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Rollin FG, Sonu S, Ahmad S, Beriwal S. Reflective Errors: A Call for a More Careful Use of Race in Research. Ophthalmic Epidemiol 2024; 31:188-189. [PMID: 37288807 DOI: 10.1080/09286586.2023.2222824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Francois G Rollin
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stan Sonu
- Department of Pediatrics and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samera Ahmad
- Resident Physician, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Surabhi Beriwal
- Medical Student, Emory University School of Medicine, Atlanta, Georgia, USA
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Choi HJ, Shin BS, Shin SH, Kim EK, Kim HS. Critical period of oxygen supplementation and invasive ventilation: implications for severe retinopathy of prematurity. Ital J Pediatr 2024; 50:58. [PMID: 38561824 PMCID: PMC10985977 DOI: 10.1186/s13052-024-01629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Several studies have identified graded oxygen saturation targets to prevent retinopathy of prematurity (ROP), a serious complication in preterm infants. We aimed to analyze the critical period of oxygen supplementation and/or invasive ventilation associated with severe ROP. METHODS This retrospective case-control study included neonates with a gestational age (GA) < 29 weeks. Participants were divided into two groups: treated retinopathy and untreated/no retinopathy. Time-weighted average FiO2 (TWAFiO2) and weekly invasive ventilation were compared between groups by postnatal age (PNA) and postmenstrual age (PMA). The association of treated retinopathy with TWAFiO2 and invasive ventilation was analyzed. RESULTS Data from 287 neonates were analyzed; 98 were treated for ROP and had lower GAs (25.5 vs. 27.4 weeks, p < 0.01) and lower birthweights (747.6 vs. 1014 g, p < 0.001) than those with untreated/no ROP. TWAFiO2 was higher from PMA 26-34 weeks, except for PMA 31 weeks in treated ROP, and higher in the first nine weeks of life in treated ROP. On multiple logistic regression, TWAFiO2 and invasive ventilation were associated with ROP treatment during the first seven weeks PNA. Invasive ventilation was associated with ROP treatment from PMA 26-31 weeks; no association was found for TWAFiO2 and PMA. CONCLUSIONS Amount of oxygen supplementation and/or invasive ventilation during the first 7 weeks of life or up to 31 weeks PMA was associated with development of severe ROP. This period might be candidate timing for strict oxygen supplementation strategies in preterm infants, while concerns of mortality with low oxygen supplementation should be further explored.
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Affiliation(s)
- Ho Jung Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Baek Sup Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
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Bhatti F, Yu Y, Ying GS, Tomlinson LA, Binenbaum G. Association of Cardiovascular Disease with Retinopathy of Prematurity. Ophthalmic Epidemiol 2023; 30:95-102. [PMID: 35137647 PMCID: PMC9360191 DOI: 10.1080/09286586.2022.2036766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/15/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the associations of presence and types of cardiovascular diseases (CVDs) with development of retinopathy of prematurity (ROP) in premature infants undergoing ROP examinations. STUDY DESIGN We performed secondary analyses of data from the multi-center Postnatal Growth and ROP Validation Study (GROP-2). CVD was categorized based on pulmonary blood flow (PBF), systemic blood flow (SBF), pulmonary hypertension (PPHN), or dysrhythmia. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated from multivariable logistic regression models that included any ROP or severe ROP as outcome variable and any CVD or type of CVD as independent variable, with adjustment of covariates including birth weight (BW), gestational age (GA), and days on supplemental oxygen in the first month of postnatal life. RESULT Among 3980 infants, 528 (13.3%) had CVD (304 had increased PBF, 101 had decreased PBF, and 49 had PPHN), 1643 (40.4%) developed ROP, and 503 (12.6%) developed severe ROP. In multivariable analyses, presence of CVD was not significantly associated with increased risk of any ROP (aOR = 1.15, 95% CI: 0.90-1.46, p = .26) or severe ROP (aOR = 0.98, 95% CI: 0.72-1.34, p = .92). However, there were trends associating CVD resulting in increased PBF with a higher risk of ROP (aOR = 1.32, 95% CI: 0.97-1.80, p = .08) and PPHN with a higher risk of severe ROP (aOR = 2.04, 95% CI: 0.96-4.35, p = .07). When adjusting only for BW and GA, these associations were significant (aOR = 1.47, 95% CI: 1.09-1.99, and aOR = 2.35, 95% CI: 1.19-4.65, respectively). CONCLUSION CVD with increased PBF likely increases the risk of ROP. PPHN likely increases the risk of severe ROP.
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Affiliation(s)
- Faizah Bhatti
- Neonatal Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology and Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
| | - Gui-shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
| | | | - Gil Binenbaum
- The Children’s Hospital of Philadelphia, Philadelphia PA
- Center for Preventive Ophthalmology and Biostatistics, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
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Al Rasheed R, Adhi MI, Alowedi SA, Albdah B, Aldebasi T, Hazzazi MA. Long-term peripheral retinal vascular behavior in retinopathy of prematurity patients treated with ranibizumab intravitreal injection as monotherapy using fluorescein angiography. Int J Retina Vitreous 2022; 8:53. [PMID: 35918740 PMCID: PMC9344754 DOI: 10.1186/s40942-022-00402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few challenges are faced with the introduction of anti-VEGF agents as a modality of treatment for retinopathy of prematurity. The clinical behavior and time course of regression post injection differ compared to post laser ablation. This study aims to evaluate the long-term peripheral retinal vascularization outcome of Ranibizumab intravitreal injections monotherapy in the treatment of retinopathy of prematurity. METHOD Hospital-based quasi-experimental study. Include ROP patients who received intravitreal ranibizumab (IVR), as primary treatment for type 1 ROP. Patients were examined under general anaesthesia to ensure documentation of all junctions of vascular and avascular zones. Images were taken by RetCam III, Phoenix ICON and fluorescein angiography was performed to describe vascular behaviors. RESULTS The mean gestational age was 24.67 weeks and the mean postmenstrual age at the time of intravitreal ranibizumab treatment was 36.3 weeks. Fluorescein angiography was performed at 155-288 weeks; most eyes showed two disk diameters of avascular peripheral retina. Only eyes with original aggressive ROP who required a second injection (six eyes) showed extensive peripheral avascular retina reaching zone I (13.64%). Neovascularization was evident in five eyes (11.36%), all with an original aggressive ROP and received multiple injections. CONCLUSIONS Ranibizumab treated babies with incomplete retinal vascularization require close and long-term follow-up visits to assess post injection vascular behavior. Peripheral retinal avascular zone of more than two-disc diameters was present in most of the patients evidenced by fluorescein angiography. Babies with initial diagnosis of aggressive ROP are more likely to have persistent peripheral neovascularization.
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Affiliation(s)
- Raghad Al Rasheed
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia
| | - Mohammad Idrees Adhi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sarah Abdullah Alowedi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia
| | - Bayan Albdah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tariq Aldebasi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammad A Hazzazi
- Department of Ophthalmology, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 22490, Riyadh, 11426, Saudi Arabia. .,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Sankar BK, Marakkar RK, Varghese S. Effectiveness of Developmentally Supportive Education Program on Nursing Knowledge of Retinopathy of Prematurity in Neonatal Intensive Care Unit. Iran J Nurs Midwifery Res 2022; 27:67-70. [PMID: 35280195 PMCID: PMC8865242 DOI: 10.4103/ijnmr.ijnmr_279_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/24/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
Background Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. India accounts for nearly 10% of the worldwide estimate of blindness and visual impairment due to ROP. Nurses are pillars of neonatal intensive care units (NICUs) and play a critical role in the prevention and management of ROP. The primary aim of this study was to evaluate the effect of developmentally supportive education program on knowledge regarding prevention and management of ROP among nurses working in NICU. Materials and Methods A hospital based pre-experimental, one group pre-test-post-test study was carried out among 32 staff nurses working in the NICU of a tertiary care center during January to February 2019. Knowledge regarding the prevention and management of ROP was assessed before and after the implementation of developmentally supportive education program using a structured knowledge questionnaire. Results Pre-test knowledge score was mean (Standard Deviation [SD]) 9.00 (3.68) and after the educational program post-test knowledge score was found to be mean (SD) 14.53 (2.39). Paired t-test was used to evaluate the effect of developmentally supportive education program and was found to be statistically significant (t32= 10.09, p < 0.001). Conclusions Developmentally supportive educational program can be used as an effective intervention for improving the knowledge regarding ROP among nurses in NICU.
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Affiliation(s)
- Bindu Kunnumpurath Sankar
- Department of Child Health Nursing, Government College of Nursing, Thrissur, Kerala, India,Address for correspondence:Mrs. Bindu Kunnumpurath Sankar, Govt. College of Nursing, Thrissur - 680 596, Kerala, India. E-mail:
| | - Riaz Karoly Marakkar
- Department of Mental Health Nursing, Government College of Nursing, Thrissur, Kerala, India
| | - Shalu Varghese
- Research Assistant, Academic Staff College, Kerala University of Health Sciences, Thrissur, Kerala, India
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Vinayahalingam N, McDougall J, Ahrens O, Ebneter A. Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Swiss cohort. BMC Ophthalmol 2022; 22:19. [PMID: 35012498 PMCID: PMC8751318 DOI: 10.1186/s12886-021-02227-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently used screening criteria for retinopathy of prematurity (ROP) show high sensitivity for predicting treatment-requiring ROP but low specificity; over 90% of examined infants do not develop ROP that requires treatment (type 1 ROP). A novel weight gain-based prediction model was developed by the G-ROP study group to increase the specificity of the screening criteria and keep the number of ophthalmic examinations as low as possible. This retrospective cohort study aimed to externally validate the G-ROP screening criteria in a Swiss cohort. METHODS Data from 645 preterm infants in ROP screening at Inselspital Bern between January 2015 and December 2019 were retrospectively retrieved from the screening log and analysed. The G-ROP screening criteria, consisting of 6 trigger parameters, were applied in infants with complete data. To determine the performance of the G-ROP prediction model for treatment-requiring ROP, sensitivity and specificity were calculated. RESULTS Complete data were available for 322 infants who were included in the analysis. None of the excluded infants had developed type 1 ROP. By applying the 6 criteria in the G-ROP model, 214 infants were flagged to undergo screening: among these, 14 developed type 1 ROP, 9 developed type 2 ROP, and 43 developed milder stages of ROP. The sensitivity for predicting treatment-requiring ROP was 100% (CI, 0.79-1.00), and the specificity was 41% (CI, 0.35 -0.47). Implementing the novel G-ROP screening criteria would reduce the number of infants entering ROP screening by approximately one third. CONCLUSIONS The overall prevalence of treatment-requiring ROP was low (2.15%). Previously published performance parameters for the G-ROP algorithm were reproducible in this Swiss cohort. Importantly, all treatment-requiring infants were correctly identified. By using these novel criteria, the burden of screening examinations could be significantly reduced.
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Affiliation(s)
- Nithursa Vinayahalingam
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jane McDougall
- Department of Neonatalogy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olaf Ahrens
- Department of Neonatalogy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Tawfik S, Mansour A, Selim NL, Habib AM, Fouad YA, Tawfik MA, Al-Feky M. Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt. BMC Ophthalmol 2021; 21:445. [PMID: 34961497 PMCID: PMC8711162 DOI: 10.1186/s12886-021-02193-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking. METHODS Retrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions. RESULTS Of the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30-34) weeks, and the median (IQR) BW was 1600 (1350-2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample. CONCLUSION The incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.
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Affiliation(s)
- Sara Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed Mansour
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Norhan Lotfy Selim
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
| | - Ahmed M Habib
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Yousef A Fouad
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt.
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt.
| | - Mohamed A Tawfik
- Al Ferdaws Eye Hospital, Sharkia, Egypt
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Memorial Institute for Ophthalmic Research, Giza, Egypt
| | - Mariam Al-Feky
- Al Mashreq Eye Center, 102 El-Sayed El-Merghany St., Cairo, 11774, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
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Herrod SK, Adio A, Isenberg SJ, Lambert SR. Blindness Secondary to Retinopathy of Prematurity in Sub-Saharan Africa. Ophthalmic Epidemiol 2021; 29:156-163. [PMID: 33818253 PMCID: PMC10186862 DOI: 10.1080/09286586.2021.1910315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Retinopathy of Prematurity (ROP) has been suggested to be increasing in Africa. However, it was only previously documented as a cause of blindness in 8 of 48 (16.7%) sub-Saharan African countries. The purpose of this study was to better understand the magnitude and breadth of blindness from ROP in sub-Saharan Africa.Methods: A questionnaire was sent to 455 ophthalmologists practicing in sub-Saharan Africa; the questionnaire was available in English, French and Portuguese.Results: Responses were received from 132 of 455 (29%) ophthalmologists to whom the survey was sent. Eighty-three respondents were identified as ROP-involved ophthalmologists and were from 26 of 48 (54%) sub-Saharan African countries. Ophthalmologists in 23 countries reported that they examined at least one child who was blind from ROP during the last 5 years. Sixteen of these countries had not previously reported cases of blindness from ROP in the literature. The perceived occurrence of Type 1 or more severe ROP was reported to be increasing by 31 of 77 (40%) ROP-involved ophthalmologists. ROP-involved pediatric ophthalmologists and retinal surgeons reported the number of infants they examined annually with Type 1 or more severe ROP increased from a median of 1 (range: 0-15) to a median of 4 (range: 0-40) from 2015 to 2019. ROP was estimated to be the cause of blindness for 10% of all blind children examined by ROP-involved pediatric ophthalmologists and retinal surgeons during 2019.Conclusions: ROP is becoming a more important and widespread cause of childhood blindness in sub-Saharan Africa.
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Affiliation(s)
- Scott K Herrod
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Adedayo Adio
- Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Sherwin J Isenberg
- Department of Ophthalmology, Stein Eye Institute, UCLA School of Medicine, Los Angeles, California, USA
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
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Benet D, Pellicer-Valero OJ. Artificial Intelligence: the unstoppable revolution in ophthalmology. Surv Ophthalmol 2021; 67:252-270. [PMID: 33741420 DOI: 10.1016/j.survophthal.2021.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
Artificial Intelligence (AI) is an unstoppable force that is starting to permeate all aspects of our society as part of the revolution being brought into our lives (and into medicine) by the digital era, and accelerated by the current COVID-19 pandemic. As the population ages and developing countries move forward, AI-based systems may be a key asset in streamlining the screening, staging, and treatment planning of sight-threatening eye conditions, offloading the most tedious tasks from the experts, allowing for a greater population coverage, and bringing the best possible care to every patient. This paper presents a review of the state of the art of AI in the field of ophthalmology, focusing on the strengths and weaknesses of current systems, and defining the vision that will enable us to advance scientifically in this digital era. It starts with a thorough yet accessible introduction to the algorithms underlying all modern AI applications. Then, a critical review of the main AI applications in ophthalmology is presented, including Diabetic Retinopathy, Age-Related Macular Degeneration, Retinopathy of Prematurity, Glaucoma, and other AI-related topics such as image enhancement. The review finishes with a brief discussion on the opportunities and challenges that the future of this field might hold.
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Affiliation(s)
| | - Oscar J Pellicer-Valero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Valencia, Spain
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Gohari M, Dastgheib SA, Noorishadkam M, Lookzadeh MH, Mirjalili SR, Akbarian-Bafghi MJ, Morovati-Sharifabad M, Neamatzadeh H. Association of eNOS and ACE Polymorphisms with Retinopathy of Prematurity: A Systematic Review and Meta-Analysis. Fetal Pediatr Pathol 2020; 39:334-345. [PMID: 31437068 DOI: 10.1080/15513815.2019.1652378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: We performed a meta-analysis to clarify the association of endothelial nitric oxide synthase (eNOS) and angiotensin I-converting enzyme (ACE) gene polymorphisms with retinopathy of prematurity (ROP) risk. Methods: PubMed, Medline, and Embase literatures up to June 01, 2019, were reviewed. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the strength of associations. Results: Eighteen case-control studies including 14 studies (810 cases and 1754 controls) on eNOS polymorphisms and four studies (1014 cases and 1215 controls) on ACE I/D polymorphism were selected. Overall, analysis showed that infants with the ACE I/D polymorphism have an increased susceptibility to ROP. No association of eNOS 27-bp, 894 G > T and -786 T > C polymorphisms with ROP risk was found. Conclusion: ACE I/D polymorphism may serve as genetic biomarker of increased ROP risk. The eNOS polymorphisms do not appear to influence susceptibility to ROP.
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Affiliation(s)
- Mohsen Gohari
- Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | | | | | | | | | | | | | - Hossein Neamatzadeh
- Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Akdogan M, Polat O. Clinical Efficacy of Topical CoQ10 and Vitamin-E Eye-drop in Retinopathy of Prematurity. Med Hypothesis Discov Innov Ophthalmol 2019; 8:291-297. [PMID: 31788491 DOI: pmid/31788491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment strategy for retinopathy of prematurity (ROP) includes anti-vascular endothelial growth factor (anti-VEGF) and/or laser therapy. The aim of this study was to investigate the clinical effects of topical Coqun® eye drop (CoQ10 and Vitamin-E) on the progression and treatment of ROP. One hundred and ten infants with type 1 ROP who received Coqun® (Coqun group) and 131 infants with type 1 ROP who did not receive Coqun® (control group) were included in this retrospective analysis. All patients were follow-up until retinal vascular maturation was complete. Intravitreal bevacizumab (IVB) injection or laser photocoagulation (LPC) were apply if needed. Treatment frequency, treatment response and mean follow-up time were compare. The number of IVB was similar between the groups, but infants in the Coqun group underwent significantly fewer LPC procedure than those in the control group (P = 0.022). The mean follow-up time was significantly shorter in infants receiving Coqun® in stage 1 ROP (P = 0.017) and similar in stages 2-4 ROP and aggressive posterior retinopathy of prematurity (APROP). The number of LPC procedure was fewer in the Coqun group in APROP (P = 0.043). These results indicate that faster retinal vascular maturation in infants with low-grade ROP and lower number of treatments with APROP could be achieve with Coqun® therapy.
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Affiliation(s)
- Muberra Akdogan
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Ophthalmology, Afyonkarahisar, Turkey
| | - Onur Polat
- Dunyagoz Hospital, Ophthalmology Clinic, Bursa, Turkey
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Abstract
Infants meeting retinopathy of prematurity (ROP) screening guidelines based on birth weight and gestational age undergo serial examinations by ophthalmologists for detection and treatment. However, less than 10% require treatment, and less than half develop ROP. Slow postnatal weight gain is highly predictive of ROP, and investigators have incorporated weight gain measures to develop more specific criteria for ROP screening. Such clinical prediction model use involves a large development study, validation studies specific to the target populations, and ongoing impact surveillance, with adjustment as necessary. Of the many weight gain inclusive prediction models intended to improve the precision of ROP screening, the Postnatal Growth and ROP (G-ROP) modified screening criteria were developed using the largest dataset and may provide the most robust model for clinical use. A recently completed G-ROP validation study will evaluate the generalizability of these modified criteria prior to clinical use.
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Affiliation(s)
- Lisa Lin
- Divison of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gil Binenbaum
- Richard Shafrtiz Chair of Ophthalmology Research, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Zarei M, Bazvand F, Ebrahimiadib N, Roohipoor R, Karkhaneh R, Farahani Dastjani A, Imani Fouladi M, Riazi Esfahani M, Khodabande A, Davoudi S, Ghasemi H, S Modjtahedi B. Prevalence and Risk Factors of Retinopathy of Prematurity in Iran. J Ophthalmic Vis Res 2019; 14:291-298. [PMID: 31660108 PMCID: PMC6815327 DOI: 10.18502/jovr.v14i3.4785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/05/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants. Methods A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age ≤ 28 weeks), extremely low-birth-weight (≤ 1000 g), and multiple-gestation (MG) infants. Results The prevalence of ROP was 27.28% (n = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion (P < 0.0001, P < 0.0001, and P = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP (P < 0.0001) were observed in EP and ELBW infants. Birth weight (P = 0.088), history of transfusion (P = 0.066), and intubation (P = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age (P = 0.037) and history of transfusion (P = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight (P = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis. Conclusion ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.
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Affiliation(s)
- Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsar Farahani Dastjani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani Fouladi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Davoudi
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Hamed Ghasemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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14
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Mohd Khair SZN, Ismail AS, Embong Z, Mohamed Yusoff AA. Detection of FZD4, LRP5 and TSPAN12 Genes Variants in Malay Premature Babies with Retinopathy of Prematurity. J Ophthalmic Vis Res 2019; 14:171-178. [PMID: 31114654 PMCID: PMC6504731 DOI: 10.4103/jovr.jovr_210_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community. Methods: A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP). Results: We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively). Conclusion: Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.
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Affiliation(s)
- Siti Zulaikha Nashwa Mohd Khair
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Salim Ismail
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zunaina Embong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Aziz Mohamed Yusoff
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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15
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Nisha KL, G S, Sathidevi PS, Mohanachandran P, Vinekar A. A computer-aided diagnosis system for plus disease in retinopathy of prematurity with structure adaptive segmentation and vessel based features. Comput Med Imaging Graph 2019; 74:72-94. [PMID: 31039506 DOI: 10.1016/j.compmedimag.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 11/28/2022]
Abstract
Retinopathy of Prematurity (ROP) is a blinding disease affecting the retina of low birth-weight preterm infants. Accurate diagnosis of ROP is essential to identify treatment-requiring ROP, which would help to prevent childhood blindness. Plus disease, which characterizes abnormal twisting, widening and branching of the blood vessels, is a significant symptom of treatment requiring ROP. In this paper, we have developed and evaluated a computer-based analysis system for objective assessment of plus disease in ROP, which best mimics the clinical method of disease diagnosis by identifying unique vessel based features. The proposed system consists of an initial segmentation stage, which will efficiently extract blood vessels of varying width and length by utilizing structure adaptive filtering, connectivity analysis and image fusion. The paper proposes the usage of additional retinal features namely leaf node count and vessel density, to portray the abnormal growth and branching of the blood vessels and to complement the commonly used features namely tortuosity and width. The test results show a better classification of plus disease in terms of sensitivity (95%) and specificity (93%), emphasizing the superiority of the proposed segmentation algorithm and vessel-based features. An additional advantage of the proposed system is that the process of selection of relevant vessels for feature extraction is fully automated, which makes the system highly useful to the non-physician graders, owing to the unavailability of a sufficient number of ROP specialists.
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Affiliation(s)
- K L Nisha
- National Institute of Technology Calicut, Kerala, India.
| | - Sreelekha G
- National Institute of Technology Calicut, Kerala, India
| | - P S Sathidevi
- National Institute of Technology Calicut, Kerala, India.
| | | | - Anand Vinekar
- Narayana Nethralaya PG Institute of Ophthalmology, Bangalore, India.
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16
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Karkhaneh R, Torabi H, Khodabande A, Roohipoor R, Riazi-Esfahani M. Efficacy of Intravitreal Bevacizumab for the Treatment of Zone I Type 1 Retinopathy of Prematurity. J Ophthalmic Vis Res 2018; 13:29-33. [PMID: 29403586 PMCID: PMC5782452 DOI: 10.4103/jovr.jovr_198_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To describe the efficacy of intravitreal bevacizumab for the treatment of type 1 retinopathy of prematurity (ROP) in zone I. Methods Preterm infants with type 1 ROP in zone I (zone I ROP, any stage with plus disease or zone I ROP, stage 3 without plus disease) were enrolled in this prospective study. Intravitreal bevacizumab (0.625 mg/0.025 ml) was injected under topical anesthesia. Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Results Seventy eyes of 35 patients with type 1 ROP in zone I were enrolled. At a gestational age of 90 weeks, ROP regressed with complete or near-complete peripheral retinal vascularization, in 82.9% of eyes after a single injection and in 92.9% of eyes after up to two injections. In five eyes (7.1%), ROP progressed to stage 4B or 5, so surgical management was required. There were no major complications such as endophthalmitis, cataract, or vitreous hemorrhage after injection. Conclusion Intravitreal bevacizumab injection is an effective method for the management of patients with Zone I ROP requiring treatment; however, some cases may progress to more advanced stages and require surgical management. Close monitoring for recurrence or progression is necessary. Eyes with persistent zone I ROP may progress to advanced stages when treated with intravitreal bevacizumab injection and re-treatment may be needed.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Torabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
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17
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Slater R, Hartley C, Moultrie F, Adams E, Juszczak E, Rogers R, Norman JE, Patel C, Stanbury K, Hoskin A, Green G. A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants: Trial protocol. Wellcome Open Res 2016; 1:7. [PMID: 28066825 PMCID: PMC5218543 DOI: 10.12688/wellcomeopenres.10005.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often undertreated. To date, few pain-relieving drugs have been tested in infants. Morphine is a potent analgesic that provides effective pain relief in adults, but there is inconclusive evidence for its effectiveness in infants. The purpose of this study is to establish whether oral morphine provides effective analgesia for procedural pain in infants. A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity (ROP) screening and heel lancing provides effective analgesia.
156 infants between 34 and 42 weeks' gestational age who require a clinical heel lance and ROP screening on the same test occasion will be included in the trial. Infants will be randomised to receive either a single dose of morphine sulphate (100 μg/kg) or placebo. Each infant will be monitored for 48 hours and safety data will be collected during the 24 hours following drug administration. The primary outcome will be the Premature Infant Pain Profile-revised (PIPP-R) score 30 seconds after ROP screening. The co-primary outcome will be the magnitude of nociceptive-specific brain activity evoked by a clinically-required heel lance. Infant clinical stability will be assessed by comparing the number of episodes of bradycardia, tachycardia, desaturation and apnoea, and changes in respiratory support requirements in the 24-hour periods before and after the clinical intervention. In addition, drug safety will be assessed by considering the occurrence of apnoeic and hypotensive episodes requiring intervention in the 24-hour period following drug administration. This study has been published as an Accepted Protocol Summary by The Lancet.
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Affiliation(s)
| | | | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Richard Rogers
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, UK
| | - Chetan Patel
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Amy Hoskin
- Department of Paediatrics, University of Oxford, Oxford, UK
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18
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Slater R, Hartley C, Moultrie F, Adams E, Juszczak E, Rogers R, Norman JE, Patel C, Stanbury K, Hoskin A, Green G. A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants: Trial protocol. Wellcome Open Res 2016. [PMID: 28066825 DOI: 10.12688/wellcomeopenres.10005.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often undertreated. To date, few pain-relieving drugs have been tested in infants. Morphine is a potent analgesic that provides effective pain relief in adults, but there is inconclusive evidence for its effectiveness in infants. The purpose of this study is to establish whether oral morphine provides effective analgesia for procedural pain in infants. A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity (ROP) screening and heel lancing provides effective analgesia.
156 infants between 34 and 42 weeks' gestational age who require a clinical heel lance and ROP screening on the same test occasion will be included in the trial. Infants will be randomised to receive either a single dose of morphine sulphate (100 μg/kg) or placebo. Each infant will be monitored for 48 hours and safety data will be collected during the 24 hours following drug administration. The primary outcome will be the Premature Infant Pain Profile-revised (PIPP-R) score 30 seconds after ROP screening. The co-primary outcome will be the magnitude of nociceptive-specific brain activity evoked by a clinically-required heel lance. Infant clinical stability will be assessed by comparing the number of episodes of bradycardia, tachycardia, desaturation and apnoea, and changes in respiratory support requirements in the 24-hour periods before and after the clinical intervention. In addition, drug safety will be assessed by considering the occurrence of apnoeic and hypotensive episodes requiring intervention in the 24-hour period following drug administration. This study has been published as an Accepted Protocol Summary by The Lancet.
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Affiliation(s)
| | | | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Richard Rogers
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, UK
| | - Chetan Patel
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Amy Hoskin
- Department of Paediatrics, University of Oxford, Oxford, UK
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19
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Mansouri M, Hemmatpour S, Sedighiani F, Ghamari M, Chavoshi D. Factors Associated with Retinopathy of Prematurity in Hospitalized Preterm Infants in Sanandaj, Iran. Electron Physician 2016; 8:2931-2934. [PMID: 27790346 PMCID: PMC5074752 DOI: 10.19082/2931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/25/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction In the near future, retinopathy of prematurity (ROP) will be the most significant cause of blindness in upper and middle-income countries. Due to the increasing survival chances for premature and low birth weight infants and the importance of the diagnosis and treatment of ROP, this study was aimed at determining the prevalence of ROP and its related factors in Sanandaj, Iran, in 2014. Methods This cross-sectional study was performed on 47 preterm infants, weighing less than 2000 g or with a gestational age of less than of 34 weeks. The sampling method was census. From the first examination to 1 to 4 weeks later, until retinal vascularization completion, examinations were performed by the same ophthalmologist. Data were analyzed using SPSS version 20 and frequency, mean, SD and Chi-square tests. Results The prevalence of ROP in the infants was 10.6%. Prevalence among girls was 16% and among boys it was 4.5%. The results showed that 23.5% of infants with ROP needed mechanical ventilation. The difference between the two groups was statistically significant (p = 0.031). Conclusion In this study, the prevalence of ROP in the NICU and neonatal ward of Besat Hospital in Sanandaj was low. However, due to serious consequences of the disease in premature infants, timely screening, determination, and control of risk factors provided necessary support to manage the disease.
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Affiliation(s)
- Majid Mansouri
- MD, Associate Professor, Pediatric Department, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sirous Hemmatpour
- MD, Assistant Professor, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fouzieh Sedighiani
- MD, Ophthalmologist, Towhid Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojgan Ghamari
- MD, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Delnia Chavoshi
- M.Sc. in Neonatal Intensive Care Nursing, Kurdistan University of Medical Sciences, Sanandaj, Iran
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20
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Roohipoor R, Karkhaneh R, Farahani A, Ebrahimiadib N, Modjtahedi B, Fotouhi A, Yaseri M, Khodabande A, Zarei M, Imani Fuladi M, Taheri A, Riazi Esfahani M, Loewenstein J. Retinopathy of prematurity screening criteria in Iran: new screening guidelines. Arch Dis Child Fetal Neonatal Ed 2016; 101:F288-93. [PMID: 27073259 DOI: 10.1136/archdischild-2015-309137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 02/29/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran. METHODS Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP. MAIN OUTCOME MEASURE Patients with ROP requiring treatment. RESULTS The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort. CONCLUSIONS Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran.
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Affiliation(s)
- Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsar Farahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bobeck Modjtahedi
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani Fuladi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Taheri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Retina Service, Noor Eye Hospital, Tehran, Iran
| | - John Loewenstein
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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21
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Alizadeh Y, Zarkesh M, Moghadam RS, Esfandiarpour B, Behboudi H, Karambin MM, Heidarzade A. Incidence and Risk Factors for Retinopathy of Prematurity in North of Iran. J Ophthalmic Vis Res 2016; 10:424-8. [PMID: 27051487 PMCID: PMC4795392 DOI: 10.4103/2008-322x.176907] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: To report the incidence and risk factors for retinopathy of prematurity (ROP) among preterm infants referred to Amiralmomenin Eye Hospital, Rasht, Iran. Methods: This cross-sectional retrospective study included all preterm infants with birth weight ≤2500 g and/or gestational age ≤36 weeks who had been referred to our facility for ROP screening over a five year period from September 2005 to September 2010. Possible risk factors and findings related to eye examinations were extracted and analyzed. Results: Among 310 infants, ROP was diagnosed in 64 (20.6%) of referred preterm infants (95% CI: 17.7%-23.5%); these included stage I in 48%, stage 2 in 29%, and stage 3 or higher disease in 23% of subjects. Mean gestational age (GA) and birth weight (BW) in the ROP–affected infants was 30.18 ± 2.28 weeks and 1,422.8 ± 420.8 g, respectively. Low BW, low GA, oxygen therapy, phototherapy, blood transfusion and apnea were risk factors for ROP. After logistic regression analysis, only low GA and low BW were independently associated with the condition. Conclusion: ROP is a relatively common finding in preterm infants of Guilan Province in the North of Iran. Low BW and low GA were significant risk factors for the disease.
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Affiliation(s)
- Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Marjaneh Zarkesh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Hassan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Abtin Heidarzade
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
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22
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Roohipoor R, Riazi-Esfahani M, Ebrahimiadib N, Karkhaneh R, Zarei M, Besharat S, Ghassemi F, Ostovaneh MR. Predictive Value of Pupillary Response to Mydriatic Agents for Diagnosis of Retinopathy of Prematurity. J Ophthalmic Vis Res 2016; 10:417-23. [PMID: 27051486 PMCID: PMC4795391 DOI: 10.4103/2008-322x.176892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the feasibility of screening for retinopathy of prematurity (ROP) by assessing the pupillary response to mydriatics. Methods: This observational case series included 134 eyes of 67 premature infants with birth weight less than 2,000 grams and gestational age less than 33 weeks. A composite eye drop composed of phenylephrine 1%, tetracaine and tropicamide 0.5% was applied 3 times within 5-minute intervals and pupil diameters were measured. The eyes were examined by experienced ROP specialists using an indirect ophthalmoscope. Zone and stage of ROP, presence of plus disease and need for treatment were recorded. The relationship between the pupillary response to mydriatics, and presence and severity of ROP was evaluated. Logistic regression was used for statistical analysis. Results: According to receiver operating characteristic (ROC) curve analysis, final pupil diameter after mydriatic administration was found the most accurate factor among other factors to recognize ROP zone I from zones II and III (Area under ROC: 0.92 [95%CI: 0.85-0.98]). The best cutoff value for final pupil diameter was 5.6 mm, because it could differentiate involvement of zone I from zones II and III with sensitivity of 80% and specificity of 100%. Conclusion: Response of the pupil to mydriatic eye drops may be useful as a less invasive method for rough estimation of ROP in high risk babies who need emergent attention; however, it cannot be considered as a screening test due to its low sensitivity.
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Affiliation(s)
- Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Besharat
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Retinopathy of prematurity (ROP), a significant morbidity in prematurely born infants, is the most common cause of visual impairment and blindness in children and persists till adulthood. Strict control of oxygen therapy and prevention of intermittent hypoxia are the keys in the prevention of ROP, but pharmacologic interventions have decreased risk of ROP. Various drug classes such as methylxanthines (caffeine), VEGF inhibitors, antioxidants, and others have decreased ROP occurrence. The timing of pharmacologic intervention remains unsettled, but early prevention rather than controlling disease progression may be preferred. These drugs act through different mechanisms, and synergistic approaches should be considered to maximize efficacy and safety.
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HEIDARY F, GHAREBAGHI R. Outcomes of Retinopathy of Prematurity. Med Hypothesis Discov Innov Ophthalmol 2016; 5:112-114. [PMID: 28293657 PMCID: PMC5346299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fatemeh HEIDARY
- Immunoregulation Research Center, Shahed University, Tehran, Iran
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Jacob MK, Sawardekar KP, Ayoub HG, Busaidi IA. Validation of the existing modified screening criteria for detection of all cases of Retinopathy of Prematurity in preterm babies - 11 year study from a governorate referral hospital in Oman. Saudi J Ophthalmol 2016; 30:3-8. [PMID: 26949350 DOI: 10.1016/j.sjopt.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose To study appropriateness of our modified screening criteria for detection of all cases of Retinopathy of Prematurity (ROP) among preterm babies. Method Retrospective observational cohort study among preterm neonates who underwent ROP screening as per set protocol for 11 years at Nizwa Hospital, Al Dhakilya Governorate, Oman. We screened all babies with gestational age ⩽32 weeks or BW ⩽ 1500 g. Preterm babies >32 weeks of GA or BW > 1500 g with unstable clinical course believed to be at high risk by the attending neonatologist also were screened. Results During the study period 528 babies were screened for ROP of which 76 babies were excluded due to death, associated congenital ocular malformation and loss for follow-up either due to transfer to other institution or defaulting. Thus 452 babies were included in the final analysis. Incidence of ROP was 46.4% of which 27.9% had mild ROP, 11.3% had severe ROP which regressed and 7.3% had severe ROP who were treated. The incidence of ROP among infants with GA < 26 wks, 26–28 wks, 29–30 wks, 31–32 wks and above 32 weeks was 100.0%, 80.0%, 59.3%, 34.4% and 19.4% respectively. 56 babies of this cohort belonged to Extended (modified) criteria group. Among these 12 babies had ROP out of which 9 had mild ROP and 3 had severe ROP. Among cases with severe ROP, two cases regressed spontaneously and one case needed treatment. Multivariate analysis using stepwise regression model showed statistically significant association of GA and BW to development of ROP. We would have missed few babies with ROP if we had followed other criteria. Conclusion Our modified screening criteria seem to be appropriate as no infant with severe ROP was missed during the study period. Incidence of severe ROP among babies in the extended criteria group (5.4%) is low but significant compared to lower gestational age. We plan to formulate a scoring system following all risk factor analysis to enable us to optimize the number of infants screened. Detection of all babies with ROP is important as they need long-term follow-up for the timely detection and management of associated ocular comorbidities.
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Hwang JH, Lee EH, Kim EAR. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors. J Korean Med Sci 2015; 30 Suppl 1:S88-94. [PMID: 26566363 PMCID: PMC4641069 DOI: 10.3346/jkms.2015.30.s1.s88] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage ≥ 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage ≥ 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage ≥ 3 in VLBW infants.
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Affiliation(s)
- Jong Hee Hwang
- Department of Pediatrics, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Eun Hee Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Goswami B, Goyal M, Beri S, Garg R, Saili A, Jain A. Role of Serum Levels of Vascular Endothelial Growth Factor and Its Receptor in Retinopathy of Prematurity. Iran J Pediatr 2015; 25:e2373. [PMID: 26396701 PMCID: PMC4575799 DOI: 10.5812/ijp.2373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/08/2015] [Accepted: 06/25/2015] [Indexed: 11/25/2022]
Abstract
Background: Retinopathy of prematurity (ROP) is a disorder of developing retina of low birth weight preterm infants which can lead to blindness. One theory attributes the fibrosis seen in ROP to deregulation of vascularization in the retina. Vascular endothelial growth factor (VEGF) is one of the important mediators involved in vascularization. Objectives: This study was carried out to assess the role of VEGF and its receptor in retinopathy of prematurity. Patients and Methods: Around 200 preterm infants born in SSK hospital were screened at 33 - 34 weeks. These babies were followed up according to the international classification of retinopathy of prematurity (ICROP) criteria. Those infants who developed ROP at 38 - 40 weeks were enrolled in group A while an equal number of infants who did not develop ROP were included in group B. Each group comprised of 30 subjects each. Venous sampling was carried out twice, once at 33 - 34 weeks and then again at 38 - 40 weeks. VEGF and VEGF-R2 were estimated by commercially available ELISA kits. Results: There was no statistically significant difference between the levels of VEGF and VEGF-R2 in both groups at first visit as well as the follow up visit. However, the intra-group difference was significant between the first and the final visit in VEGF and VEGF-R2 levels in the cases with ROP. In the control population, the VEGF levels were significantly lower in the follow up visit as compared to the initial visit. Conclusions: Our study demonstrates that a significant difference is seen in the serum VEGF and VRGF-R2 in the second visit of the infants with ROP demonstrating that VEGF might be responsible for the initiation and aggravation of ROP.
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Affiliation(s)
- Binita Goswami
- Department of Biochemistry, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
| | - Monika Goyal
- Department of Ophthalmology, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
| | - Sarita Beri
- Department of Ophthalmology, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
| | - Rajiv Garg
- Department of Ophthalmology, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
| | - Arvind Saili
- Department of Pediatrics, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
| | - Anju Jain
- Department of Biochemistry, Lady Hardinge Medical College & Associated SSK Hospital, New Delhi, India
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Narang S, Singh A, Jain S, Sood S, Chawla D. Optical coherence tomography of fovea before and after laser treatment in retinopathy of prematurity. Middle East Afr J Ophthalmol 2015; 21:302-6. [PMID: 25371634 PMCID: PMC4219220 DOI: 10.4103/0974-9233.142265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To study the fovea in preterm babies with Type I retinopathy of prematurity (ROP) before and after laser treatment using optical coherence tomography (OCT). Materials and Methods: This was a prospective observational case-control study including preterm neonates undergoing screening for ROP from May 2009 to July 2011. Group 1 included 30 eyes of 15 neonates with Type I ROP. A 532-nm laser was used for treatment in all cases for Group 1. Group 2 included 14 eyes of 7 preterm neonates without ROP that served as controls. OCT was performed under sedation in the lateral position before and after laser treatment. P <0.05 was considered statistically significant. Results: The mean initial central macular thickness (CMT) was comparable in both groups (P = 0.832) and statistically significantly correlated with gestational age (P = 0.015). No adverse effects on the anterior segment or posterior segment were observed. There was no significant difference in CMT before and after laser treatment in Group 1 (P = 0.007). There was one case of cystoid macular edema after laser treatment. Conclusion: The macula in preterm babies with Type 1 ROP was comparable to those without ROP. Gestational age was the only predictor of CMT.
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Affiliation(s)
- Subina Narang
- Department of Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Amrita Singh
- Department of Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
| | - Sunandan Sood
- Department of Ophthalmology, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
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Bin-Khathlan AA, Al-Ballaa FN, AlYahya AK. Ophthalmic short- and long-term outcomes for premature infants: Results of an extended follow-up program in Saudi Arabia. Saudi J Ophthalmol 2014; 28:268-73. [PMID: 25473342 DOI: 10.1016/j.sjopt.2014.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/16/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Study the ophthalmic morbidities for infants born prematurely at a Tertiary care center in Riyadh city. METHODS Retrospective, longitudinal cohort study at King Fahad Medical City for premature infants born at gestational age (GA) ⩽32 weeks or birth weight (BW) ⩽1500 g during the study period from January 1, 2007, until the end of December 2009 was conducted. Short term outcome was diagnosis with Retinopathy of Prematurity (ROP) and long-term outcome was ophthalmic findings at age 18-24 months. RESULTS The cumulative incidence of ROP was 30%. Infants diagnosed with ROP had a mean GA of 27 weeks (23-35 weeks) and mean BW of 907 g (530-1730 g). Risk factors other than GA and BW for ROP, identified in the predictive logistic regression model, were blood transfusion [odds ratio (OR) 1.27] and diagnosis with intraventricular hemorrhage (OR = 2.90). Strabismus was identified in 14% of the study cohort. Diagnosis of hyperopia (spherical equivalent ⩾+0.75 D) was equal in both ROP and no-ROP groups (p = 0.56). Myopia (spherical equivalent ⩾-0.75 D) and astigmatism ⩾1.00 D were diagnosed more frequently in the ROP group (p < 0.0001 and 0.04, respectively). CONCLUSIONS A higher incidence of ROP was observed in this cohort compared to some Saudi Arabian centers. It is recommended that the screening criteria be maintained and that the effects of further control of blood transfusion be assessed in a prospective study. The authors recommend an extra ophthalmic evaluation at the age of 18-24 months for all premature infants born with GA ⩽ 32 weeks.
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Affiliation(s)
- Afaf A Bin-Khathlan
- Department of Surgical Specialties, King Fahad Medical City, Al Sulymania, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Fatin N Al-Ballaa
- King Fahad Medical City, Department of Surgical Specialties, P.O. Box 59046, Riyadh 11525, Saudi Arabia
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Affiliation(s)
- Neil Finer
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Saurabh Jain
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
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Wani VB, Uboweja AK, Gani M, Al-Kandari J, Kazem M, Al-Naqeeb N, Thomas C, Al-Serafi M, Shukkur MM. Type I retinopathy of prematurity in infants with birth weight less than 1251 g: incidence and risk factors for its development in a nursery in Kuwait. Middle East Afr J Ophthalmol 2014; 20:66-71. [PMID: 23580855 PMCID: PMC3617532 DOI: 10.4103/0974-9233.106393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: To report the rate of acute retinopathy of prematurity (ROP) and Type I ROP among infants with birth weight (BW) <1251 g and identify the risk factors for the development of Type I ROP. Materials and Methods: A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants (74.4%) and Type I ROP in 95 eyes of 50 infants (24.4%). The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four (46.3%) eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth (OR 0.657, 95% CI: 0.521-0.827; P < 0.0001) and number of ventilated days (OR 1.017, 95% CI: 1.005-1.029; P = 0.006) were identified as independent risk factors for the development of Type I ROP. Conclusions: The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP.
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Affiliation(s)
- Vivek B Wani
- Department of Ophthalmology, Al-Adan Hospital, Hadiya, Kuwait
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Piyasena C, Dhaliwal C, Russell H, Hellstrom A, Löfqvist C, Stenson BJ, Fleck BW. Prediction of severe retinopathy of prematurity using the WINROP algorithm in a birth cohort in South East Scotland. Arch Dis Child Fetal Neonatal Ed 2014; 99:F29-33. [PMID: 23985883 DOI: 10.1136/archdischild-2013-304101] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We tested the ability of the 'Weight, IGF-1, Neonatal Retinopathy of Prematurity (WINROP)' clinical algorithm to detect preterm infants at risk of severe Retinopathy of Prematurity (ROP) in a birth cohort in the South East of Scotland. In particular, we asked the question: 'are weekly weight measurements essential when using the WINROP algorithm?' STUDY DESIGN This was a retrospective cohort study. Anonymised clinical data were uploaded to the online WINROP site, and infants at risk of developing severe ROP were identified. The results using WINROP were compared with the actual ROP screening outcomes. Infants with incomplete weight data were included in the whole group, but were excluded from a subgroup analysis of infants with complete weight data. In addition, data were manipulated to test whether missing weight data points in the early neonatal period would lead to loss of sensitivity of the algorithm. RESULTS The WINROP algorithm had 73% sensitivity for detecting infants at risk of severe ROP when all infants were included and 87% when the complete weight data subgroup was analysed. Manipulation of data from the complete weight data subgroup demonstrated that one or two missing weight data points in the early postnatal period lead to loss of sensitivity performance by WINROP. IMPLICATIONS The WINROP program offers a non-invasive method of identifying infants at high risk of severe ROP and also identifying those not at risk. However, for WINROP to function optimally, it has to be used as recommended and designed, namely weekly body weight measurements are required.
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Affiliation(s)
- Chinthika Piyasena
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, , Edinburgh, UK
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Parvaresh MM, Ghasemi Falavarjani K, Modarres M, Nazari H, Saiepour N. Transscleral diode laser photocoagulation for type 1 prethreshold retinopathy of prematurity. J Ophthalmic Vis Res 2013; 8:298-302. [PMID: 24653815 PMCID: PMC3957034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 05/18/2013] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To report the outcomes of transscleral diode laser photocoagulation for treatment of type 1 prethreshold retinopathy of prematurity (ROP). METHODS In this prospective interventional case series, 139 eyes of 73 infants with type 1 prethreshold ROP underwent transscleral diode laser photocoagulation of the avascular retina under topical anesthesia without making a conjunctival incision. Supplemental transpupillary diode laser photocoagulation was used for zone 1 ROP in one eye. All patients were followed for 6 months. Main outcome measures were regression of ROP, incidence of unfavorable outcomes and adverse effects. RESULTS At the end of follow-up, neovascularization regressed completely in all eyes and no eye developed an unfavorable outcome. Repeated laser therapy was performed employing the same technique in 3 eyes (2.3%). Ocular adverse effects were minor including mild conjunctival injection and edema in all patients, small conjunctival lacerations in 12 eyes (8.7%), minor self-limited vitreous hemorrhage in 2 eyes (1.4%) and mild self-limited hyphema in one eye (0.7%). CONCLUSION Transscleral diode laser photocoagulation is a safe and effective treatment option for type 1 prethreshold ROP. This technique can be performed under topical anesthesia.
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Affiliation(s)
| | - Khalil Ghasemi Falavarjani
- Correspondence to: Khalil Ghasemi Falavarjani MD. Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niayesh Street, Tehran 14455, Iran; Tel: +98 912 172 5850, Fax:+98 21 6650 9162;
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Abstract
While current management of retinopathy of prematurity (ROP) is well evidenced, the recent Neonatal Oxygenation Prospective Meta-analysis (NeoPROM) oxygen therapy trials, and the Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity (BEAT-ROP) trial of intravitreal injection bevacizumab, have reopened debate on optimal management. Early postnatal manipulation of oxygen therapy, nutrition and serum IGF 1 levels may improve early retinal blood vessel development and prevent later severe ROP. While the use of intravitreal injections of antivascular endothelial growth factor (VEGF) agents may appear to be an attractive alternative to laser ablation of the peripheral retina, caution is needed. The optimal choice of agent and dose remain unknown, and suppression of serum VEGF levels might interfere with normal angiogenesis processes in developing tissues. There is a pressing need for good Phase 1 studies of these agents, and safety trials.
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Affiliation(s)
- Brian William Fleck
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, UK.
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Abrishami M, Maemori GA, Boskabadi H, Yaeghobi Z, Mafi-Nejad S, Abrishami M. Incidence and risk factors of retinopathy of prematurity in mashhad, northeast iran. Iran Red Crescent Med J 2013; 15:229-33. [PMID: 23984003 PMCID: PMC3745752 DOI: 10.5812/ircmj.4513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 07/16/2012] [Accepted: 01/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a vascular retinal disease that can cause low vision or blindness and affects premature newborns of very low birth weight. OBJECTIVES The purpose of this study was to determine the incidence and risk factors for ROP among very premature infants in Mashhad located northeast of Iran. MATERIAL AND METHODS In this cross-sectional study performed between 2006 and 2010, predisposing factors and severity of ROP were evaluated in very premature infants (<32 gestational weeks). Consecutive infants were enrolled at birth and screened for ROP at 4 to 6 weeks of age by indirect ophthalmoscopy. Severe ROP was defined as stage 4 or 5. Chi-square, Student's t-, and Fisher's test were used for statistical analysis. RESULTS The incidence of ROP was 26.2%. Significant differences between the ROP and control groups were observed, these include; gestational age, sex, birth weight, Apgar score, durationof parenteral nutrition, oxygen therapy, phototherapy, maximum PaO2 and minimum SpO2 (P < 0.05). Severe ROP was seen in 31.4% (11/32) of ROP cases (5.4% of newborns). CONCLUSION The incidence of ROP is relatively high in this region. Risk factors for ROP among very premature infants include hypoxia, severe hyperoxia, relatively low blood SPO2, gestational age, birth weight, and Apgar score.
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Affiliation(s)
- Majid Abrishami
- Eye Research Center, School of Medicine; Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Gholam-Ali Maemori
- Neonatal Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hassan Boskabadi
- Neonatal Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Zakiye Yaeghobi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Shahin Mafi-Nejad
- Department of Pediatrics, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mojtaba Abrishami
- Eye Research Center, School of Medicine; Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Mojtaba Abrishami, Eye Research Center, School of Medicine; Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-511433192, Fax: +98-511433192, E-mail:
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Abstract
Background: Retinopathy of prematurity (ROP) is a serious complication of prematurity treatment and can lead to blindness unless recognized and treated early. Objective: The objective was to estimate the prevalence of ROP in preterm infants in the Neonatal Intensive Care Unit (NICU), to identify the risk factors which predispose to ROP, and to assess the outcome of these cases. Materials and Methods: A ROP prospective screening survey was performed enrolling all prematures admitted to the NICU from January 2009 to December 2010, with a gestational age of 32 weeks or less at birth and a birth weight of 1500 g or less. Infants whose gestational age was >32 weeks or birth weight was >1500 g were included if they were exposed to oxygen therapy for more than 7 days. A total of 172 infants (84 males and 88 females) had retinal evaluation by indirect ophthalmoscopy from the fourth postnatal week and followed up periodically. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Infants who progressed to stage 3 ROP were given laser therapy. Results: Out of the studied 172 infants, 33 infants (19.2%) developed ROP in one or both eyes; 18 (54.5%) cases stage 1, 9 (27.3%) cases stage 2, and 6 (18.2%) cases stage 3. None of the studied neonates presented ROP at stages 4 or 5. The six cases diagnosed as ROP stage 3 underwent laser ablative therapy. Univariate analysis showed that there was a significant relationship between the occurrence of ROP and gestational age (P = 0.000), sepsis (P = 0.004), oxygen therapy (P = 0.018), and frequency of blood transfusions (P = 0.030). However, an insignificant relationship was found between the occurrence of ROP and sex, mode of delivery, birth weight, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, hypotension, phototherapy, duration of oxygen therapy, mechanical ventilation, and CPAP (all P > 0.05). Gestational age, sepsis, oxygen therapy, and frequency of blood transfusions remained significant variables after logistic regression analysis. Conclusion: The prevalence of ROP in this study was 19.2%; low gestational age, sepsis, oxygen therapy, and frequent blood transfusions were significant risk factors for ROP. Laser was effective in treatment and decreasing the progression of ROP. As this is a unit-based study, a comprehensive countrywide survey on ROP in Egypt is recommended to determine any regional differences in disease prevalence.
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Affiliation(s)
- Abdel H A A Hakeem
- Department of Pediatrics, Faculty of Medicine, Al Minia University, Egypt
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Abstract
Purpose: The purpose of this study is to report the screening data for retinopathy of prematurity (ROP) at a screening center in Southern Iran. Materials and Methods: A chart review was performed of all screened neonates who were referred to Poostchi screening center affiliated to Shiraz University of Medical Sciences from February 2006 to January 2010. Statistical analysis of data was performed with the Chi-square and independent t-test where appropriate. A P < 0.05 was considered statistically significant. Results: Of 787 infants referred, 293 (37.2%) had some form of ROP and 77 cases (9.8%) had plus disease, only 6 (2%) patients progressed to advanced ROP stages 4 and 5. The mean gestational age (GA) of patients with ROP (ROP group) was statistically significantly lower at 29.46 ± 2.31 weeks compared to patients without ROP (non-ROP group) (31.56 ± 2.03 weeks) (P < 0.05). The mean GA of patients with plus disease was statistically significantly lower at 28.92 ± 2.18 weeks compared to patients without plus disease (30.98 ± 2.30 weeks) (P < 0.05). The mean birth weight in the ROP group was statistically significantly lower at 1248.46 ± 301.75 g compared to the non-ROP group (1485.79 ± 268.66 g) (P < 0.05). The mean birth weight of patients with plus disease was statistically significantly lower at 1207.92 ± 334.79 g compared to patients without plus disease (417.99 ± 293.19 g) (P < 0.05). There was no difference in the occurrence of ROP or plus disease between single or multiple births, normal vaginal delivery, and caesarian section and between clomiphene users and nonusers (P > 0.05, all cases). Conclusion: Greater cooperation between ophthalmologists, neonatologists, gynecologists, and health policy makers is necessary to optimize ROP screening programs. Data from this study can be used by health policy makers for implementation of health programs. These programs must include screening guidelines and effective coordination among the screening centers, antenatal, obstetric, and neonatal care services.
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Affiliation(s)
- Mehrdad Afarid
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
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Kong M, Shin DH, Kim SJ, Ham DI, Kang SW, Chang YS, Park WS. Retinopathy of prematurity in infants born before 25 weeks gestation in a Korean single neonatal intensive care unit: incidence, natural history and risk factors. J Korean Med Sci 2012; 27:1556-62. [PMID: 23255858 PMCID: PMC3524438 DOI: 10.3346/jkms.2012.27.12.1556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/11/2012] [Indexed: 11/23/2022] Open
Abstract
As younger preterm infants are able to survive, more extremely preterm infants are at risk of developing retinopathy of prematurity (ROP). To investigate the incidence, progression and risk factors of ROP in extremely preterm infants in Korea, the medical records of infants born before 25 weeks gestation were retrospectively reviewed. The criteria for laser treatment agreed with type 1 ROP as defined by the Early Treatment for Retinopathy of Prematurity study. Of the 121 infants included in the analysis, 119 (98.4%) infants developed any stage ROP, including 78 infants (64.5%) with type 1 ROP. The mean postmenstrual age (PMA) at the onset of any ROP and type 1 ROP were 33.5 and 36.1 weeks, respectively. All but one infant developed type 1 ROP after 31 weeks PMA. Univariate analysis showed that duration of total parenteral nutrition and onset of any ROP (PMA) were associated with the development of type 1 ROP. In conclusion, this study shows high incidence of ROP in extremely preterm infants and suggests that, although current screening protocols are feasible for most preterm infants born before 25 weeks gestation, earlier screening before 31 weeks PMA may be necessary in infants with an unstable clinical course.
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Affiliation(s)
- Mingui Kong
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hoon Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Don Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bejeh Mir KP, Mohagheghi P, Bejeh Mir AP, Fereshtehnejad SM. New Predictors for Advanced Retinopathy of Prematurity among Neonates in Tehran/Iran. Iran J Pediatr 2012; 22:375-84. [PMID: 23400326 PMCID: PMC3564095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 07/28/2011] [Accepted: 09/25/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Since a new epidemic (third wave) of retinopathy of prematurity (ROP) sensed throughout the world in recent years, we aimed to assess newer risk factors for advanced ROP which needs treatment in Iranian neonates as a new target output of various neonatal care for this serious disease of newborn infants especially those born prematurely. METHODS In an analytic cross-sectional study all neonates <1500 g birth weight and/or <32 weeks gestational age admitted to our NICU as a tertiary level intensive care unit in Milad Hospital, Tehran, Iran during June 2006-June 2007 were included. All data were extracted from medical records and compared in two groups with or without treatment. FINDINGS Seventy one neonate infants entered our study. Twelve neonates (16.9%) progressed to advanced ROP. Final multivariate analysis model revealed that mean leukocyte counts during first 14 days of life (P=0.04), transfusions number (P=0.01) and hypocapnic episodes during first 14 days of life (P=0.02) were significantly different between the two groups of infants independently, even after simultaneous adjustment. CONCLUSION Based on our findings, more amenable risk factors should be approached regarding more careful modulation of such overlooked risk factors which may lessen the burden of prematurity.
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Affiliation(s)
| | - Parisa Mohagheghi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Poorsattar Bejeh Mir
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran,Student Research Committee, Babol University of Medical Sciences, Babol, Iran,Corresponding Author:Address: Research Committee, Babol University of Medical Sciences, Ganj Afrooz Ave, Babol, Iran. E-mail:
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Gharaibeh A, Khassawneh M, Khriesat W, Alkhatib S, Migdadi Y. Adopting Western Retinopathy of Prematurity Screening Programs in Eastern Countries, are we Screening Properly? Middle East Afr J Ophthalmol 2011; 18:209-13. [PMID: 21887075 PMCID: PMC3162732 DOI: 10.4103/0974-9233.84047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To describe retinopathy of prematurity (ROP) among Jordanian preterm infants and evaluate the efficacy of applying current Western screening guidelines for Jordanian preterms. MATERIALS AND METHODS In this retrospective, descriptive hospital-based study, we collected data on preterm infants who were referred by their neonatologist for ROP screening at King Abdullah University Hospital between July 2006 and June 2007. Guidelines suggested by the American Academy of Pediatrics were followed. Additionally, older preterms considered at risk for ROP by the neonatal intensive care unit were screened. Any neonate with stage 1 ROP or higher in either eye was considered a positive case of ROP. RESULTS Ninety-one preterms were included in the study. The median birth weight was 1390 gm (range,730-1980 gms) and the gestational age ranged from 26 to 35 weeks with 64.8% of preterms ≤ 32 weeks. ROP occurred in 28.6% of all patients, in 20% of infants with birth weight greater than 1500 gms and in 9.4% of preterms with gestational age ≥ 32 weeks. Six patients (6.6%) required laser treatment, two with low birth weight greater than 1250 gm and one was 33 weeks of age. Consanguinity was identified in 19.2% of infants with ROP while consanguinity in infants who did not develop ROP was 1.9%. This difference was statistically significant (P<0.05). CONCLUSION ROP occurs in premature infants in Jordan with gestational age above 32 weeks and birth weight above 1250 gm. Future guidelines for screening should incorporate the current study outcomes. A prospective, population-based is required to set national guidelines for ROP screening in the Jordanian population and similarly for different populations worldwide. Consanguinity may play a role in ROP development and further genetic studies may aid in elucidating the pathogenesis of ROP.
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Affiliation(s)
- Almutez Gharaibeh
- Department of Special Surgery-Division of Ophthalmology, The University of Jordan, Amman, Jordan
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Chalam KV, Lin S, Murthy RK, Brar VS, Gupta SK, Radhakrishnan R. Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion. Middle East Afr J Ophthalmol 2011; 18:214-9. [PMID: 21887076 PMCID: PMC3162733 DOI: 10.4103/0974-9233.84048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose was to determine if birth weight (BW) alone can be the sole criterion for screening infants at risk for retinopathy of prematurity (ROP). MATERIALS AND METHODS In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Guidelines (1997). Variables examined included gestational age (GA), birth weight (BW), and a composite variable BWGA Index [(grams × weeks)/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW ≤1250 g, and Group 2, BW >1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic (ROC) curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. RESULTS Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve (AUC) of 0.797 (standard error [SE] = 0.0329, P < 0.0001); for GA, AUC was 0.801 (SE = 0.0340, P < 0.0001) and for the BWGA Index, the AUC was 0.808 (SE = 0.0324, P < 0.0001). Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. CONCLUSION Data from our neonatal intensive care unit suggest that birth weight ≤ 1250 g alone is an adequate parameter to identify premature infants at risk for ROP.
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Affiliation(s)
- Kakarla V Chalam
- Department of Ophthalmology, University of Florida School of Medicine, Jacksonville, FL, USA
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Abstract
Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. Severe visual impairment (SVI) and blindness in infants must be detected as early as possible to initiate immediate treatment to prevent deep amblyopia. Although difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos, microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy of prematurity, and cortical visual impairment are acquired during the perinatal period. Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts should occur within the first 4 months of life. Anterior vitrectomy and primary posterior capsulotomy are required, followed by aphakic glasses with secondary intraocular lens implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature in response to relative hypoxia in a premature infant. Screening in the first few weeks of life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however, enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants, nurses, and ophthalmologists should be sensitive to a parent’s complaints of poor vision in an infant and ensure adequate follow-up to determine the cause. If required, evaluation under anesthesia should be performed, which includes funduscopy, refraction, corneal diameter measurement, and measurement of intraocular pressure.
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Ahmed AE, Channa R, Durrani J, Ali A, Ahmad K. Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity. Middle East Afr J Ophthalmol 2011; 17:264-7. [PMID: 20844684 PMCID: PMC2934720 DOI: 10.4103/0974-9233.65500] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity (ROP) at a single institution over a 13-month-period. METHODS A retrospective case series of eight children with ROP who received intravitreal bevacizumab combined with laser treatment between June 2007 and July 2008 were reported. A chart review was conducted to evaluate if stability of the ROP lesion had been achieved. Main information collected included data on demographics, gestational age, birth weight, length of stay in neonatal intensive care unit, and stage of ROP. RESULTS Fifteen eyes of eight subjects were treated. One eye did not receive any treatment due to complete retinal detachment. The median age at treatment was 8 weeks (range, 6 weeks to 1 year). The most common stage of ROP was 3+. All eyes remained stable at 1 year or later after treatment. CONCLUSION Intravitreal bevacizumab in conjunction with laser treatment had promising results at our institution. We recommend prospective, randomized, controlled clinical trials to compare the effect of laser treatment alone, of bevacizumab treatment alone (at different doses), and of combined bevacizumab and laser treatment.
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Affiliation(s)
- Ayesha E Ahmed
- Department of Ophthalmology, Aga Khan University Medical College, Karachi, Pakistan
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Mousavi SZ, Karkhaneh R, Riazi-Esfahani M, Mansouri MR, Roohipoor R, Ghalichi L, Kadivar M, Nili-Ahmadabadi M, Naieri F. Retinopathy of prematurity in infants with late retinal examination. J Ophthalmic Vis Res 2009; 4:24-8. [PMID: 23056670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Accepted: 10/03/2008] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To report the incidence, severity and risk factors of retinopathy of prematurity (ROP) in premature infants with late ROP examination in Farabi Eye Hospital. METHODS In a retrospective study from January 2001 to July 2007, hospital records of premature infants who were examined later than 9 weeks after birth were reviewed to determine the incidence, severity and possible risk factors of ROP including gender, singleton or multiple gestations, gestational age (GA), birth weight (BW), oxygen therapy,blood transfusion, phototherapy, respiratory distress syndrome (RDS), mechanical ventilation,intraventricular hemorrhage and sepsis as well as age at initial examination. RESULTS Out of a total of 797 infants referred for ROP screening during the study period,216 (27.1%) had late examinations at a mean age of 141.7± 150.4 (range 64-1,460) days. Of these, 87 (40.3%) had different stages of ROP, 65 (30.1%) had stage 4 or 5 disease including 34 (16.2%) infants with stage 5 ROP in both eyes which was untreatable. Lower GA (P<0.001), RDS (P=0.041) and blood transfusion (P=0.009) were associated with the development of ROP. CONCLUSION The overall prevalence of ROP and the incidence of severe ROP in particular,were unacceptably high in premature infants with late screening. These findings necessitate interventions to optimize timely referral for screening of premature infants.
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