80 Years of vision: preventing blindness from retinopathy of prematurity

Long-term visual function and refractive changes after vitrectomy for stage 4 retinopathy of prematurity

PURPOSE

This study aimed to investigate longitudinal changes in best-corrected visual acuity (BCVA) and refraction in patients following vitrectomy for stage 4 retinopathy of prematurity (ROP).

METHODS

We conducted a retrospective review of 42 eyes from 25 patients (35 eyes with stage 4A, 7 eyes with stage 4B) who had successful vitrectomy for stage 4 ROP and were followed for at least 8 years. Postoperative BCVAs and refractive errors between ages 5 and 8 years were compared. Factors related to BCVA at ages 5 and 8, as well as their differences, were analyzed.

RESULTS

In stage 4A ROP eyes, the mean logMAR BCVA improved significantly from 0.83 (20/135) to 0.63 (20/85) (p < 0.001) and a myopic shift of 1 D or more occurred in 21 eyes (61.8%) between ages 5 and 8. In the poor BCVA group at age 5 in the stage 4A eyes, dominant eyes showed a trend of BCVA improvement by ages 5-8 (p = 0.06). Multiple regression analysis of the patients with stage 4A ROP showed that phakic and dominant eyes at age 5 were independently associated with better BCVA at ages 5 and 8 (p = 0.006 and 0.016 for age 5; p = 0.009 and 0.002 for age 8). No significant BCVA improvement was noted in stage 4B ROP eyes during the same period.

CONCLUSION

This study indicated the possibility of continued visual improvement beyond age 5 in patients who underwent vitrectomy for stage 4A ROP, although a myopic shift occurred concurrently.

KEY MESSAGES

What is known Previous studies have reported long-term visual prognosis and refractive errors at specific time points after vitrectomy for ROP in small case series, but there has been limited research on serial changes. What is new This study demonstrates the potential for ongoing visual improvement beyond age 5 and highlights longitudinal myopic changes between ages 5 and 8 in patients who underwent vitrectomy for stage 4A ROP. In patients with poor visual acuity at age 5, being the dominant eye was significantly associated with improved visual acuity by age 8. The findings indicate that postoperative visual acuity in ROP patients gradually improves, even as myopia progresses, underscoring the need for long-term follow-up.

Association between hematocrit in the first two hours of life and retinopathy during prematurity: a retrospective study from DRYAD

INTRODUCTION

Our study investigated the association between hematocrit in the first two hours (HCT2h) of life and retinopathy of prematurity (ROP).

METHODS

Data were obtained from an observational study of the DRYAD database. The study was conducted at the Santa Clara Valley Medical Center (SCVMC). Data on preterm babies whose gestational age (GA) was < 34 weeks were collected prospectively from January 2008 to February 2014. Logistic regression was applied to explore the association between HCT2h and ROP.

RESULTS

A total of 326 very preterm infants born at or earlier than 34 weeks were included. The incidence of any ROP was 23.9%, and the incidence of severe ROP was 4.6%. The HCT2h, birth weight, GA, Apgar1 min, and Apgar5 min of any ROP group were significantly lower than those of preterm babies without ROP (p < 0.001). Sex differences, the rate of multiples, and delivery mode between the two groups were not statistically significant (p > 0.05). We classified HCT2h into three levels, and after multivariate logistic regression, we found that high HCT2h remained a significant protective factor against ROP (p < 0.001). Through subgroup analysis, we observed that among preterm infants with a GA of 28 weeks or more, there was a significant inverse association between a 1% increase in HCT2h and a 17% reduction in the occurrence of ROP.

CONCLUSION

We found that HCT2h may be an effective biomarker for identifying the risk of ROP of very preterm infants born between 28 and 34 weeks of gestation.

TRIAL REGISTRATION

This was a retrospective study and the data were from the DRYAD database. Santa Clara Valley Medical Center's (SCVMC) ethical committee reviewed and approved the studies involving human participants. Informed consent was waived for this study. We did not perform any extra interventions.

Modern Biomarkers for Early Diagnosis of Ocular Surface Disease in Type 1 Diabetes. A Pilot Study

Patients with dry eye syndrome form a significant proportion of those treated in everyday ophthalmology practice. Diabetes mellitus is a major risk factor for the development of dry eye syndrome. Changes in tear film homeostasis, chronic inflammation and subsequent corneal nerve fiber pathology play a key role in its progression. The aim of this study was to describe the status of modern biomarkers of ocular surface damage in patients with type 1 diabetes and asses their utility in early diagnosis of dry eye syndrome.

MATERIAL AND METHODS

 In total the pilot study included 19 patients with type 1 diabetes (T1D) and 15 patients in the control group. All patients underwent a detailed ocular surface examination, sample collection for matrix metalloproteinase-9 (MMP-9) laboratory analysis and epithelial HLA-DR expression evaluation, and in-vivo corneal confocal microscopy.

RESULTS

 T1D patients showed statistically significantly reduced corneal nerve fiber length (p = 0.0482). The differences between the groups in terms of osmolarity, corneal sensitivity, Oxford score, tear break-up time and MMP-9 level were not statistically significant (p = 0.8272, p = 0.6029, p = 0.3507, p = 0.7561 and p = 0.0826 respectively). HLA-DR expression was examined in 10 T1D patients and 8 patients in the control group. Both groups showed minimal or no expression (p > 0.9999).

CONCLUSION

 The previously published literature supports our finding of corneal nerve fiber length reduction in T1D patients compared to controls. However, we did not find any significant changes in standard or modern ocular surface markers (MMP-9 levels, HLA-DR expression) measured in patients with dry eye syndrome.

Validation of the "TWO-ROP" Algorithm at a Multi-Neonatal Intensive Care Unit Tertiary Referral Center

PURPOSE

We aim to validate the previously published TWO-ROP algorithm on an external data set.

DESIGN

Retrospective consecutive study.

SUBJECTS

Infants screened for retinopathy of prematurity (ROP) between January 2013 and August 2023 at a tertiary referral multi-site.

METHODS

Infants with higher birth weight (BW) and greater gestational age (GA) were included and stratified into 3 groups as follows: group 1 (BW <1500 g, GA ≥30 weeks), group 2 (BW ≥1500 g, GA <30 weeks), and group 3 (BW ≥1500 g, GA ≥30 weeks).

MAIN OUTCOME MEASURES

The rate of ROP, treatment-warranted ROP (TW-ROP), and number of inpatient examinations were evaluated in the 3 groups.

RESULTS

In total, 1095 (33.8%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 was 837 (76.4%), 72 (6.6%), and 186 (17.0%), respectively. Retinopathy of prematurity was detected in 120 (11.0%) patients; the rate was 9.8% in group 1, 20.8% in group 2, and 12.4% in group 3 (P = 0.013). The overall mean number of inpatient examinations for patients undergoing traditional, TWO-ROP 36-week, and TWO-ROP 40-week screening systems was 1.95, 1.43, and 0.99, respectively (P < 0.001). Stage 3 was found in 9 eyes of 5 patients (0.5%, all zone II). Three eyes of 2 patients (0.2%) had plus disease. Two patients had bilateral laser treatment at 44 and 39.4 weeks postconceptional age (PCA); 3 out of 4 of these eyes met type 1 treatment criteria. Overall, the ROP screening burden saved was 9.0% and 16.7% for the TWO-ROP 36-week and 40-week systems, respectively. The sensitivity for TW-ROP was 100% for TWO-ROP 36-week system and 99.4% for TWO-ROP 40-week system.

CONCLUSION

The TWO-ROP algorithm can reduce the number of inpatient examinations while maintaining safety. To ensure timely management, we recommend that the single first ROP examination occur at 38 to 39 weeks PCA.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Easy Method of Pterygium Excision using Autologous Blood for Conjunctiva Autograft Fixation

AIMS

 This study was planned to explore the efficacy of autologous blood as a stabilizing agent for graft surgery in pterygium.

MATERIAL AND METHODS

 For this observational, non-comparative, interventional study, the hospital data of patients who underwent pterygium surgery with autografting using autologous blood between October 2021 to March 2022 were retrospectively analyzed. The graft stability post-surgery and recurrence was studied. There were 37 eyes of 37 patients undergoing pterygium surgery with autograft using autologous serum. The mean age was 53.5 ±10.10 years.

RESULTS

 Pterygium included were nasal sided primary grade 3 pterygium, double-head pterygium and recurrent pterygium. Postoperatively, there were 4 cases of graft loss (10.8%). The mean time of follow up was 1.8 ±1.4 months (range 1 to 5 months). There was no recurrence seen in patients with graft intact.

CONCLUSION

 Autologous blood is a good and cost-effective stabilizing agent for graft surgery in pterygium.

Long-Term Refractive and Topographical Changes in Keratoconic Eyes after Accelerated Corneal Crosslinking

AIM

To evaluate the long-term impact of accelerated corneal cross-linking (A-CXL) on selected refractive and topographical parameters in eyes with progressive keratoconus.

METHODS

77 eyes with keratoconus in 54 patients treated with A-CXL (10 min "epi-off" protocol) were included in the analysis. Preoperative and postoperative (1, 3 and 5 years after A-CXL) values of the studied parameters were compared.

RESULTS

In the cohort, there was an improvement in best corrected central visual acuity (BCCVA) 1 year (p = 0.004) and 3 years (p.

The Relationship Between Retinal Nerve Fiber Thickness and Retinal Functional Sensitivity During Oct and Static Perimeter Examinations

AIMS

To demonstrate the relationship of dependency between the thickness of the retinal nerve fiber layer and the functional sensitivity of the retina in healthy young individuals. We also secondarily investigated the relationship between refractive error and mean retinal thickness in the macula.

MATERIAL AND METHODS

The basic cohort contained 30 subjects with an average age of 23.4 ±4.2 years. These were young, generally healthy individuals without serious ocular pathologies. The average value of spherical equivalent in both eyes of all individuals was -1.2 ±2.5 D. We measured the thickness of the retinal nerve fiber layer (RNFL) in the papilla area and the average thickness of the retina in the area of the macula using the device OPKO Spectral OCT SLO Combination Imaging System (Opko Health, USA). We performed a functional examination of the retina within an area up to 30° using a perimeter with a stimulus with a Frequency Doubling Technology (FDT) from the company Humphrey (Carl Ziess Meditec, Inc., Dublin, CA). As a significant variable for comparison, we determined the mean value of retinal sensitivity deviation (MD).

RESULTS

In our study, we did not demonstrate a statistically significant relationship between the average thickness of the retinal nerve fiber layer (RNFL) and the average value of retinal functional sensitivity (r = 0.18, p = 0.34) in either right eyes or the left eyes of the examined subjects (r = 0.20, p = 0.29). We also did not find a statistically significant relationship secondarily between the variable called the spherical equivalent of refractive error (SE) and the average retinal thickness in the macula in either the right eyes (r = 0.34, p = 0.06) or the left eyes (r = 0.18, p = 0.32).

CONCLUSION

When comparing the average thickness of the nerve fibers in the papilla with the help of OCT examination and the functional sensitivity of the retina measured on an FDT perimeter, we did not find a statistically significant dependence in the group of right eyes or in the group of left eyes. We also achieved a similar result when examining the interdependence of the variables of spherical equivalent of refractive error of the eye and the average thickness of the retina in the macula.

The Effect of Retinal Tear Location and Internal Tamponade on The Success of Pars Plana Vitrectomy in Patients with Uncomplicated Retinal Detachment

AIM

Retinal detachment is an acute sight-threatening condition that requires immediate surgical intervention. The aim of this study is to compare the outcomes of pars plana vitrectomy (PPV) for uncomplicated rhegmatogenous retinal detachment (RRD) between the different types of gases used, the position, and the number of tears.

MATERIAL AND METHODS

This is a retrospective non-randomized comparative study of patients with uncomplicated RRD treated at the Department of Ophthalmology from March 2018 to April 2021 using PPV. A total of 494 evaluated eyes were included in the study. The anatomical success of the surgery was monitored with regard to the extent of retinal detachment, the number and position of tears, and the tamponade used.

RESULTS

The success rate of retinal reattachment with a single operation was 90.7% (448 eyes), and the final anatomical success rate was 100%. A very weak paired relationship was found between the success of the surgery for tears in the 4-8 hours region and the 9-3 hours region (89.1% vs. 92%). Similarly, no significant differences were observed between procedures using SF6 and C3F8 gases for RRD with a tear in the 4-8 hours region (success rate 93.4% for SF6 vs. 89.1% for C3F8). The average postoperative improvement of best corrected visual acuity was 29.6 ETDRS letters, and a gain of 15 letters was recorded in 55.1% (272 eyes). Overall, the complication rate was very low.

CONCLUSION

PPV is a safe and effective method for treating RRD. Extensive experience with this method allows the use of short-acting tamponades in selected patients.

Surgical Treatment of Rhegmatogenous Retinal Detachment in the Only Seeing Eye

AIM

To retrospectively evaluate the anatomical and functional success of surgical treatment of rhegmatogenous retinal detachment (RRD) in the only remaining seeing eye.

MATERIAL AND METHODS

The study included 28 eyes of 28 patients, 19 (68%) of whom were men, with an average age of 46 years. They were operated on by a single surgeon for RRD at the Eye Clinic of the University Hospital and Faculty of Medicine, Masaryk University in Brno, from July 1, 2019, to April 30, 2023, using cryosurgical techniques and/or 25G+ pars plana vitrectomy (PPV). In 11 patients, 25G+ PPV was performed with the application of a pre-equatorial cerclage. The Blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens were admissible within the patient histories. The cause of RRD was retinal tear(s) regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grades A-D2 were acceptable. Patients with a history of penetrating eye injury were excluded. Patients were evaluated 1-3 months after the performance of PPV. The surgery was considered anatomically successful if the retina was completely reattached. Each patient's final visual acuity (VA) was assessed using a Snellen chart. Numerical results were expressed as arithmetic means and percentages. Since the different groups were not compared, no statistical tests were needed.

RESULTS

Retinal reattachment was achieved in 27 patients (97%), while 1 patient (3%) experienced retinal detachment, resulting in anatomical failure of the treatment. 9 patients (32%) achieved VA ≥ 4/8.

CONCLUSION

We consider cryosurgical techniques using episclerally fixed cerclage bands and buckles, 25G+ PPV, and possibly a combination thereof, to be suitable methods for treating RRD in the only remaining seeing eye.

Efficacy and Safety of Intravitreal Dexamethasone Implant in Treatment-Resistant Diabetic Macular Edema: Six-month Results

AIMS

To investigate the efficacy and safety of intravitreal Dexamethasone implant (DEX-I) therapy in the treatment of diabetic macular edema (DME) refractory to intravitreal bevacizumab (IVB).

MATERIAL AND METHODS

This retrospective and cross-sectional study included 37 eyes of 37 patients who received 3 loading doses of IVB injections for DME with no response and underwent DEX-I implant. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurements and central foveal thickness (CFT) measured by spectral domain optical coherence tomography (SD-OCT) were recorded and compared before DEX-I, at the first week, first, second, third and sixth months. Duration of DME, glycated hemoglobin (HbA1c) levels, DME types and lens status (phakic, pseudophakic) were also recorded.

RESULTS

The mean age of the patients was 61.14 ±8.69 years (59.5% male, 40.5% female). 35.1% of the patients had cystoid macular edema, 64.9% had diffuse macular edema and 73 % were phakic and 27% were pseudophakic. BCVA, CFT and IOP values before DEX-I injection were 0.78 ±0.16 LogMAR, 493.73 ±107.6 µm and 13.05 ±2.59 mmHg, respectively. At 6 months after DEX-I, BCVA, CFT and IOP values were 0.64 ±0.11 LogMAR, 397.35 ±59.72 µm and 16.3 ±2.51 mmHg, respectively. In all follow-ups, there was a significant improvement in BCVA, a significant decrease in CFT and a significant increase in IOP compared to pre-injection. Ocular hypertension was observed in 0.8 % of patients and progression of cataract progression in 1% of patients after treatment.

CONCLUSION

DEX-I therapy is an effective and safe treatment option for DME refractory to IVB treatment.

Internal Limiting Membrane Dehiscence and Rouleaux Formation in a Case with Branch Retinal Vein Occlusion and Macular Edema Treated with a Single Dexamethasone Implant Administration. A Case Report

A 70-year-old woman was examined with a 10-day history of photopsia and floaters in her left eye. Her best-corrected visual acuity was 20/25 in both eyes, with a normal intraocular pressure and some nuclear sclerosis. Spectral-domain optical coherence tomography revealed a separated posterior vitreous, with a rolled internal limiting membrane flap and inner retinal dimples in the left eye. Optical coherence tomography angiography demonstrated reduced vessel density in both the superficial and deep capillary plexuses of the left fundus. Sixteen months earlier, she had received a single intravitreal Dexamethasone implant injection, due to inferotemporal branch retinal vein occlusion-related macular edema. A diagnosis of internal limiting membrane tear following an uneventful posterior vitreous detachment was reached and no treatment was recommended.

Cytomegalovirus Anterior Uveitis

AIM

The aim of the article is to summarize observations on cytomegalovirus (CMV) anterior uveitis, and in short case reports present cases of patients treated at our Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague.

MATERIAL AND METHODS

Retrospective analysis of patients at the Centre for diagnosis and treatment of uveitis from 2003 to 2024. Presentation of our experiences with CMV anterior uveitis confirmed by polymerase chain reaction (PCR) in aqueous humor in case reports.

RESULTS

From a cohort of 3844 patients with uveitis, 3 patients were diagnosed with CMV anterior uveitis, confirmed by PCR in the aqueous humor. The clinical presentation was as acute recurrent hypertensive anterior uveitis in all patients, with a switch to chronic form with elevated intraocular pressure (IOP). Despite local anti-inflammatory and antiglaucomatous therapy, there was high recurrence of uveitis with decompensation of IOP when the medication was reduced. Patients underwent antiglaucoma surgery because of persistent high IOP despite maximal local antiglaucomatous therapy. An anterior chamber tap was taken for PCR analysis, with a CMV-positive result. After the initiation of antiviral therapy with local ganciclovir, patients manifested compensated IOP and a pronounced reduction of recurrences of uveitis and progression of glaucoma.

CONCLUSIONS

CMV anterior uveitis is a rare pathology in our geographic region, but it is important to consider this etiology in cases of recurrent anterior hypertensive uveitis with a low response to local anti-inflammatory medication. Timely verification of the etiological agent with prompt diagnosis and treatment is essential in order to achieve a favorable prognosis. Long-term, low maintenance doses of antiviral therapy with local ganciclovir for several months reduce relapses of uveitis and lead to compensation of IOP.

Sleeping Behavior and Keratoconus: A Scoping Review

AIMS

This scoping review was conducted to investigate whether nocturnal eye compression from inappropriate sleeping postures may contribute to the development or asymmetry of keratoconus (KC), by examining the association between sleeping positions and KC.

MATERIAL AND METHODS

A systematic search of CENTRAL, MEDLINE, EMBASE, LILACS, ClinicalTrials.gov, gray literature, and selected journals from inception to January 18, 2023, was undertaken.

RESULTS

Ten studies involving 2 322 participants met inclusion criteria. These studies were categorized into analytical and non-analytical designs to evaluate the relationship between prone, lateral, or supine sleeping positions and KC presence or asymmetry. Among the included studies, 50% were non-analytical, all indicating a correlation between KC parameters and nocturnal eye compression. In contrast, a statistically significant association between sleeping positions and KC risk was reported in 3 out of 5 analytical studies (60%).

CONCLUSION

Findings suggest a possible link between prone or lateral sleeping positions and KC development or asymmetry, implying that these positions may increase corneal biomechanical stress during sleep. However, the association was confirmed in only 60% of analytical studies. The review highlights the necessity for additional research to validate these findings and to explore potential causal mechanisms between sleeping positions and KC.

Evaluating the Influence of Eye Rubbing and Genetic Predisposition on Keratoconus in Bucaramanga (Colombia): A Case-control Study

AIM

To determine risk factors associated with keratoconus in Bucaramanga, Colombia.

MATERIAL AND METHODS

A paired case-control study was conducted at Bucaramanga, Colombia, between November 2022 and December 2023. The controls were age- and sex-matched. Patients answered a questionnaire designed for this study regarding their family history of keratoconus, eye rubbing, atopy, sun exposure, and sleeping habits. Information from medical records was also obtained. Univariate and multivariate conditional analyses were used to test the significance of associations.

RESULTS

One hundred fifty-six patients with a diagnosis of keratoconus and 312 controls were included. Univariate analyses revealed significant differences between cases and controls in the following factors: very frequent eye rubbing (OR = 20.9, 95% CI 6.2-70.1), a positive family history of keratoconus (OR = 13.0, 95% CI 5.5-30.8), a personal history of atopy (OR = 2.2), and nocturnal eye compression (OR = 1.7, 95% CI 1.0-2.7). Multivariate analysis showed a statistical significance for eye rubbing (OR = 6.9, 95% CI 3.8-12.5), and family history of keratoconus (OR = 10.3, 95% CI 2.3-44.9). There was a significant mild interaction between both, since when the two coincided the OR increased up to 74.1 times.

CONCLUSION

Eye rubbing and family history of keratoconus were the most important risk factors for keratoconus in our population. Although it is impossible to establish causal relationships, our results suggest that controlling eye rubbing could be a potentially useful preventive measure, particularly in individuals with a family history of keratoconus. Other factors, such as sun exposure, sleeping position, and atopy, may play a role in the pathophysiology of the disease.

Targeting endothelial ERG to mitigate vascular regression and neuronal ischemia in retinopathies

Retinopathy of prematurity (ROP) and diabetic retinopathy (DR) are ocular disorders in which a loss of retinal vasculature leads to ischemia followed by a compensatory neovascularization response. In mice, this is modeled using oxygen-induced retinopathy (OIR), whereby neonatal animals are transiently housed under hyperoxic conditions that result in central retina vessel regression and subsequent neovascularization. Using endothelial cell (EC)-specific gene deletion, we found that loss of two ETS-family transcription factors, ERG and FLI1, led to regression of OIR-induced neovascular vessels but failed to improve visual function, suggesting that relevant retinal damage occurs prior to and independently of neovascularization. Turning our attention to the initial stage of OIR, we found that hyperoxia repressed ERG expression in retinal ECs of wild type mice, raising the possibility that oxygen-induced ERG downregulation promotes vessel regression during the initiation of OIR-induced pathology. We therefore developed a murine model of EC-specific ERG overexpression and found it sufficient to prevent hyperoxia-induced vascular regression, neuronal cell death, and neovascularization in the OIR model. Importantly, ERG overexpression also improved visual function in OIR-challenged mice. Moreover, we show that both ERG and FLI1 are downregulated in the retinal vessels of human patients with early stages of DR, suggesting that neovascular disorders of the eye may share common mechanisms underlying pathological retinal capillary regression. Collectively, these data suggest that the regulation of vascular regression by EC-expressed ETS transcription factors may be adapted towards novel therapeutic approaches for the prevention and/or alleviation of ocular neovascular disorders.

Retinopathy of Prematurity: Incidence, Risk Factors, and Treatment Outcomes in a Tertiary Care Center

Retinopathy of prematurity (ROP) remains a major cause of childhood blindness. Its pooled prevalence worldwide is 31.9%, and that of severe ROP is 7.5% among prematurely born babies. Investigating risk factors is essential for improving early detection and treatment outcomes. Purpose: To determine the frequency and stages of ROP cases and evaluate the treatment methods for premature infants at the Medical University of Vienna. Methods: In this retrospective study, 352 children who underwent ROP screening between 2018 and 2021 with a gestational age (GA) ≤ 32 weeks and/or a birth weight (BW) ≤ 1500 g were included. Results: ROP was found in 144 (40.9%) of the 352 screened premature infants, with 17 (4.8%) requiring treatment. Significant risk factors included GA and BW, while sex and pregnancy type were not significant. The mean GA was 27.7 ± 2.5 weeks, and the mean BW was 989.1 ± 359.7 g. Infants with ROP had a lower GA (25.9 ± 1.7 weeks) and BW (778.6 ± 262.4 g) than those without ROP (28.9 ± 2.2 weeks; 1134.9 ± 345.9 g). GA and BW were significantly lower in infants developing ROP (p < 0.001). Stage 2 ROP was the most common severity in 74 children (51.4%). Laser therapy was the most common first-line treatment, used in 11 infants (64.7%), followed by anti-VEGF therapy, used in 6 infants (35.3%). Children were treated within 1.0 ± 0.6 days on average. Of the 17 infants treated, 14 (82.4%) showed initial regression. Three infants (17.6%) required re-treatment: two with initial anti-VEGF therapy and one after laser therapy. Conclusions: The findings provide insights into ROP's prevalence and treatment preferences at a university tertiary care center. GA and BW were confirmed to be significant predictors, aiding in early detection and informing treatment decisions. These insights will enable comparisons with similar studies and contribute to improved patient care.

Novel Small Molecules with Anti-Inflammatory and Anti-Angiogenic Activity in a Mouse Model of Oxygen-Induced Retinopathy

Retinopathy of prematurity (ROP) has a dual-phase disease pathology; in phase 1, hyperoxia-induced vaso-obliteration occurs in the retinal vasculature due to increased oxidative stress (OS) and inflammation, followed by phase 2, where hypoxia increases the overproduction of growth factors, inducing retinal neovascularization. Toll-like receptor 2 and -4 (TLR2 and TLR4) overactivation, hyper-inflammation, macrophages, and neutrophil infiltration contribute to the developing ROP. AVR-121 and AVR-123 are novel classes of small-molecule dual inhibitors of TLR2/4 tested in a human leukemia monocytic cell line (THP-1) and cord-blood-derived mononuclear cells (CBMCs). Both compounds inhibited TLR2/4 signaling-related inflammatory cytokines in THP-1 cells and inhibited VEGF-induced neovascularization in human retinal endothelial cells (HRECs), which are hallmarks of ROP. In an oxygen-induced retinopathy (OIR) murine model, the intraperitoneal injection of AVR-123 in the hyperoxia phase (P7-P12) or a nanosuspension eyedrop of AVR-123 in the hypoxic phase (P12-P17) significantly reduced vaso-obliteration, angiogenesis, and inflammatory cytokine profiles while not inhibiting the necessary growth factor VEGF in the juvenile mouse eyes. The results are consistent with our hypothesis that targeting the dual TLR2/4 pathway will reduce inflammation, angiogenesis, and vaso-obliteration in vitro and in vivo and reduce cytotoxic immune cells. AVR-123 has the potential to be developed as a therapy for ROP.

FOXC1 regulates endothelial CD98 (LAT1/4F2hc) expression in retinal angiogenesis and blood-retina barrier formation

Angiogenesis, the growth of new blood vessels from pre-existing vasculature, is essential for the development of new organ systems, but transcriptional control of angiogenesis remains incompletely understood. Here we show that FOXC1 is essential for retinal angiogenesis. Endothelial cell (EC)-specific loss of Foxc1 impairs retinal vascular growth and expression of Slc3a2 and Slc7a5, which encode the heterodimeric CD98 (LAT1/4F2hc) amino acid transporter and regulate the intracellular transport of essential amino acids and activation of the mammalian target of rapamycin (mTOR). EC-Foxc1 deficiency diminishes mTOR activity, while administration of the mTOR agonist MHY-1485 rescues perturbed retinal angiogenesis. EC-Foxc1 expression is required for retinal revascularization and resolution of neovascular tufts in a model of oxygen-induced retinopathy. Foxc1 is also indispensable for pericytes, a critical component of the blood-retina barrier during retinal angiogenesis. Our findings establish FOXC1 as a crucial regulator of retinal vessels and identify therapeutic targets for treating retinal vascular disease.

4D label-free proteomics analysis of oxygen-induced retinopathy with or without anti-VEGF treatment

Oxygen-induced retinopathy (OIR) animal model is widely used for retinopathy of prematurity (ROP) researches. The purpose of this study was to identify proteins and related pathways of OIR with or without anti-vascular endothelial growth factor (VEGF) treatment, for use as biomarkers in diagnosing and treating ROP. Nine samples were subjected to proteomic analysis. Retina specimens were collected from 3 OIR mice, 3 OIR mice with anti-VEGF treatment and 3 normal mice (control group). Liquid chromatography-tandem mass spectrometry analysis was performed using the 4D label-free technique. Statistically significant differentially expressed proteins, gene ontology (GO) terms, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway representations, InterPro (IPR) and protein interactions were analyzed. In total, 4585 unique proteins were identified as differentially expressed proteins (DEPs). Enrichment analysis of the GO and KEGG indicated functional clusters related to peptide biosynthetic and metabolic process, cellular macromolecule biosynthetic process and nucleic acid binding in OIR group. For anti-VEGF treatment group, DEPs were clustered in DNA replication, PI3K/Akt signaling pathway and Jak/STAT signaling pathway. Proteomic profiling is useful for the exploration of molecular mechanisms of OIR and mechanisms of anti-VEGF treatment. These findings may be useful for identification of novel biomarkers for ROP pathogenesis and treatment.

Biomarkers in retinopathy of prematurity: a systematic review and meta-analysis

Aim

Retinopathy of prematurity is a significant global cause of childhood blindness. This study aims to identify serum biomarkers that are associated with the development of ROP.

Methods

A systematic review and meta-analysis was conducted using PRISMA guidelines. Three databases were searched (Pubmed, Scopus and Web of Science) from 2003 to March 2023. Only studies investigating serum biomarker levels in preterm infants (<37 weeks gestation) were included.

Results

Meta-analysis suggests that low serum IGF-1 levels have a strong association with the development of ROP [SMD (95% CI) of -.46 [-.63, -.30], p < .001]. Meta-analysis suggests that higher serum glucose levels were associated with the development of ROP [SMD (95% CI) of 1.25 [.94, 1.55], p < .001]. Meta-analysis suggests that thrombocytopenia is associated with the development of ROP [SMD (95% CI) of -.62 [-.86, -.37], p < .001].

Conclusion

Low levels of serum IGF-1, high levels of serum glucose and thrombocytopenia all appear to have the strongest association with the development of ROP out of the 63 biomarkers investigated in this review. These associations highlight their potential use as diagnostic biomarkers in ROP, though further research is needed to establish the exact relationship between these biomarkers and disease pathogenesis.

Monitoring SpO2: The Basics of Retinopathy of Prematurity (Back to Basics) and Targeting Oxygen Saturation

Oxygen (O2) is a drug frequently used in newborn care. Adverse effects of hypoxia are well known but the damaging effects of excess oxygen administration and oxidative stress have only been studied in the last 2 decades. Many negative effects have been described, including retinopathy of prematurity . Noninvasive pulse oximetry (SpO2) is useful to detect hypoxemia but requires careful evaluation and understanding of the frequently changing relationship between O2 and hemoglobin to prevent hyperoxemia. Intention to treat SpO2 ranges should be individualized for every newborn receiving supplemental O2, according to gestational age, post-natal age, and clinical condition.

Retinopathy of Prematurity-Targeting Hypoxic and Redox Signaling Pathways

Retinopathy of prematurity (ROP) is a proliferative vascular ailment affecting the retina. It is the main risk factor for visual impairment and blindness in infants and young children worldwide. If left undiagnosed and untreated, it can progress to retinal detachment and severe visual impairment. Geographical variations in ROP epidemiology have emerged over recent decades, attributable to differing levels of care provided to preterm infants across countries and regions. Our understanding of the causes of ROP, screening, diagnosis, treatment, and associated risk factors continues to advance. This review article aims to present the pathophysiological mechanisms of ROP, including its treatment. Specifically, it delves into the latest cutting-edge treatment approaches targeting hypoxia and redox signaling pathways for this condition.

Knowledge, Attitudes, and Practices Toward Retinopathy of Prematurity Among Neonatal Intensive Care Nurses: A Cross-sectional Study

It is important to study the awareness of retinopathy of prematurity (ROP) among neonatal care nurses in hospitals. Unfortunately, there is a lack of studies conducted among nurses on this subject in Palestine. Thus, this study purposed to assess the knowledge, attitudes, and practices toward ROP among neonatal intensive care nurses in Palestine. A cross-sectional was used to conduct this study. A convenience sampling method was utilized to recruit 289 neonate intensive care nurses working in private and governmental hospitals. The findings showed that around 48.0% of the nurses had low knowledge about preventing ROP. Most of the nurses (78%) reported a neutral attitude toward preventing ROP. Moreover, overall nurses' practices regarding ROP were fair (57.1%). There was a difference in practices regarding ROP according to the health sector (P < .05), in which the private sector had better practices compared to the governmental sector. Additionally, there was a significant difference in knowledge regarding ROP according to educational level (P < .05). Also, a significant difference was found in knowledge and practices regarding ROP according to nurses' experience. Attitudes and practices were the main significant predictors of knowledge (B = 0.153, P < .05; B = 0.172, P < .05, respectively). Knowledge and practices were the main predictors of attitudes (B = 0.126, P < .05; B = 469, P < .001), respectively. Knowledge, attitudes, and experience in neonate intensive care nurses were the main significant predictors of practices (B = 0.135, P < .05; B = 0.449, P < .001; B = 0.224, P < .05, respectively). It is necessary to develop an educational program and competency-based training programs for neonate intensive care nurses about ROP and implement preventive strategies.

Genetic Modulation of the Erythrocyte Phenotype Associated with Retinopathy of Prematurity-A Multicenter Portuguese Cohort Study

The development of retinopathy of prematurity (ROP) may be influenced by anemia or a low fetal/adult hemoglobin ratio. We aimed to analyze the association between DNA methyltransferase 3 β (DNMT3B) (rs2424913), methylenetetrahydrofolate reductase (MTHFR) (rs1801133), and lysine-specific histone demethylase 1A (KDM1A) (rs7548692) polymorphisms, erythrocyte parameters during the first week of life, and ROP. In total, 396 infants (gestational age < 32 weeks or birth weight < 1500 g) were evaluated clinically and hematologically. Genotyping was performed using a MicroChip DNA on a platform employing iPlex MassARRAY^®. Multivariate regression was performed after determining risk factors for ROP using univariate regression. In the group of infants who developed ROP red blood cell distribution width (RDW), erythroblasts, and mean corpuscular volume (MCV) were higher, while mean hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were lower; higher RDW was associated with KDM1A (AA), MTHFR (CC and CC + TT), KDM1A (AA) + MTHFR (CC), and KDM1A (AA) + DNMT3B (allele C); KDM1A (AA) + MTHFR (CC) were associated with higher RDW, erythroblasts, MCV, and mean corpuscular hemoglobin (MCH); higher MCV and MCH were also associated with KDM1A (AA) + MTHFR (CC) + DNMT3B (allele C). We concluded that the polymorphisms studied may influence susceptibility to ROP by modulating erythropoiesis and gene expression of the fetal/adult hemoglobin ratio.

Most Up-to-Date Analysis of Epidemiological Data on the Screening Guidelines and Incidence of Retinopathy of Prematurity in Europe-A Literature Review

INTRODUCTION

Global predictions indicate that the incidence of retinopathy of prematurity (ROP) is increasing, but the lack of current epidemiological data on the occurrence of ROP in Europe prompted the authors to update these data.

METHODS

European studies related to the presence of ROP were analyzed, and the reason for the differences in the percentage of ROP and different screening criteria were checked.

RESULTS

The study presents results from individual and multiple centers. Current ROP incidence data varies from a low of 9.3% in Switzerland to the highest values of 64.1% in Portugal and 39.5% in Norway. The national screening criteria are used in the Netherlands, Germany, Norway, Poland, Portugal, Switzerland, and Sweden. Uniform criteria-Royal College of Paediatrics and Child Health guidelines are used in England and Greece. American Academy of Pediatrics screening guidelines are used in France and Italy.

CONCLUSIONS

The epidemiology of ROP in European countries varies significantly. The increase in the diagnosis and treatment rate of ROP in recent years correlates with the narrowing of diagnostic criteria in newly issued guidelines (which include the WINROP and G-ROP algorithms), a higher number of less developed preterm infants, and a lower percentage of live births.

Hematologic Risk Factors for the Development of Retinopathy of Prematurity—A Retrospective Study

(1) Background: Retinopathy of prematurity (ROP) can cause severe visual impairment or even blindness. We aimed to assess the hematological risk factors that are associated with different stages of ROP in a cohort of preterm newborns, and to compare the clinical characteristics and therapeutic interventions between groups. (2) Methods: This retrospective study included 149 preterm newborns from a tertiary maternity hospital in Romania between January 2018 and December 2018, who were segregated into: Group 1 (with ROP, n = 59 patients), and Group 2 (without ROP, n = 90 patients). The patients that were affected by ROP were subsequently divided into the following subgroups: Subgroup 1 (Stage 1, n = 21), Subgroup 2 (Stage 2, n = 35), and Subgroup 3 (Stage 3, n = 25). The associations were analyzed using multivariate logistic regression and sensitivity analysis. (3) Results: Platelet mass indexes (PMI) that were determined in the first, seventh, and tenth days of life were significantly associated with Stage 1 ROP. PMI determined in the first day of life was also significantly associated with Stage 2 ROP. The sensitivity and specificity of these parameters were modest, ranging from 44 to 57%, and 59 to 63%. (4) Conclusions: PMI has a modest ability to predict the development of ROP.

The β3 adrenoceptor in proliferative retinopathies: "Cinderella" steps out of its family shadow

In the retina, hypoxic condition leads to overgrowing leaky vessels resulting in altered metabolic supply that may cause impaired visual function. Hypoxia-inducible factor-1 (HIF-1) is a central regulator of the retinal response to hypoxia by activating the transcription of numerous target genes, including vascular endothelium growth factor, which acts as a major player in retinal angiogenesis. In the present review, oxygen urge by the retina and its oxygen sensing systems including HIF-1 are discussed in respect to the role of the beta-adrenergic receptors (β-ARs) and their pharmacologic manipulation in the vascular response to hypoxia. In the β-AR family, β1- and β2-AR have long been attracting attention because their pharmacology is intensely used for human health, while β3-AR, the third and last cloned receptor is no longer increasingly emerging as an attractive target for drug discovery. Here, β3-AR, a main character in several organs including the heart, the adipose tissue and the urinary bladder, but so far a supporting actor in the retina, has been thoroughly examined in respect to its function in retinal response to hypoxia. In particular, its oxygen dependence has been taken as a key indicator of β3-AR involvement in HIF-1-mediated responses to oxygen. Hence, the possibility of β3-AR transcription by HIF-1 has been discussed from early circumstantial evidence to the recent demonstration that β3-AR acts as a novel HIF-1 target gene by playing like a putative intermediary between oxygen levels and retinal vessel proliferation. Thus, targeting β3-AR may implement the therapeutic armamentarium against neovascular pathologies of the eye.

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.

Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity: An International Multicenter Study

PURPOSE

To report practice patterns of intravitreal injections of anti-VEGF for retinopathy of prematurity (ROP) and outcomes data with a focus on retreatments and complications.

DESIGN

Multicenter, international, retrospective, consecutive series.

SUBJECTS

Patients with ROP treated with anti-VEGF injections from 2007 to 2021.

METHODS

Twenfty-three sites (16 United States [US] and 7 non-US) participated. Data collected included demographics, birth characteristics, examination findings, and methods of injections. Comparisons between US and non-US sites were made.

MAIN OUTCOME MEASURES

Primary outcomes included number and types of retreatments as well as complications. Secondary outcomes included specifics of the injection protocols, including types of medication, doses, distance from limbus, use of antibiotics, and quadrants where injections were delivered.

RESULTS

A total of 1677 eyes of 918 patients (43% female, 57% male) were included. Mean gestational age was 25.7 weeks (range, 21.2-41.5 weeks), and mean birth weight was 787 g (range, 300-2700 g). Overall, a 30-gauge needle was most commonly used (51%), and the quadrant injected was most frequently the inferior-temporal (51.3%). The distance from the limbus ranged from 0.75 to 2 mm, with 1 mm being the most common (65%). Bevacizumab was the most common anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases. Overall, 604 (36%) eyes required retreatment. Of those, 79.8% were retreated with laser alone, 10.6% with anti-VEGF injection alone, and 9.6% with combined laser and injection. Complications after anti-VEGF injections occurred in 15 (0.9%) eyes, and no cases of endophthalmitis were reported. Patients in the United States had lower birth weights and gestational ages (665.6 g and 24.5 weeks, respectively) compared with non-US patients (912.7 g and 26.9 weeks, respectively) (P < 0.0001). Retreatment with reinjection and laser was significantly more common in the US compared with the non-US group (8.5% vs. 4.7% [P = 0.0016] and 55% vs. 7.2% [P < 0.001], respectively). There was no difference in the incidence of complications between the 2 geographic subgroups.

CONCLUSIONS

Anti-VEGF injections for ROP were safe and well tolerated despite a variance in practice patterns. Infants with ROP receiving injections in the US tended to be younger and smaller, and they were treated earlier with more retreatments than non-US neonates with ROP.

Nine-Year Epidemiological Data on the Incidence of Retinopathy of Prematurity in Poland-A Literature Review for the 2012-2021 Period

BACKGROUND

The epidemiology of retinopathy of premature infants (ROP) in Poland is a topic rarely discussed in the literature. Single publications (Pubmed) concern only specific regions of Poland and date back to 2000-2006, which prompted the authors to update Polish epidemiological data.

METHODS

Data from the 2012-2021 screening tests were analyzed for: diagnosis of ROP, severe ROP and the percentage of ROP undergoing treatment (laser-diode, anti-VEGF, and complications such as retinal detachment). The Polish results were compared with the available data from Europe in the same period.

RESULTS

The analysis of the GOCC data confirmed that the prevalence of ROP in Poland for 2016-2019 was 15.1%; in 2012-2021 (15.6%). Polish epidemiological data shows a lower percentage of ROP diagnosis compared to other European countries (15.6% vs. 23.8% in Portugal, 28.3% in the Netherlands, 25.1% in Genoa, Italy, 38% in Florence, Italy).

CONCLUSIONS

In order to obtain and create an epidemiological database, it is important to undertake activities aimed at a detailed verification of the analyzed parameters and the collection of similar or the same data from all centers in Poland. There is no economic data available on the cost of caring for a child with ROP.

Anti-vascular endothelial growth factor therapy in retinopathy of prematurity: An updated literature review

Laser photocoagulation can still be considered the gold standard for treatment for retinopathy of prematurity (ROP). However, anti-vascular endothelial growth factor (anti-VEGF) therapy has increasingly become an important option that plays a significant role in the treatment of ROP. Major clinical trials have been published regarding the anti-VEGF use in ROP, along with multiple other studies looking into the different agents, doses, techniques, and possible complications. Anti-VEGF therapies can be considered as a safe and effective option for managing ROP. More longitudinal randomized clinical trials are necessary to evaluate the preferred treatment agent, the appropriate dose, best follow-up protocol, and the long-term ocular and systemic outcomes following treatment.

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates

Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA (p = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332-15.573, p = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP.

Seeing stars: Development and function of retinal astrocytes

Throughout the central nervous system, astrocytes adopt precisely ordered spatial arrangements of their somata and arbors, which facilitate their many important functions. Astrocyte pattern formation is particularly important in the retina, where astrocytes serve as a template that dictates the pattern of developing retinal vasculature. Thus, if astrocyte patterning is disturbed, there are severe consequences for retinal angiogenesis and ultimately for vision - as seen in diseases such as retinopathy of prematurity. Here we discuss key steps in development of the retinal astrocyte population. We describe how fundamental developmental forces - their birth, migration, proliferation, and death - sculpt astrocytes into a template that guides angiogenesis. We further address the radical changes in the cellular and molecular composition of the astrocyte network that occur upon completion of angiogenesis, paving the way for their adult functions in support of retinal ganglion cell axons. Understanding development of retinal astrocytes may elucidate pattern formation mechanisms that are deployed broadly by other axon-associated astrocyte populations.