Neonatal Intensive Care Unit-based screening program for retinopathy of prematurity and its treatment in an Indian population

Purpose: The purpose was to study the incidence, risk factors, and anatomical outcomes after laser treatment in retinopathy of prematurity (ROP). Methods: A retrospective observational study was carried out. Infants admitted to Neonatal Intensive Care Unit of 12 referral hospitals between April 2016 and September 2017 were screened according to the latest Indian guidelines based on the International Classification of Retinopathy of Prematurity. Results: The incidence of ROP in 1648 eyes screened was 25.36% (418 eyes), out of which high-risk prethreshold ROP (type 1) was observed in 9.95% (164 eyes). Decreased hemoglobin (P < 0.001), oxygen requirement (P = 0.008), and number of blood transfusions (P = 0.037) were significant with type 1 than type 2 (low-risk prethreshold) ROP. Stages 1, 2, and 3 were observed in 82 (32.28%), 154 (60.62%), and 18 (7.08%) eyes, respectively. Aggressive posterior ROP (APROP) was observed in 20.73% eyes with type 1 ROP. Ten eyes showing APROP were treated at an early gestational age of 29 weeks. All infants with type 1 ROP were treated with laser photocoagulation only. Conclusion: One-fourth of the infants showed ROP and one-tenth needed laser photocoagulation, the outcome of which was excellent. Risk factors predisposing to ROP were anemia, high oxygen supplementation, increased number of blood transfusions, and septicemia. ROP screening in infants ?1700 g birth weight associated with various systemic risk factors may be beneficial in the Indian population.

Clinical report of intravitreal Bevacizumab for 26 cases with retinopathy of prematurity in Zone Ⅰ / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical effects of intravitreal Bevacizumab for 26 cases with retinopathy of prematurity (ROP) in Zone Ⅰ. METHODS:A retrospective study. Totally 26 ROP infants between September 2013 and October 2014 diagnosed as high - risk ROP in Zone Ⅰ had been treated with intravitreal bevacizumab. They were divided into three groups, pre - threshold ROP, threshold ROP and acute posterior ROP ( APROP ). Postoperative effects were compared. RESULTS:There were 26 infants (52 eyes) diagnosed as ROP in Zone Ⅰ, including 3 infants( 6 eyes) with pre -threshold ROP, 15 infants (30 eyes) with threshold ROP and 8 infants (16 eyes) with APROP. The first operation recovery rate of three groups respectively were 100% (6 /6), 60% ( 18 / 30 ) and 75% ( 12 / 16 ), which were not significantly different (P>0. 05). CONCLUSION:Intravitreal bevacizumab for ROP in ZoneⅠ seems effective and has some advantages over conventional laser treatment, which could be first line treatment for high-risk ROP in Zone Ⅰ.

Structural sequelae and refractive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes.

Aim: The aim was to study the structural sequelae and refractive outcome after laser treatment for Type 1 prethreshold retinopathy of prematurity (ROP) in Asian Indian eyes. Materials and Methods: A retrospective chart review of infants with Type 1 prethreshold ROP (defined according to the Early Treatment for Retinopathy of Prematurity study) undergoing laser treatment at a tertiary center between January 2004 and December 2008 was done. The 1-year outcome of infants was analyzed. Results: Sixty-nine eyes of 36 infants were included. The mean birth weight was 1121.69 ± 254.81 g and the gestational age was 28.99 ± 2.03 weeks. Sixty-five eyes (94.2%) had zone 2 and 4 (5.8%) had zone 1 disease. Forty-four (63.77%) eyes had stage 2 ROP with plus disease and 25 (36.23%) eyes had prethreshold (fewer than five contiguous or eight cumulative clock hours) stage 3 ROP with plus disease. None of the eyes developed retinal structural sequelae. On cycloplegic retinoscopy, 59.4% eyes had nonsignificant hyperopia [spherical equivalent (SE) ≤ 4 D], 14.5% eyes had no refractive error (SE 0 D), 24.7% eyes had low myopia (SE < 5 D), and 1.4% eyes had high myopia (SE > 5.0 D). Eyes developing myopia were associated with a greater number of clock hours of ROP, greater number of laser spots used, and a longer time to disease regression. Two infants (5.6%) had esotropia and one (2.8%) had exotropia. Conclusion: Asian Indian infants treated for Type 1 prethreshold ROP did not develop retinal structural sequelae. Myopia was seen in nearly one-fourth of the eyes.The risk factors for myopia were a greater number of clock hours of ROP, greater number of laser spots, and a longer time to regression of ROP.

Outcome of Diode Laser Photocoagulation for Threshold and Prethreshold Retinopathy of Prematurity

PURPOSE: To compare outcomes after diode laser photocoagulation between threshold and prethreshold retinopathy of prematurity (ROP). METHODS: The outcomes of 133 eyes of 80 infants who received laser treatment with diode laser were retrospectively evaluated. ROP stage was noted upon treatment. Of the eyes studied, 39 were classified as threshold and 94 were prethreshold, and these were further divided into type 1 (72 eyes) and type 2 (22 eyes). Outcomes among the groups were examined, as well as the effects of mean birth weight, gestational age, postconceptional age (PCA) at diagnosis, PCA at treatment, and the interval between diagnosis and treatment RESULTS: Three threshold eyes (7.7%) and 5 prethreshold eyes (5.3%) progressed to unfavorable outcomes. All 5 eyes with prethreshold disease were type 1. Mean birth weight and gestational age were not associated with prognosis. Unfavorable outcomes were related to lower PCA at diagnosis (p=0.022), lower PCA at treatment (p=0.008), and longer intervals between diagnosis and intervention (p=0.015), whereas neither birth weight nor gestational age significantly influenced outcomes. CONCLUSIONS: Unfavorable outcomes occurred in threshold and type 1 prethreshold ROP. Earlier treatment appeared to decrease the incidence of unfavorable outcomes.

Screening Guidelines for Retinopathy of Prematurity in Extremely Low Birth Weight Infants

PURPOSE: The ophthalmologic screening examination in extremely low birth weight (ELBW) infants shoud be done at a postconceptional age (PCA) of 31 to 33 weeks or the chronological age (CA) of 4 to 6 weeks. If the first ophthalmologic examination in ELBW infants is perfomed at 31 to 33 weeks PCA, there is a risk of threshold retinopathy of prematurity (ROP) having already developed on the first examination. The risk of a visual loss is high if threshold ROP has already developed before the initial screening examination of ROP. Therefore, we investigated the ideal timing of the initial ophthalmologic screening examination based on PCA and CA in ELBW infants. SUBJECTS: The medical records of 38 ELBW infants (<1000 g at birth) admitted to neonatal intensive care unit of Severance hospital between January 1991 and December 2000, whose follow-up ophthalmologic examinations were available, were reviewed retrospectively. We investigated the PCA and CA at the diagnosis of prethreshold ROP and threshold ROP. RESULTS: Sixty-five percent of subjects was diagnosed with prethreshold ROP and 64% of the infants progressed to threshold ROP. The median time of progression from prethreshold ROP to threshold ROP was 14 days (2-33). Twenty-four percent was diagnosed with prethreshold ROP on the first eye examination. Prethreshold ROP was diagnosed as early as 33 weeks PCA and threshold ROP was diagnosed as early as 35 weeks PCA. Prethreshold ROP was diagnosed as early as 4 weeks CA and threshold ROP was diagnosed as early as 6 weeks CA. CONCLUSION: We suggest that the initial screening examination for ROP should be performed by CA or PCA in ELBW infants, whichever is earlier, to detect prethreshold ROP before its progression to threshold ROP.

Treatment of Acute Retinopathy of Prematurity with Argon Indirect Laser Ophthalmoscope 2nd Report

PURPOSE: It is to report the efficacy and safety of an argon laser photocoagulation which was the treatment modality for retinopathy of prematurity. METHODS: From March 1996 to December 1999, on 69 prethreshold retinopathy of prematurity, they were series of observations following periods of two to five days, one week, two weeks, four weeks, three months and one year time respectively. RESULTS: We noticed the regressions in 84 prethreshold retinopathy of prematurity cases as well. CONCLUSIONS: The report emphasized the advantages of the argon laser photocoagulation which reduce the risk from a general anesthesia by applying a topical anesthesia, and the safety of using laser technique of convenience to apply and minimize the tissue damages of the lesions. It also described the preferable consequent results following the early treatment with divided applications on the prethreshold cases.