ABSTRACT
The aim of this study was to compare the cardiac effects and aortic arterial indices followingintravitreal aflibercept treatment or diode laser photocoagulation for the treatment of retinopathy of prematurity (ROP) in infants.Methods:This single-centre, retrospective study was conducted in infants who were administered laser photocoagulation (LPC) or intravitreal aflibercept (IVA) treatment as initialtreatment and had completed at least one year of corrected age. The patients were evaluated in terms of aortic elastic parameters, right and left ventricular systolic and diastolic function using conventional, pulsed Doppler and tissue Doppler imaging (TDI) echocardiographic parameters.Results:Fifteen infants were in the LPC group, 16 in the IVA group, and 20 in the control group. Although there were some statistically significant differences in terms of pulsed and TDI echocardiographic parameters between the treatmentand control groups, these values could not clearly be adoptedas a diastolic dysfunction and myocardial performance indices were not influenced. The aortic elastic parameters were impaired in both LPC and IVA groups compared to the control group. Consequently, we observed only minor differences between the treatment groups, which may suggest subtle changes due to the anti-angiogenictreatment.Conclusion:Although favourable and promising outcomes were obtained with intravitreal injection of anti-vascular endothelial growth factor agents for the treatment of ROP,concerns have been raised about potential systemic side effects, including potential cardiovascular side effects caused by these agents. The small reduction in right ventricular Doppler velocities could probably be explained by the us of anti-angiogenic or laser treatment in infants
Subject(s)
Echocardiography , Retinopathy of Prematurity , Vascular StiffnessABSTRACT
Introduction. Les auteurs ont examiné les prématurés au Complexe Pédiatrique de Bangui, dans le but d'évaluer les facteurs de risque de survenue de la rétinopathie du prématuré et les modalités de dépistage de cette maladie en Centrafrique. Patients et méthodes. Il s'agit d'une étude transversale prospective analytique de Janvier 2012 à Décembre 2014 à la Clinique Pédiatrique de Bangui. Tous les prématurés nés avant 32 semaines de gestation ou ayant un poids de naissance inférieur à 1500 grammes ont bénéficié d'un examen du fond d'Åil à 5 semaines de vie. Le matériel utilisé était composé d'un ophtalmoscope binoculaire indirect Neitz, assorti d'une source d'alimentation électrique portative Zeiss/Opton, de deux lentilles d'examen 20 et 28 dioptries, d'un mydriatique (tropicamide®) et d'un anesthésique de contact. Les lésions observées ont été réparties selon la classification de Calgary. Résultats. 88 prématurés dont 39 garçons (44,3%) et 49 filles (55,7%) ont été étudiés. Leur âge gestationnel moyen était de 29,2 ±2,8 semaines et le poids de naissance moyen de 1205 ± 255 grammes. L'examen a été satisfaisant dans tous les cas. Le diagnostic de rétinopathie a été posé chez 29 (32,95%) prématurés, dont 12 garçons (41,4%) et 17 filles (58,6%), avec une atteinte bilatérale chez tous. 28 enfants sur 31 (90.3%) avaient des lésions minimes ou modérées et toutes ont régressé spontanément sans laisser de séquelle. Dix décès ont été enregistrés durant le suivi. Conclusion. L'ophtalmoscope binoculaire indirect est l'outil de choix pour le dépistage de la rétinopathie des prématurés et le tropicamide peut être utilisé sans effets indésirables pour obtenir une mydriase adéquate. Le poids de naissance et l'âge gestationnel sont deux facteurs de risque à considérer. Le risque semble être le même que l'enfant soit sous oxygène ou non
Subject(s)
Central African Republic , Fundus Oculi , Infant, Newborn , Ophthalmoscopy , Pediatrics , Retinopathy of PrematurityABSTRACT
Background. Retinopathy of prematurity (ROP) is a vasoproliferative disease affecting premature babies and a major cause of blindness in childhood. Appropriate screening and treatment can prevent blindness.Objective. To report on the efficacy of using antivascular endothelial growth factor (bevacizumab) as first-line therapy in ROP.Methods. This was a retrospective analysis of patients with ROP treated at St John Eye Hospital, Johannesburg, South Africa, over a 3-year period. Outcome measures were the clinical response to intravitreal bevacizumab (IVB) as well as the economic impact of IVB therapy.Results. Twenty-three patients were treated for active ROP or type 1 disease, in 44 eyes. Two patients required treatment in one eye only. The mean birth weight of these patients was 1 074 g (range 810 - 1 480). Response to treatment outcome was available for 22 patients (43 eyes). The mean follow-up period was 9 months (range 1 - 18). Forty-one eyes (95.3%) showed complete regression or non-progression of the disease. Two eyes (one eye each in two patients) progressed to advanced disease. There were no short-term adverse events. A cost-effective model showed that IVB treatment was much more economical than laser therapy.Conclusion. IVB is a safe and effective first-line treatment for ROP and should be considered in resource-limited centres
Subject(s)
Bevacizumab , Intravitreal Injections , Retinopathy of Prematurity/therapy , South AfricaABSTRACT
Background. Retinopathy of prematurity (ROP) is a leading cause of blindness for very-low-birth-weight (VLBW; 1 500 g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment.Objectives. To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines; the grades of ROP found and the treatment modality received. Methods. This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH; whether inborn or transferred in. The babies were divided into two groups based on age at final outcome. Final outcome was defined as death; discharge or transfer out of the unit. The 'early' outcome group had their final outcome before day 28 of life. The 'late' outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening.Results. There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1 127 (standard deviation (SD) 244.75) g and gestational age of 29 (2.743) weeks. The mean duration of stay was 29 (21.66) days and there were 309 female babies. Of these 572 babies; 304 comprised the early outcome group and 268 comprised the late outcome group. In the early outcome group babies who were transferred out of the unit or died were excluded; therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included five babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal antivascular endothelial growth factor (VEGF) and three babies required surgery. Conclusions. More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one-third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented; therefore prevalence cannot be established
Subject(s)
Diabetic Retinopathy , Mass Screening , Retinopathy of Prematurity , Tertiary Care CentersABSTRACT
Background. Retinopathy of prematurity (ROP) is an emerging public health problem in many middle-income countries where improved neonatal survival rates coupled with inadequate health resources have created a new epidemic. There are limited available data on the magnitude of the problem; and screening in South African (SA) hospitals has not been uniformly practised.OBJECTIVE:To describe the results of various interventions implemented over a 6-year period while developing a new ROP screening service in a provincial hospital in Port Elizabeth; SA.METHOD: A retrospective case folder review of ROP screening at Dora Nginza Hospital; Port Elizabeth; SA; over the 6-year period 2009 - 2014 was conducted.RESULTS:A total of 919 new cases were seen. Fifteen patients received treatment for type 1 ROP (T1ROP); 223 had type 2 (T2) or earlier ROP; 1 had stage 4 ROP and 6 had stage 5 ROP. The combination of healthcare worker education; improved equipment and human resources and the introduction of dual responsibility for case referrals resulted in an increase in the number of new infants screened from 33 in year 1 to 292 in year 6. The number of infants who were screened late decreased from 33/33 (100%) in year 1; prior to the interventions; to 23/292 in the final year (7.9%). Improved oxygen delivery and adequate oxygen saturation monitoring contributed to a decrease in the incidence of T1ROP from 1.5% to 1% over 1 year and in the incidence of T2 or earlier ROP from 30.3% to 24%.CONCLUSIONS:Better management of ROP can be achieved through adequate provision of healthcare professionals and material resources coupled with education and a well-supported referral system. A close working relationship between paediatricians and ophthalmologists results in a more efficient screening programme