted by LEC-exos. Based on Luminex multiplex assays, the expressions of chemokines such as SCYB16/CXCL16, MCP-1/CCL2, I-TAC/CXCL11, and MIP 3beta/CCL19 were decreased after treatment with LEC-exos. Transwell assays showed that LEC-exos restricted the migration of the mouse microglia cell line (BV2 cells). After incubation with LEC-exos-treated BV2 cells, human umbilical vein endothelial cells (hUVECs) were collected for further evaluation using tube formation, Transwell assays, and 5-ethynyl-2'-deoxyuridine (EDU) assays. Using in vitro experiments, the pro-angiogenic effect of microglia was restricted by LEC-exos. Hence, it was investigated that LEC-exos attenuated ocular NV, which might attribute to the inhibition of microglial activation and accumulation.

Melatonin and its bioisosteres as potential therapeutic agents for the treatment of retinopathy of prematurity

We conducted a study on the impact of intraperitoneal injections of melatonin and its three bioisosteres (compounds 1-3) on the development of oxygen-induced retinopathy in newborn rats during a 21-day experiment. It was demonstrated that melatonin and its analogues 1-3 effectively reduce the total protein concentration in the vitreous body of rat pups, decrease concentration of VEGF-A, and lower the level of oxidative stress (as indicated by normalization of antioxidant activity in the vitreous body). Melatonin and its analogues 1-3 equally normalize the level of VEGF-A. Analogues 1 and 2 even exceed melatonin in their ability to reduce protein influx into the vitreous body. However, analogue 2 had no effect on antioxidant activity, while analogues 1 and 3 caused a significant increase in this parameter, with analogue 3 even slightly exceeding melatonin. Thus, it can be concluded that analogues 1-3 are comparable to melatonin and can be utilized as potential therapeutic agents for the treatment of retinopathy of prematurity.

Image-free recognition of moderate ROP from mild with machine learning algorithm on plasma Raman spectrum

The retinopathy of prematurity (ROP) can cause serious clinical consequences and, fortunately, it is remediable while the time window for treatment is relatively narrow. Therefore, it is urgent to screen all premature infants and diagnose ROP degree timely, which has become a large workload for pediatric ophthalmologists. We developed a retinal image-free procedure using small amount of blood samples based on the plasma Raman spectrum with the machine learning model to automatically classify ROP cases before medical intervention was performed. Statistical differences in infrared Raman spectra of plasma samples were found among the control, mild (ZIIIS1), moderate (ZIIIS2 & ZIIS1), and advanced (ZIIS2) ROP groups. With the different wave points of Raman spectra as the inputs, the outputs of our support vector machine showed that the area under the curves in the receiver operating characteristic (AUC) were 0.763 for the pair comparisons of the control with the mild groups, 0.821 between moderate and advanced groups (ZIIS2), while more than 90% in comparisons of the other four pairs: control vs. moderate (0.981), control vs. advanced (0.963), mild vs. moderate (0.936), and mild vs. advanced (0.953), respectively. Our study could advance principally the ROP diagnosis in two dimensions: the moderate ROPs have been classified remarkably from the mild ones, which leaves more time for the medical treatments, and the procedure of Raman spectrum with a machine learning model based on blood samples can be conveniently promoted to those hospitals lacking of the pediatric ophthalmologists with experience in reading retinal images.

Congenital Malformations of the Eye: A Pictorial Review and Clinico-Radiological Correlations

Congenital malformations of the eye represent a wide and heterogeneous spectrum of abnormalities that may be part of a complex syndrome or be isolated. Ocular malformation severity depends on the timing of the causative event during eye formation, ranging from the complete absence of the eye if injury occurs during the first weeks of gestation, to subtle abnormalities if the cause occurs later on. Knowledge of ocular malformations is crucial to performing a tailored imaging protocol and correctly reporting imaging findings. Together with the ophthalmologic evaluation, imaging may help frame ocular malformations and identify underlying genetic conditions. The purpose of this pictorial review is to describe the imaging features of the main ocular malformations and the related ophthalmologic findings in order to provide a clinico-radiological overview of these abnormalities to the clinical radiologist. Sight is a crucial sense for children to explore the world and relate with their parents from birth. Vision impairment or even blindness secondary to ocular malformations deeply affects children's growth and quality of life.

Identification of immune-related genes in diagnosing retinopathy of prematurity with sepsis through bioinformatics analysis and machine learning

Background: There is increasing evidence indicating that immune system dysregulation plays a pivotal role in the pathogenesis of retinopathy of prematurity (ROP) and sepsis. This study aims to identify key diagnostic candidate genes in ROP with sepsis. Methods: We obtained publicly available data on ROP and sepsis from the gene expression omnibus database. Differential analysis and weighted gene correlation network analysis (WGCNA) were performed to identify differentially expressed genes (DEGs) and key module genes. Subsequently, we conducted functional enrichment analysis to gain insights into the biological functions and pathways. To identify immune-related pathogenic genes and potential mechanisms, we employed several machine learning algorithms, including Support Vector Machine Recursive Feature Elimination (SVM-RFE), Least Absolute Shrinkage and Selection Operator (LASSO), and Random Forest (RF). We evaluated the diagnostic performance using nomogram and Receiver Operating Characteristic (ROC) curves. Furthermore, we used CIBERSORT to investigate immune cell dysregulation in sepsis and performed cMAP analysis to identify potential therapeutic drugs. Results: The sepsis dataset comprised 352 DEGs, while the ROP dataset had 307 DEGs and 420 module genes. The intersection between DEGs for sepsis and module genes for ROP consisted of 34 genes, primarily enriched in immune-related pathways. After conducting PPI network analysis and employing machine learning algorithms, we pinpointed five candidate hub genes. Subsequent evaluation using nomograms and ROC curves underscored their robust diagnostic potential. Immune cell infiltration analysis revealed immune cell dysregulation. Finally, through cMAP analysis, we identified some small molecule compounds that have the potential for sepsis treatment. Conclusion: Five immune-associated candidate hub genes (CLEC5A, KLRB1, LCN2, MCEMP1, and MMP9) were recognized, and the nomogram for the diagnosis of ROP with sepsis was developed.

Potential application of foveal structural measurements in treatment decision for retinopathy of prematurity: an OCT-based study

PURPOSE

To investigate foveal changes in infants with ROP not requiring treatment(nROP) and ROP infants needing treatment (tROP) using a handheld SD-OCT device.

METHOD

We performed horizontal SD-OCT scans through the fovea in 156 eyes of 81 infants diagnosed with ROP. Foveal immaturity indices including the presence of inner retinal layers (IRL), absence of foveal outer nuclear layers widening (ONL) and attenuation of hyperreflective outer segment layers (OS), presence and type of cystoid macular edema (CME), epiretinal membrane (ERM), foveal pit depth (FPD), foveal pit width (FPW) and central foveal thickness (CFT) were calculated. The multivariate logistic regression model was used to predict the need for treatment based on OCT measurements.

RESULTS

The shape of the foveolar pit was not significantly different among tROP and nROP groups (P-value = 0.287, Chi-square test). IRL extrusion was incomplete in both tROP and nROP groups (P-value = 0.0.41, Chi-square test). Nevertheless, the presence of thicker IRL was more frequent in the nROP group in comparison with the tROP group (100% vs.64.8%, P-value = 0.001). CME was observed in 29% of eyes in the tROP group and 40% of eyes in the nROP group; however, this difference was not statistically significant (P-value = 0.32, Chi-square test). ERM was detected in 15 (75%) and 84 (65.6%) eyes in the nROP and tROP groups, respectively (P-value = 0.39, Chi-square test). Multivariate logistic regression analyses showed that the need for treatment was significantly associated with gestational age (GA), CFT and FPD (P-values 0.001 and 0.002 respectively).

CONCLUSIONS

This study demonstrated GA, foveal pit depth and the central foveal thickness could accurately predict the need for treatment with sensitivity, specificity, and diagnostic accuracy of 97%, 65% and 91.7% respectively.

Emerging role of metabolic reprogramming in hyperoxia-associated neonatal diseases

Oxygen therapy is common during the neonatal period to improve survival, but it can increase the risk of oxygen toxicity. Hyperoxia can damage multiple organs and systems in newborns, commonly causing lung conditions such as bronchopulmonary dysplasia and pulmonary hypertension, as well as damage to other organs, including the brain, gut, and eyes. These conditions are collectively referred to as newborn oxygen radical disease to indicate the multi-system damage caused by hyperoxia. Hyperoxia can also lead to changes in metabolic pathways and the production of abnormal metabolites through a process called metabolic reprogramming. Currently, some studies have analyzed the mechanism of metabolic reprogramming induced by hyperoxia. The focus has been on mitochondrial oxidative stress, mitochondrial dynamics, and multi-organ interactions, such as the lung-gut, lung-brain, and brain-gut axes. In this article, we provide an overview of the major metabolic pathway changes reported in hyperoxia-associated neonatal diseases and explore the potential mechanisms of metabolic reprogramming. Metabolic reprogramming induced by hyperoxia can cause multi-organ metabolic disorders in newborns, including abnormal glucose, lipid, and amino acid metabolism. Moreover, abnormal metabolites may predict the occurrence of disease, suggesting their potential as therapeutic targets. Although the mechanism of metabolic reprogramming caused by hyperoxia requires further elucidation, mitochondria and the gut-lung-brain axis may play a key role in metabolic reprogramming.

Correlation between tear levels of vascular endothelial growth factor and vitamin D at retinopathy of prematurity stages in preterm infants

Deregulation of vascular endothelial growth factor (VEGF) levels leads to retinopathy of prematurity (ROP). Vitamin D (VIT-D) is known to regulate VEGF in an oxygen dependent manner. The purpose of this study was to correlate tear levels of VEGF and VIT-D with different ROP stages in preterm infants. In this prospective cross-sectional study, we enrolled 104 pre-term infants. They were grouped into: Group-1 (Classical ROP) and Group-2 (Aggressive ROP), which were further subdivided into Group-1A (progressing), Group-1B (regressing), Group-2A (pre-treatment), and Group-2B (post-treatment). Tear VEGF and VIT-D levels and their association with different ROP stages were assessed. Stage 1 and stage 2 had higher whereas stage 3 had lower VEGF levels in Group-1B compared to Group-1A. Stage 1 and stage 3 showed higher levels of VIT-D with no difference in stage 2 in Group-1B compared to Group-1A., Group-2B showed higher VEGF and lower VIT-D levels compared to Group-2A. Presence of a positive correlation at an early stage (stage 1) of ROP and a negative correlation at a more advanced stage (stage 3) of ROP with VIT-D and VEGF implies stage-specific distinct signaling crosstalk. These findings suggest that VIT-D supplementation may have the potential to modify the course and outcome of ROP.

A Quality Improvement Study to Improve Oxygen Prescription in the PICU of a Tertiary Care Centre in Delhi, India

Introduction Oxygen has been gravely misused since its inception as a therapeutic agent. There is a deficit of audits and baseline data for the Indian population, especially in the pediatric age group, which doesn't allow for standardization of protocols and guidelines. Objective Our study aimed at increasing valid prescription rates to 90% by implementation of quality improvement interventions, and assessing knowledge and perception of healthcare workers towards oxygen therapy. Methodology It followed a before-and-after prospective observational study model where baseline audit data was compared with data observed after the implementation of quality improvement strategies. The data was collected through an audit of the medical records of all pediatric patients receiving oxygen therapy in the PICU. Knowledge and perception of healthcare workers about oxygen therapy were assessed via a self-designed questionnaire. The study was undertaken in three phases, including Quality Improvement (QI) team formation and data collection, root cause analysis, and implementation of Plan-Do-Study-Act (PDSA) cycles. Observations and results In the baseline audit, 1.4% of the prescriptions were complete and valid. Subsequently, over the course of four PDSA cycles, valid prescription rates increased; 62.07% in the first, 79.51% in the second, 81.81% in the third, and 91.42% in the fourth cycle respectively. After applying the chi-square test to compare PDSA4 and baseline data, the p-values for written prescriptions and target saturation were found to be statistically significant. In the healthcare worker survey, we found that 100% of them were aware of indications of oxygen prescription, FiO2, and side effects of excessive usage of oxygen therapy, 95% were aware of conditions affecting pulse-oximetry in the pediatric age group, and 75% knew about target saturation and its significance and the procedure to change alarm settings on the monitor. Conclusion Currently, there exists a lack of effective oxygen prescription audits, especially in India, which can be attributed to a lack of awareness and partly, a lack of initiative. Quality improvement initiatives are effective in improving the valid oxygen prescription rate. However, sustained goals can be achieved through regular audits only.

Tear-based MMP-9 detection: A rapid antigen test for ocular inflammatory disorders using vanadium disulfide nanowires assisted chemi-resistive biosensor

A sensitive, non-invasive, and biomarker detection in tear fluids for inflammation in potentially blinding eye diseases could be of great significance as a rapid diagnostic tool for quick clinical decisions. In this work, we propose a tear-based MMP-9 antigen testing platform using hydrothermally synthesized vanadium disulfide nanowires. Also, various factors contributing to baseline drifts of the chemiresistive sensor including nanowire coverage on the interdigitated microelectrode of the sensor, sensor response duration, and effect of MMP-9 protein in different matrix solutions were identified. The drifts on the sensor baseline due to nanowire coverage on the sensor were corrected using substrate thermal treatment providing a more uniform distribution of nanowires on the electrode which brought the baseline drift to 18% (coefficient of variations, CV = 18%). This biosensor exhibited sub-femto level limits of detection (LODs) of 0.1344 fg/mL (0.4933 fmoL/l) and 0.2746 fg/mL (1.008 fmoL/l) in 10 mM phosphate buffer saline (PBS) and artificial tear solution, respectively. For a practical tear MMP-9 detection, the proposed biosensor response was validated with multiplex ELISA using tear samples from five healthy controls which showed excellent precision. This label-free and non-invasive platform can serve as an efficient diagnostic tool for the early detection and monitoring of various ocular inflammatory diseases.

Retinal structure and visual pathway function at school age in children born extremely preterm: a population-based study

BACKGROUND

Children born extremely preterm (gestational age < 28 weeks) show reduced visual function even without any cerebral or ophthalmological neonatal diagnosis. In this study, we aimed to assess the retinal structure with optical coherence tomography (OCT) and visual function with pattern-reversal visual evoked potentials (PR-VEPs) in a geographically defined population-based cohort of school-aged children born extremely preterm. Moreover, we aimed to explore the association between measures of retinal structure and visual pathway function in this cohort.

METHODS

All children born extremely preterm from 2006-2011 (n = 65) in Central Norway were invited to participate. Thirty-six children (55%) with a median age of 13 years (range = 10-16) were examined with OCT, OCT-angiography (OCT-A), and PR-VEPs. The foveal avascular zone (FAZ) and circularity, central macular vascular density, and flow were measured on OCT-A images. Central retinal thickness, circumpapillary retinal nerve fibre layer (RNFL) and inner plexiform ganglion cell layer (IPGCL) thickness were measured on OCT images. The N70-P100 peak-to-peak amplitude and N70 and P100 latencies were assessed from PR-VEPs.

RESULTS

Participants displayed abnormal retinal structure and P100 latencies (≥ 2 SD) compared to reference populations. Moreover, there was a negative correlation between P100 latency in large checks and RNFL (r = -.54, p = .003) and IPGCL (r = -.41, p = .003) thickness. The FAZ was smaller (p = .003), macular vascular density (p = .006) and flow were higher (p = .004), and RNFL (p = .006) and IPGCL (p = .014) were thinner in participants with ROP (n = 7).

CONCLUSION

Children born extremely preterm without preterm brain injury sequelae have signs of persistent immaturity of retinal vasculature and neuroretinal layers. Thinner neuroretinal layers are associated with delayed P100 latency, prompting further exploration of the visual pathway development in preterms.

Intraocular pressure effect of intravitreal conbercept injection for retinopathy of prematurity

Purpose: Intravitreal injection of conbercept (IVC) is a novel anti-vascular endothelial growth factor (anti-VEGF) treatment for retinopathy of prematurity (ROP). This study aimed to assess the intraocular pressure (IOP) effect of IVC. Methods: All IVC surgeries were performed in the Department of Ophthalmology, Guangdong Women and Children Hospital, from January 2021 to May 2021. In this study, 30 eyes of 15 infants who received intravitreal injections of conbercept at a dose of 0.25 mg/0.025 mL were included. The IOP of all participants was measured prior to administering the injection and subsequently at 2 min, 1 h, 1 day, and 1 week thereafter. Results: We included 30 eyes (10 boys and 5 girls) with ROP. For the male group, the mean birth weight, mean gestational age at birth, and the mean time of postmenstrual age (PMA) at IVC treatment were 1,174.0 ± 446.0 g, 28.4 ± 3.0 weeks, and 37.1 ± 1.6 weeks, respectively; for the female group, they were 1,108 ± 285.5 g, 28.2 ± 2.5 weeks, and 36.8 ± 2.1 weeks, respectively. For the male group, the IOP at baseline, 2 min, 1 h, 1 day, and 1 week after IVC were 12.4 ± 1.5 mmHg, 49.0 ± 3.1 mmHg, 26.3 ± 2.5 mmHg, 13.4 ± 2.2 mmHg, and 11.6 ± 1.7 mmHg, respectively; for the female group, they were 10.7 ± 2.0 mmHg, 47.3 ± 3.2 mmHg, 26.4 ± 3.2 mmHg, 10.7 ± 1.8 mmHg, and 10.2 ± 1.8 mmHg, respectively. In both groups, the IOP immediately (2 min) after the operation was significantly higher than that at any other time point (p < 0.01). IOP values returned to the preoperative baseline level on the first day after surgery, with no significant difference compared with that before injection (p > 0.05). IOP continued to be maintained at the preoperative baseline level on the first week after surgery, with no significant difference compared with that before surgery (p > 0.05). Conclusion: Infants with ROP who received IVC experienced a sharp increase in the IOP immediately after injection, which decreased to below 30 mmHg after 1 h and maintain that level for 1 week or longer.

Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies

Retinopathy of prematurity (ROP) is a vasoproliferative disorder with an imminent risk of blindness, in cases where early diagnosis and treatment are not performed. The doctors' constant motivation to give these fragile beings a chance at life with optimal visual acuity has never stopped, since Terry first described this condition. Thus, throughout time, several specific advancements have been made in the management of ROP. Apart from the most known risk factors, this narrative review brings to light the latest research about new potential risk factors, such as: proteinuria, insulin-like growth factor 1 (IGF-1) and blood transfusions. Digital imaging has revolutionized the management of retinal pathologies, and it is more and more used in identifying and staging ROP, particularly in the disadvantaged regions by the means of telescreening. Moreover, optical coherence tomography (OCT) and automated diagnostic tools based on deep learning offer new perspectives on the ROP diagnosis. The new therapeutical trend based on the use of anti-VEGF agents is increasingly used in the treatment of ROP patients, and recent research sustains the theory according to which these agents do not interfere with the neurodevelopment of premature babies.

Refractive Changes among Diode Laser-treated Retinopathy of Prematurity Patients: A Retrospective Study

PURPOSE

The purpose of this study was to assess the refractive outcomes of patients who underwent indirect laser photocoagulation for prethreshold type 1 retinopathy of prematurity (ROP) and high-risk type 2 prethreshold ROP in comparison to conservatively managed low-risk prethreshold type 2 ROP.

METHODS

A retrospective analysis was carried out on infants screened for ROP between the years 2015 and 2020. Surviving children who had developed ROP in one or both eyes and received diode laser photocoagulation and those with conservatively managed regressed type 2 ROP who underwent at least one cycloplegic retinoscopy were included in the study.

RESULTS

A total of 144 patients were screened for ROP between 2015 and 2020 at our institution. One hundred and thirty patients (260 eyes) fulfilled the study criteria and were included in this study. The treated group consisted of 132 eyes of 66 infants, of which 38 (14.6%) eyes had prethreshold type 1 ROP while 94 (36.2%) eyes had high-risk prethreshold type 2. The nontreated control group consisted of 128 (49.2%) eyes of 64 infants with low-risk type 2 prethreshold ROP. Earlier prematurity was found to be a significant determinant of the mean change in spherical equivalent among different gestational age groups (P = 0.035). In our cohort, we found that myopia is significantly related to Zone II ROP in comparison to Zone III ROP in the treated eyes (22% vs. 9%) (P = 0.002). No statistically significant difference was found in the final refraction among the treated eyes in relation to the birth weight or stage of prematurity.

CONCLUSION

In the present study, the majority of patients who were treated with diode laser for ROP had favorable anatomical and refractive outcomes. In contrast to previous studies that had suggested a trend toward myopia in laser-treated patients, in our study, the majority (71%) were hyperopes. This study suggests that other factors such as the stage and zone of ROP possibly contribute more to the development of myopia than the laser photocoagulation itself.

Amino Acids Metabolism in Retinopathy: From Clinical and Basic Research Perspective

Retinopathy, including age-related macular degeneration (AMD), diabetic retinopathy (DR), and retinopathy of prematurity (ROP), are the leading cause of blindness among seniors, working-age populations, and children. However, the pathophysiology of retinopathy remains unclear. Accumulating studies demonstrate that amino acid metabolism is associated with retinopathy. This study discusses the characterization of amino acids in DR, AMD, and ROP by metabolomics from clinical and basic research perspectives. The features of amino acids in retinopathy were summarized using a comparative approach based on existing high-throughput metabolomics studies from PubMed. Besides taking up a large proportion, amino acids appear in both human and animal, intraocular and peripheral samples. Among them, some metabolites differ significantly in all three types of retinopathy, including glutamine, glutamate, alanine, and others. Studies on the mechanisms behind retinal cell death caused by glutamate accumulation are on the verge of making some progress. To develop potential therapeutics, it is imperative to understand amino acid-induced retinal functional alterations and the underlying mechanisms. This review delineates the significance of amino acid metabolism in retinopathy and provides possible direction to discover therapeutic targets for retinopathy.

Oxidative Stress Implication in Retinal Diseases-A Review

Oxidative stress (OS) refers to an imbalance between free radicals (FRs), namely highly reactive molecules normally generated in our body by several pathways, and intrinsic antioxidant capacity. When FR levels overwhelm intrinsic antioxidant defenses, OS occurs, inducing a series of downstream chemical reactions. Both reactive oxygen species (ROS) and reactive nitrogen species (RNS) are produced by numerous chemical reactions that take place in tissues and organs and are then eliminated by antioxidant molecules. In particular, the scientific literature focuses more on ROS participation in the pathogenesis of diseases than on the role played by RNS. By its very nature, the eye is highly exposed to ultraviolet radiation (UVR), which is directly responsible for increased OS. In this review, we aimed to focus on the retinal damage caused by ROS/RNS and the related retinal pathologies. A deeper understanding of the role of oxidative and nitrosative stress in retinal damage is needed in order to develop targeted therapeutic interventions to slow these pathologies.

Effect of ranibizumab on retinopathy of prematurity: A meta-analysis

The primary objective of this study was to systematically evaluate the clinical efficacy of intravitreal ranibizumab injection in the treatment for retinopathy of prematurity (ROP) in infants. The MEDLINE (PubMed), Embase, China Biology Medicine disc, Cochrane Library, Web of Science, WanFang Data, CNKI, and CQVIP databases were searched to collect randomized controlled trials (RCTs) comparing the efficacy of ranibizumab with laser treatment in ROP. The retrieval time was from 2007, on which ranibizumab was approved until 12 January 2022. Data were extracted based on predetermined inclusion and exclusion criteria. Two investigators employed QUADAS-2 to independently assess the quality of all eligible original studies. Following quality evaluation, we also performed a meta-analysis using STATA v 15.1 and RevMan v 5.4 and funnel plots were used to detect publication bias. A total of five RCTs were included in the meta-analysis. In this study, the regression rate of retinal neovascularization was used as the index of therapeutic effectiveness. According to the results, the retinal neovascularization regression rate of the intravitreal ranibizumab injection group was statistically higher than that of the laser therapy group [risk ratio (RR) = 1.26, 95% confidence interval (CI): 1.18–1.35]; however, the incidence of adverse events, including recurrence and complications, was not different between them (RR = 0.73, 95%CI: 0.19–2.80). Therefore, intravitreal ranibizumab injection may be more clinically effective than laser therapy in the treatment for ROP. The safety and efficacy of ranibizumab in the long-term treatment for ROP needs further investigation.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42022296387

Is low cerebral near infrared spectroscopy oximetry associated with neurodevelopment of preterm infants without brain injury?

OBJECTIVES

To evaluate the association between low regional cerebral oxygen saturation (rScO2) and neurodevelopment in preterm infants classified as no brain injury (NBI).

METHODS

We retrospectively reviewed data of rScO2 monitoring during the first 3 days of life of infants with a gestational age (GA)<28 weeks or birth weight (BW)<1,000 g, with and without brain injury (BI). BI was defined as intraventricular haemorrhage, cystic periventricular leukomalacia or cerebellar haemorrhage. Univariate and multivariate analyses were used to study the association of rScO2<55% for more than 10 h in the first 3 days of life (NIRS<55%^>10H) and the 24 months neurodevelopment.

RESULTS

Of the 185 patients who met the inclusion criteria, 31% were classified as BI infants and 69% NBI. BI compared to NBI infants had a significantly lower GA and a higher incidence of complications of prematurity. Mean rScO2 in the first 72 h of life was significantly lower in BI than NBI. NIRS<55%^>10H in NBI patients was negatively associated with neurodevelopmental scores both at the univariate and multivariate analysis (p<0.05). NBI infants with NIRS<55%^>10H were found to have lower systemic oxygenation than their counterparts with rScO2<55% for less than 10 h.

CONCLUSIONS

NIRS<55%^>10H in NBI small preterm infants was found to be an independent predictor of neurodevelopment at 24 months and it was associated with low systemic saturation values.

Appropriate dose of intravitreal ranibizumab for ROP: a retrospective study

Objective

To compare the recurrence rate of retinopathy of prematurity (ROP) after treatment with 0.3 mg vs. 0.25 mg ranibizumab.

Subjects

All patients with ROP who underwent intravitreal injection of ranibizumab in Hainan General Hospital between January 2014 and May 2020 were included in this retrospective study.

Methods

Eighty-two cases (146 eyes) who received intravitreal injection of 0.25 mg ranibizumab were included in the conventional-dose group, and 59 cases (108 eyes) who received intravitreal injection of 0.3 mg ranibizumab were included in the high-dose group. The two groups were further divided into the 25-28-week, 29-31-week, 32-34-week, and 35-36-week GA subgroups. The differences between the conventional-dose group and the high-dose group in gestational age (GA), birth weight (BW), age at initial injection (weeks), incidence of systemic diseases, the recurrence rate of ROP, and age at retinal vascularization completed (weeks) were analyzed.

Results

GA, BW, age at initial injection, and the incidence of systemic diseases were not significantly different between the conventional-dose group and the high-dose group (p > 0.05). The recurrence rates of ROP were significantly lower in the 25-28-week, 29-31-week, and 32-34-week subgroups of the high-dose group than in the same subgroups of the conventional-dose group (p < 0.05). Within the conventional-dose group, the recurrence rate of ROP was significantly lower in the 32-34-week and 35-36-week subgroups than in the 25-28-week and 29-31-week subgroups (p < 0.05). Within the high-dose group, the recurrence rate of ROP was not significantly different between the four subgroups (p > 0.05). Retinal vascularization was completed at a later age in the 32-34-week subgroup of the high-dose group than in the 32-34-week subgroup of the conventional-dose group (p < 0.05) but was not significantly different between the two groups at any other GA range (p > 0.05). No severe ocular or systemic complications occurred in any patient.

Conclusion

Treatment with 0.3 mg ranibizumab can reduce the recurrence rate of ROP without prolonging retinal vascularization or causing serious systemic complications. Therefore, this dose may be an appropriate therapeutic dose for ROP.

Review on Artificial Intelligence Based Ophthalmic Application

Artificial intelligence is the leading branch of technology and innovation. The utility of artificial intelligence in the field of medicine is also remarkable. From drug discovery and development till the introduction of products in the market, artificial intelligence can play its role. As people age, they are more prone to be affected by eye diseases around the globe. Early diagnosis and detection help in minimizing the risk of vision loss and providing a quality life. With the help of artificial intelligence, the workload of humans and manmade errors can be reduced to an extent. The need for artificial intelligence in the area of ophthalmic is also found to be significant. As people age, they are more prone to be affected by eye diseases around the globe. Early diagnosis and detection help in minimizing the risk of vision loss and providing a quality life. In this review, we elaborated on the use of artificial intelligence in the field of pharmaceutical product development mainly with its application in ophthalmic care. AI in the future has a high potential to increase the success rate in the drug discovery phase has already been established. The application of artificial intelligence for drug development, diagnosis, and treatment is also reported with the scientific evidence in this paper.

The Role of MiR-181 Family Members in Endothelial Cell Dysfunction and Tumor Angiogenesis

Endothelial dysfunction plays a critical role in many human angiogenesis-related diseases, including cancer and retinopathies. Small non-coding microRNAs (miRNAs) repress gene expression at the post-transcriptional level. They are critical for endothelial cell gene expression and function and are involved in many pathophysiological processes. The miR-181 family is one of the essential angiogenic regulators. This review summarizes the current state of knowledge of the role of miR-181 family members in endothelial cell dysfunction, with emphasis on their pathophysiological roles in aberrant angiogenesis. The actions of miR-181 members are summarized concerning their targets and associated major angiogenic signaling pathways in a cancer-specific context. Elucidating the underlying functional mechanisms of miR-181 family members that are dysregulated in endothelial cells or cancer cells is invaluable for developing miRNA-based therapeutics for angiogenesis-related diseases such as retinopathies, angiogenic tumors, and cancer. Finally, potential clinical applications of miR-181 family members in anti-angiogenic tumor therapy are discussed.

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

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 twenty-nine 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 70mo after the treatments.

A case of anterior persistent hyperplastic primary vitreous associated with morning glory disc anomaly and retinopathy of prematurity like retinopathy in a term-born child

Background

Association of morning glory disc anomaly (MGDA) with persistent hyperplastic primary vitreous (PHPV) has been reported earlier. Retinopathy of prematurity (ROP) like retinopathy in preterm babies with optic disc anomalies has also been published. Our case is unique in terms of presence MGDA, PHPV, unilateral ROP like retinopathy in a term infant with normal birth weight.

Case presentation

A 5-month-old girl, born at term with a birth weight of 3750 g, presented with anterior PHPV, MGDA and ROP like retinopathy. In order to prevent retinal detachment, she received 360 degree barrage laser photocoagulation at the edge of the optic disc excavation of the left eye. In the follow-up a month later, laser scars were found in her left fundus without other complications.

Conclusion

PHPV and MGDA with ROP like retinopathy in term and normal weight baby is rare. The peripheral avascular retinal area, caused by the dragging of the defected optic disc, might have been more vulnerable to the oxygen change after birth which resulted in ROP like retinopathy. High sensitivity to oxygen results in a series of changes such as upregulation of VEGF and IGF-1 may cause ROP-like retinopathy.

Novel Regulators of Retina Neovascularization: A Proteomics Approach

The purpose of this study was to identify proteins that regulate vascular remodeling in an ROP mouse model. Pups were subjected to fluctuating oxygen levels and retinas sampled during vessel regression (PN12) or neovascularization (PN17) for comparative SWATH-MS proteomics using liquid chromatography-tandem mass spectrometry (LC-MS/MS). We developed a human retinal endothelial cell (HREC) ROP correlate to validate the expression of retina neovascular-specific markers. A total of 5191 proteins were identified in OIR retinas with 498 significantly regulated in elevated oxygen and 345 after a return to normoxia. A total of 122 proteins were uniquely regulated during vessel regression and 69 during neovascularization (FC ≥ 1.5; p ≤ 0.05), with several validated by western blot analyses. Expressions of 56/69 neovascular-specific proteins were confirmed in hypoxic HRECs with 23 regulated in the same direction as OIR neovascular retinas. These proteins control angiogenesis-related processes including matrix remodeling, cell migration, adhesion, and proliferation. RNAi and transfection overexpression studies confirmed that VASP and ECH1, showing the highest levels in hypoxic HRECs, promoted human umbilical vein (HUVEC) and HREC cell proliferation, while SNX1 and CD109, showing the lowest levels, inhibited their proliferation. These proteins are potential biomarkers and exploitable intervention tools for vascular-related disorders. The proteomics data set generated has been deposited to the ProteomeXchange/iProX Consortium with the Identifier:PXD029208.

Comparison of choroidal structural changes between children born preterm without retinopathy of prematurity and age-matched children born at full term

AIM

To evaluate the effect of prematurity on choroidal structure in children born preterm with no history of retinopathy of prematurity (ROP) by comparing them with age-matched healthy children born at full term.

METHODS

Enhanced depth imaging optical coherence tomography (EDI-OCT) scans of children aged 5 to 9 years with a history of prematurity but no history of ROP, and age-matched full-term healthy children were evaluated, retrospectively. Choroidal thicknesses (CTs) were measured at subfoveal (SFCT), 1000 µm temporal and nasal from the fovea (T1, N1), and 2000 µm temporal and nasal (T2, N2) from the fovea. The EDI-OCT images were binarized to stromal (SA) and luminal areas (LA) using the ImageJ software. The choroidal vascularity index (CVI) was calculated by dividing LA by the total choroidal area (TCA).

RESULTS

Twenty-nine eyes of 15 preterm children and 41 eyes of 26 full-term children were included. Demographic characteristics including axial length (AL), eye side, age, and the sex of the children in the groups were similar (p>0.05). There was no statistically significant difference in the mean CVI, SFCT, N1, and T1 values between the groups (p>0.05); however, the mean T2 and N2 values were significantly higher in the full-term group than in the preterm group (p<0.05). There was a significant positive correlation between the birth week and the T1 (p<0.05) CONCLUSION: : Prematurity can affect CT even with no history of ROP. The decreases in CTs were significant at 2000 µm nasal and temporal from the fovea. The impairment of temporal choroidal region was more evident than nasal choroidal region. The mean CVI values were similar between the groups.

An imbalance in autophagy contributes to retinal damage in a rat model of oxygen-induced retinopathy

In retinopathy of prematurity (ROP), the abnormal retinal neovascularization is often accompanied by retinal neuronal dysfunction. Here, a rat model of oxygen‐induced retinopathy (OIR), which mimics the ROP disease, was used to investigate changes in the expression of key mediators of autophagy and markers of cell death in the rat retina. In addition, rats were treated from birth to postnatal day 14 and 18 with 3‐methyladenine (3‐MA), an inhibitor of autophagy. Immunoblot and immunofluorescence analysis demonstrated that autophagic mechanisms are dysregulated in the retina of OIR rats and indicated a possible correlation between autophagy and necroptosis, but not apoptosis. We found that 3‐MA acts predominantly by reducing autophagic and necroptotic markers in the OIR retinas, having no effects on apoptotic markers. However, 3‐MA does not ameliorate retinal function, which results compromised in this model. Taken together, these results revealed the crucial role of autophagy in retinal cells of OIR rats. Thus, inhibiting autophagy may be viewed as a putative strategy to counteract ROP.

Rates of Comorbidities in Very Low Birth Weight Infants Fed an Exclusive Human Milk Diet Versus a Bovine Supplemented Diet

Background: Our level III neonatal intensive care unit (NICU) implemented the use of an exclusive human milk diet (EHD) and sought to determine its effect on the severe co-morbidities of preterm infants as well as the potential cost-savings due to the anticipated reduction in these co-morbidities. Methods: A retrospective cohort study was completed to determine if an EHD statistically decreased the rate of co-morbidities including length of stay (LOS), days on total parental nutrition (TPN), rates of late onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP). Results: An EHD significantly decreased the odds of severe ROP (adjusted odds-ratio (aOR)=0.349; 95%CI [0.156, 0.739]; p=0.008) and late onset sepsis (aOR=0.323; 95%CI [0.123, 0.768]; p=0.014). Analysis of cost-effectiveness of an EHD relative to a BSD based on the incremental costs of these co-morbidities determined the net loss in direct hospital costs per patient were estimated to be $420 in 2016 US dollars; however, given the long-term health-care costs and non-pecuniary damages from the co-morbidities of severe ROP and sepsis this net loss appears negligible. Conclusion: This study found that an EHD significantly decreased the odds of severe ROP and late onset sepsis; though not significant, there was a positive trend in decreasing cases of medical NEC; our surgical NEC rates dropped to 0. The benefits of human milk are vital, and the costs are nominal.

Pitfalls of Advanced Retinopathy of Prematurity Presentation: A Content Analysis of Medical Records

Purpose

To identify the pitfalls in retinopathy of prematurity (ROP) screening leading to advanced disease at Ministry of Health (MOH) hospitals in Saudi Arabia.

Methods

A qualitative deductive content analysis was used to study the phenomena of defects in ROP screening. A retrospective review of medical records of newborns presenting to two tertiary eye care centers with advanced ROP (stage 4 and 5) from January 2012 to June 2019 was completed. An extensive review of the original files at the referring hospitals was conducted, including the general condition and findings of ophthalmic examination and the sequence of follow-up until the infant was discharged/referred. Data analysis was completed using pre-structured categorization matrix.

Results

Records of 29 infants with advanced stage ROP were identified. Only 13 medical records were available and obtained. The pitfalls in screening found in the study were failure to refer by the neonatologist, delayed follow-up by the ophthalmologist, failure to follow-up by the ophthalmologist, failure to diagnose by the ophthalmologist, poor documentation in patient files, unavailability of ophthalmologist, family negligence, lack of treatment and delayed referral to a higher center, and progression despite timely screening and management.

Conclusion

Although clear ROP screening guidelines are available, implementations of these guidelines are suboptimal. This study showed that the most common defect in screening is physician’s inadequacy and unavailability. A proper network of competent ROP screening physicians in all neonatal intensive care units should be established. Centers for advanced ROP surgery should be allocated to deliver a timely surgical care if needed.

Early skin contact combined with mother's breastfeeding to shorten the process of premature infants ≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial

BACKGROUND

Most hospitalized preterm infants experience difficulties in transitioning from tube feeding to full oral feeding. Interventions to promote full oral feeding in preterm infants in the neonatal intensive care unit (NICU) are limited to pacifier use or bottle-feeding exercises. Skin contact has been shown to be beneficial to start and maintain lactation and provide preterm infants with the opportunity to suck on the mother's breast, which may promote further development of the preterm infant's suckling patterns. The objective of this study is to compare and evaluate the effects of skin contact combined with breastfeeding (suck on the mother's empty breast) as compared to the routine pacifier suckling training model in achieving full oral feeding for infants whose gestational age are ≤ 30 weeks.

METHODS

This is a single-center, randomized controlled clinical trial conducted in the NICU and designed according to the SPIRIT Statement. The subjects included in the study are premature infants born between April 2020 and July 2021 with a gestational age of ≤30 weeks, birth weight of <1500 g, admission age of <72 h, and absence of congenital malformations. Those with oxygenation indices of >40 and those born to mothers with poor verbal communication skills will be excluded. A sample of 148 infants is needed. The infants will be randomized to the intervention (skin contact combined with mother's breastfeeding model) or control group (routine pacifier sucking training model). The primary outcome is the time required to achieve full oral feeding. The secondary outcomes are the breastfeeding abilities of preterm infants as assessed by the Preterm Infant Breastfeeding Behavior Scale (PIBBS), breastfeeding rates at 3 and 6 months corrected gestational age, complication rates, duration of oxygen requirement, days of hospital stay, and satisfaction of parents.

DISCUSSION

This paper describes the first single-center, open-label, randomized clinical trial on this topic and will provide crucial information to support the implementation of skin contact combined with the breastfeeding model in the NICU setting.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04283682. Registered on 8 February 2020.

Description and management of retinopathy of prematurity reactivation after intravitreal antivascular endothelial growth factor therapy

PURPOSE OF REVIEW

To review the literature regarding reactivation of retinopathy of prematurity (ROP) after treatment with antivascular endothelial growth factor (anti-VEGF) agents.

RECENT FINDINGS

Reactivation can occur after anti-VEGF or laser. Risk factors for reactivation include patient and disease-related factors. Various studies are evaluating the use of different anti-VEGF agents and reactivation rates. However, the definition of reactivation varies between studies.

SUMMARY

The literature has varied definitions of reactivation, which is often used interchangeably with recurrence. It is important to recognize features of reactivation of ROP to appropriately manage patients and conduct clinical trials. The International Classification of ROP 3rd edition has established a consensus guideline regarding terminology describing reactivation.

Cerebral and splanchnic oxygenation during automated control of inspired oxygen (FiO2 ) in preterm infants

OBJECTIVES

Our aim in this study was to assess the effect of the Predictive Intelligent Control of Oxygenation (PRICO^® ) system on cerebral (rSO₂ C) and splanchnic (rSO₂ S) oxygenation in a cohort of preterm infants with frequent desaturations.

METHODS

Twenty infants with gestational age <32 weeks (n = 20) were assigned in random sequence to 12 h of automated or manual adjustment of FiO₂ . Over this period, they were studied continuously by near-infrared spectroscopy (NIRS).

RESULTS

We found that rSO₂ C [68.0% (60.5%-74.7%) vs. 68.5% (62%-72%); p = .824] and rSO₂ S [27.0% (17.3%-45.7%) vs. 27.0% (15%-53%); p = .878] were similar during automatic and manual control of FiO₂ . Time spent with SpO₂ 90%-95% was higher during the automatic than manual control of FiO₂ , while time spent with SpO₂ <80% or >95% was lower.

CONCLUSIONS

Automated control of FiO₂ with PRICO^® system did not improve brain and splanchnic oxygenation in comparison with manual control in a cohort of preterm infants, but it significantly decreased SpO₂ fluctuations and limited the duration of both hypoxemia and hyperoxemia.

Eph Receptors and Ephrins in Retinal Diseases

Retinal diseases are the leading cause of irreversible blindness. They affect people of all ages, from newborns in retinopathy of prematurity, through age-independent diabetic retinopathy and complications of retinal detachment, to age-related macular degeneration (AMD), which occurs mainly in the elderly. Generally speaking, the causes of all problems are disturbances in blood supply, hypoxia, the formation of abnormal blood vessels, and fibrosis. Although the detailed mechanisms underlying them are varied, the common point is the involvement of Eph receptors and ephrins in their pathogenesis. In our study, we briefly discussed the pathophysiology of the most common retinal diseases (diabetic retinopathy, retinopathy of prematurity, proliferative vitreoretinopathy, and choroidal neovascularization) and collected available research results on the role of Eph and ephrins. We also discussed the safety aspect of the use of drugs acting on Eph and ephrin for ophthalmic indications.

Galectins in the Pathogenesis of Common Retinal Disease

Diseases of the retina are major causes of visual impairment and blindness in developed countries and, due to an ageing population, their prevalence is continually rising. The lack of effective therapies and the limitations of those currently in use highlight the importance of continued research into the pathogenesis of these diseases. Vascular endothelial growth factor (VEGF) plays a major role in driving vascular dysfunction in retinal disease and has therefore become a key therapeutic target. Recent evidence also points to a potentially similarly important role of galectins, a family of β-galactoside-binding proteins. Indeed, they have been implicated in regulating fundamental processes, including vascular hyperpermeability, angiogenesis, neuroinflammation, and oxidative stress, all of which also play a prominent role in retinopathies. Here, we review direct evidence for pathological roles of galectins in retinal disease. In addition, we extrapolate potential roles of galectins in the retina from evidence in cancer, immune and neuro-biology. We conclude that there is value in increasing understanding of galectin function in retinal biology, in particular in the context of the retinal vasculature and microglia. With greater insight, recent clinical developments of galectin-targeting drugs could potentially also be of benefit to the clinical management of many blinding diseases.

Changed ophthalmic workload following introduction of digital retinal photography for retinopathy of prematurity screening

BACKGROUND

ROP screening is vital in care of premature infants but is considered burdensome, difficult and time consuming for ophthalmologists. This study assessed the reduction in workload following the introduction of nurse-led WFDRI to a large neonatal nursery.

METHODS

We report a retrospective audit of 628 infants screened for ROP in the years 2010, 2013 and 2019 at the Royal Women's Hospital, Victoria. The last complete year of screening for ROP using binocular indirect ophthalmoscopy (BIO) alone (2010) was compared with two subsequent years after the introduction of nurse-led WFDRI. The main outcome measures were the time taken to report and document WFDRI and the time taken to undertake BIO examination of a premature infant and document the results.

RESULTS

The ophthalmologist's time taken to conduct BIO, review images and document the results per 100 patient examinations was reduced from 16.7 hours before introduction of WFDRI to 3.7 hours. Similarly, the weekly time spent on this component of ROP screening fell from 2.3 hours per week to 0.8 and 1.0 hours per week after introduction of WFDRI.

CONCLUSIONS

The introduction of nurse-led WFDRI has resulted in a dramatic and sustained reduction in ophthalmologist workload involved in ROP screening in a large Australian neonatal nursery. This may result in improved retention of the ophthalmic workforce required to undertake ROP screening.

Risk Factors Associated with Retinopathy of Prematurity in Very and Extremely Preterm Infants

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.