Macular pigmentary changes as a sequelae of retinal hemorrhages in premature infants with retinopathy of prematurity

Referable Macular Hemorrhage-A Clinically Meaningful Screening Target in Newborn Infants. Position Statement of the Association of Pediatric Retina Surgeons

Universal newborn eye screening facilitates early diagnosis of ocular abnormalities and mitigates vision loss. "Referral warranted" eye disease is present at birth in about 5.5% of term infants, with "macular hemorrhage impinging on the fovea" representing about 50% of referral warranted disease. The Association of Pediatric Retina Surgeons held a symposium on February 9, 2021 that culminated in a position statement on "referable macular hemorrhage" (RMH) in newborn infants. RMH is meaningful in that in can cause amblyopia through deprivation, can be readily captured with wide-angle photography in a safe and efficient manner, and may lead to early intervention with mitigation of vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:3-6.].

New grading criterion for retinal haemorrhages in term newborns based on deep convolutional neural networks

BACKGROUND

To define a new quantitative grading criterion for retinal haemorrhages in term newborns based on the segmentation results of a deep convolutional neural network.

METHODS

We constructed a dataset of 1543 retina images acquired from 847 term newborns, and developed a deep convolutional neural network to segment retinal haemorrhages, blood vessels and optic discs and locate the macular region. Based on the ratio of areas of retinal haemorrhage to optic disc, and the location of retinal haemorrhages relative to the macular region, we defined a new criterion to grade the degree of retinal haemorrhages in term newborns.

RESULTS

The F1 scores of the proposed network for segmenting retinal haemorrhages, blood vessels and optic discs were 0.84, 0.73 and 0.94, respectively. Compared with two commonly used retinal haemorrhage grading criteria, this new method is more accurate, objective and quantitative, with the relative location of the retinal haemorrhages to the macula as an important factor.

CONCLUSIONS

Based on a deep convolutional neural network, we can segment retinal haemorrhages, blood vessels and optic disc with high accuracy. The proposed grading criterion considers not only the area of the haemorrhages but also the locations relative to the macular region. It provides a more objective and comprehensive evaluation criterion. The developed deep convolutional neural network offers an end-to-end solution that can assist doctors to grade retinal haemorrhages in term newborns.

Retinal nerve fiber thickness in inflammatory demyelinating diseases of childhood onset

PURPOSE

To evaluate retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography (OCT) in children with acquired demyelinating diseases.

METHODS

This is a cross-sectional study of patients seen between 2006-2008 at the Pediatric MS Center of the Jacobs Neurological Institute. Consensus definitions for pediatric demyelinating disease were followed. All children received OCT testing and assessment of visual acuity (VA) using Snellen and low contrast letter acuity (LCLA) charts.

RESULTS

Thirty-eight children diagnosed with acquired demyelinating disease, 15 healthy controls, and five children with other neurological disorders (OND) were included. Average RNFLT in healthy controls was 107 +/- 12 microm(n = 30) versus 108 +/- 5 microm (n = 10) in OND controls. In children with multiple sclerosis, average RNFLT +/- SD was 99 +/- 14 microm in unaffected (n = 24) versus 83 +/- 12 micromin eyes affected by optic neuritis ("affected eyes") (n = 10). Average RNFLT in children with acute disseminated encephalomyelitis and transverse myelitis was 102 +/- 15 microm in unaffected (n = 18) versus 67 +/- 17 microm in affected eyes (n = 6). In children with optic neuritis (ON), average RNFLT +/- SD was 97 +/- 13 microm in unaffected (n = 5) versus 89 +/- 12 microm in affected eyes (n = 9). Differences between children with demyelinating disease and controls and between ON and nonON eyes were statistically significant (P < 0.001). Bivariate correlations of RNFLT with LCLA (P = 0.002) and VA (P < 0.001) were significant.

CONCLUSIONS

OCT may be a valuable tool for the assessment and monitoring of anterior optic pathway dysfunction in children with demyelinating diseases.

The risk for retinal detachment associated with hemorrhages pre- and postlaser treatment in retinopathy of prematurity

PURPOSE

To determine the risk factors including retinal or vitreous hemorrhage for retinal detachment after laser photocoagulation in threshold or aggressive posterior retinopathy of prematurity.

METHODS

The medical records of 184 eyes of 94 consecutive infants who underwent diode laser photocoagulation for threshold or aggressive posterior retinopathy of prematurity between 1996 and 2006 were retrospectively reviewed. Eight clinical variables were included in the logistic regression analysis to assess the relationship between each variable and retinal detachment of 4A or greater.

RESULTS

The mean follow-up after laser photocoagulation was 25.06 +/- 23.59 months (range: 6-85 months). Sixteen (8.7%) eyes developed a retinal detachment. Pre and posttreatment retinal or vitreous hemorrhage was present in 30 (16.3%) eyes. Among 154 eyes without hemorrhage, 6 (3.9%) developed a retinal detachment, whereas 10 of 30 (33.3%) eyes with a hemorrhage developed a retinal detachment (P < 0.001). The logistic regression analysis showed that a pretreatment hemorrhage, vitreous organization, a persistent active element of plus disease after 21 days, and posttreatment hemorrhage were statistically associated with the development of a retinal detachment.

CONCLUSION

Pre and posttreatment hemorrhage was significantly associated with the progression to retinal detachment along with vitreous organization, a persistent plus disease activity 21 days after treatment.