Ocular sequelae of retinopathy of prematurity in Manaus, Amazonas / Sequelas oculares estruturais da retinopatia da prematuridade em crianças em Manaus, Amazonas

Abstract Purpose: To evaluate the structural ocular sequelae of retinopathy of prematurity in children at risk for the disease in Manaus, Amazonas, Brazil. Methods: A prospective, cohort-type, observational study was conducted. Fifty-seven children at risk for this retinopathy, who were born in the public health system facilities, were referred for ophthalmic evaluation at a secondary eye hospital. Inclusion criteria were gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g. Results: Eighteen (31.6%) children were diagnosed with any stage of retinopathy of prematurity during the study period, and four (7.0%) of them needed treatment. Structural ocular sequelae were identified in 3 of 56 children (5.3%), consisting of peripheral retinal detachment with macular dragging in 3 eyes of 3 children and macular involving retinal detachment in 2 eyes of 2 children. Associations between occurrence of retinopathy of prematurity and birth weight, gestational age at birth and days in oxygen were observed (p<0.05). Indication of treatment was associated with birth weight (p<0.05). Conclusion: Retinopathy of prematurity stands out as an important cause of avoidable blindness in Amazonas, affected 31.6 % of children at risk in the present paper, which in this same context, led to ocular strucutral sequelae in about 5.3% of these infants, either peripheral or macular involving retinal detachment. A local program for screening and treatment of the population at risk is necessary in order to avoid blindness from this disease, providing care to the public health system users that contemplates equality and universality of access.

Resumo Objetivo: Avaliar as sequelas oculares estruturais da retinopatia da prematuridade em crianças com risco para a doença em Manaus, Amazonas, Brasil. Métodos: Foi conduzido um estudo observacional prospectivo, do tipo coorte. Cinquenta e sete crianças que nasceram em um hospital público, com risco desta retinopatia, foram referênciadas para avaliação oftamológica em um hospital de olhos secundário. Critérios de inclusão foram idade gestacional ≤ 32 semanas e/ou peso ao nascer ≤ 1500 g. Resultados: Dezoito (31.6%) crianças foram diagnosticadas com retinopatia da prematuridade em qualquer estágio durante o período de estudo, quatro (7.0%) delas precisaram de tratamento. Sequelas oculares estruturais foram identificadas em 3 de 56 (5.3%) crianças, consistindo de descolamento de retina periférico com tração macular em 3 olhos de 3 crianças e descolamento de retina envolvendo a mácula em 2 olhos de 2 crianças. Associações entre a ocorrência de retinopatia da prematuridade e peso, idade gestacional e dias em oxigênio foram observadas (p<0.05). Indicação de tratamento foi associada com peso ao nascer (p<0.05). Conclusão: A retinopatia da prematuridade constitui uma importante causa de cegueira prevenível no Amazonas, acometeu 31.6% das crianças em risco no presente estudo, que neste mesmo contexto, levou a seqüelas estruturais oculares em cerca de 5.3% destas, tanto descolamento de retina periférico quanto envolvendo a mácula. Um programa local de triagem e tratamento da população de risco é necessário a fim de evitar a cegueira por esta comorbidade em Manaus, proporcionando cuidados aos usuários do sistema público de saúde que contemplem a igualdade e universalidade de acesso.

Referentes teóricos sobre la retinopatía de la prematuridad y sus criterios de pesquisa / Theoretical framework on retinopathy of prematurity and research criteria

Fundamento: La retinopatía de la prematuridad es una microangiopatía vasoproliferativa que se desencadena en los niños pretérminos y con factores de riesgo para su desarrollo. Puede avanzar, de no ser detectada y tratada, hacia la discapacidad visual e incluso la ceguera, de ahí la importancia de su pesquisaje. Se realizó una revisión sistemática sobre este tema relativamente joven en la oftalmología, en la base de datos Medline, que involucrara la última década, por ser esta la etapa en que Cuba ha desarrollado el trabajo de pesquisaje y tratamiento de la enfermedad. Objetivo: Actualizar los conocimientos acerca de la retinopatía de la prematuridad y sus criterios de pesquisa. Desarrollo: En el mundo se han realizado estudios multicéntricos para su mejor comprensión y manejo; y se han unificado criterios para su clasificación, siendo los principales factores de riesgo a los que se asocia la baja edad gestacional al nacimiento, el bajo peso extremo, el empleo de ventilación y oxígeno, entre otros. Existen varios tratamientos para evitar la ceguera por retinopatía de la prematuridad, siendo el láser el más utilizado actualmente, combinándose en muchos casos con terapéuticas novedosas como la vitrectomía y los antiangiogénicos. En cuanto a los criterios de pesquisa no existe uniformidad en el mundo, pero Cuba cuenta con un Protocolo Nacional para su manejo, que garantiza su diagnóstico oportuno y un tratamiento inmediato. Conclusiones: La retinopatía de la prematuridad es una enfermedad oftalmológica que constituye prioridad en Cuba, existiendo en el país un protocolo nacional para su manejo y así evitar el daño visual que puede ocasionar.

Background: The retinopathy of the prematurity is a vasoproliferative microangiopathy that is unchained in preterm children and with factors of risk for its development. It can advance, of not being detected and treated, toward the visual handicap and even the blindness, of there the importance of their inquire criteria. It was carried out a systematic revision on this relatively young topic in ophthalmology, in the database Medline that involved the last decade, to be this the stage in that Cuba has developed the inquire criteria work and treatment of the illness. Objective: To upgrade the knowledge about the retinopathy of the prematurity and its investigation approaches. Development: In the world there have been carried out multicentre studies for its best understanding and handling; and it have become unified approaches for its classification, being the main factors of risk to those that associates the low gestational age at birth, the extreme low weight, the ventilation and oxygen employment, among others. Several treatments exist to avoid the blindness for retinopathy of the prematurity, being the laser the more used at the moment, combining in many cases with therapeutic novel as the vitrectomy and the angiogenic. As for the investigation approaches uniformity doesn't exist in the world, but Cuba has a National Protocol for its handling that guarantees its opportune diagnosis and an immediate treatment. Conclusions: The retinopathy of the prematurity is an ophthalmologic illness that constitutes priority in Cuba, existing in the country a national protocol for its handling and this way to avoid the visual damage that can cause.

Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.

Riesgo de Retinopatías relacionado con la oxigenoterapia en neonatos menores de 36 semanas de gestación en el Hospital Materno Infantil Germán Urquidi, gestión 2011 / Retinopathy risk related to oxygen in infants under 36 weeks gestation at Hospital Maternal and Child Germain Urquidi, management 2011

La retinopatía del prematuro provoca una lesión en los vasos retinianos originada por la inmadurez de la retina al nacer, asociada principalmente con la oxigenoterapia. El presente trabajo investigó el riesgo de Retinopatía del Prematuro relacionado con la oxigenoterapia en menores de 36 semanas de gestación en el área de Neonatología Intensiva del Hospital Materno Infantil Germán Urquidi de Cochabamba, bajo una metodología cuantitativa, descriptiva transversal y utilizando una guía de observación y de recolección de datos de las historias clínicas, hojas de registro de enfermería correspondientes a los meses de mayo a julio, gestión 2011. Las siguientes conclusiones son las más importantes, ya que incrementan el riesgo de retinopatía del prematuro: la administración de la oxigenoterapia por más de 96 horas fue más frecuente entre recién nacidos que recibían AVM, predomina la patología respiratoria entre los recién nacidos que recibieron oxigenoterapia, el 83.8% de los recién nacidos menores de 36 semanas de gestación presentan parámetros elevados de saturación de oxígeno, todos los menores de 1.500 gramos registran saturaciones no permitidas por encima de 93%. Por lo tanto, se recomienda al equipo de salud tomar en cuenta las recomendaciones sobre los cuidados y el manejo de la oxigenoterapia, con miras a prevenir la Retinopatía del Prematuro y sus complicaciones y contribuir a reducir la incidencia de ceguera infantil

Retinoblastoma in patients with regressed retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a well-known clinical entity in premature babies. We report two patients (1 and 2) with regressed ROP who later presented with retinoblastoma (RB). To the best of our knowledge, there is only one such report in the literature so far. Two unrelated patients 1 and 2, born at 32 weeks gestation were screened for ROP at 34 weeks gestation. This showed Zone II Stage II ROP which regressed by 38 weeks of gestation on follow-up. Both patients were lost to follow-up by 40 weeks of gestation. They presented at four years of age with white reflex in the eye. Patient 1 was found to have unilateral and patient 2 bilateral RB. The occurrence of RB in these patients with regressed ROP is probably coincidental.

Tratamiento con láser por retinopatía del prematuro en 27 servicios públicos argentinos / Laser treatment for retinopathy of prematurity in 27 public services of Argentina

La retinopatía del prematuropuede conducir a pérdida parcial de la visión y ceguera; la fotocoagulación con láser es el tratamiento electivo, aunque aún no está garantizado el acceso universal a él en la Argentina.Objetivo. Estimar la prevalencia de niños que requirieron tratamiento con láser por retinopatía,sus características clínico-demográficas, lugar de procedencia y tratamiento.Población, material y método. Estudio observacional, descriptivo, retrospectivo. Población: recién nacidos prematuros que requirieron tratamiento en servicios públicos durante 2008.Variables: peso y edad gestacional al nacer, pronóstico, casos inusuales y oportunidades perdidas.Fuente: 27 Servicios públicos de 18/24provincias.

Epidemiología de la retinopatía del prematuro en servicios públicos de la Argentina durante 2008 / Epidemiology of retinopathy of prematurity in publics services from Argentina during 2008

El aumento de la supervicencia en prematuros y las deficiencias en su atención incrementan los casos de retinopatía del prematuro (ROP) la ROP afecta a pacientes con mayor peso (PN) y edad gestacional (EG) al nacer que en países desarrollados; se observan casos inusuales y oportunidades perdidas. Objetivo. Describir la epidemiología de la ROP 2008 y comparar los resultados con los del año anterior. Población y Método. Estudio obserbacional, descriptivo, retrospectivo. Población: pretérminos con PN menor 1500g y/o 0 menor o igual 32 sem EG y mayor igual 1500g y 33-36 sem con oxigenoterapia. Fuente: 31 servicios públicos de la Argentina. Variables: PN, EG, pesquisa oftalmológica, edad al 1er control, grado de ROP, necesidad y lugar de tratamiento y alta oftalmológica. Resultados. Respondieron 24 servicios (84200 nacimientos) donde se registraron 3371 niños con riesgo de ROP; 956 con PN menor 1500g. Pesquisados 90 por ciento, tardíamente 6 por ciento. Egresaron sin alta oftalmológica 93 por ciento. La incidencia de ROP fue de 11,93 por ciento; 26,25 por ciento en menor 1500g. Requirieron tratamiento 2,60 por ciento; 7 por ciento fueron menor 1500g; los casos inusuales fueron 20,3 por ciento y hubo una oportunidad perdida. Los casos tratados aumentaron 20 por ciento en 2008 respecto del 2007, sin alcanzar significación estadística. Las medias de PN, EG y los CI no variaron. El 75 por ciento de los tratamientos fueron in situ, sin cambios respecto a 2007. Conclusiones: Persisten indicadores preocupante de ROP en los servicios públicos de la Argentina. La falta de cambios en el 2008 respecto del 2007 hace suponer que no se han consolidado los conceptos sustantivos de la prevención. La pesquisa y el acceso al tratamiento son perfectibles.

Prevalence and predisposing factros of retinopathy of prematurity in very low-birth-weight infants discharged from NICU

Retinopathy of prematurity [ROP] is a disease of the eye caused by disorganized growth of retinal blood vessels resulting in scarring and retinal detachment. All preterm babies are at high risk for ROP, and very low birth weight is an additional risk factor. An increased incidence of ROP is expected in Iran because of improved survival of low birth weight and premature babies, and it is obvious that pediatricians and ophthalmologists are concerned about prevention and timely treatment of ROP in these children. To asses the real situation of ROP in our NICU we studied its prevalence and risk factors. This was a retrospective analysis of premature infants with birth weight of

Resultados de um programa de prevenção da cegueira pela retinopatia da prematuridade na Região Sul do Brasil / Results of a program for the prevention of blindness caused by retinopathy of prematurity in southern Brazil

OBJETIVO: Descrever os resultados do programa de prevenção da cegueira pela retinopatia da prematuridade implantado em um hospital universitário de nível terciário desde 2002, conforme os critérios de triagem adotados no Brasil, e comparar alguns aspectos com critérios preconizados para outros países. MÉTODOS: Estudo observacional descritivo incluindo todos os prematuros nascidos na instituição com peso de nascimento < 1.500 g ou idade gestacional < 32 semanas que sobreviveram até a sexta semana pós-natal no período entre outubro de 2002 e junho de 2006. Os exames oftalmológicos iniciaram na sexta semana de vida e foram repetidos de acordo com a necessidade até a regressão da doença. RESULTADOS: Foram incluídos 300 recém-nascidos e detectaram-se 18 casos de doença limiar e tratável (18/300, 6 por cento) com o critério brasileiro. Um dos pacientes não realizou tratamento, pois desenvolveu doença após a alta hospitalar e não retornou para exame a tempo de realizar o tratamento. Com critérios sugeridos para países desenvolvidos, haveria redução na totalidade de exames nas mesmas condições, porém não teriam sido detectados 11,76 por cento dos casos de doença limiar. CONCLUSÕES: O critério para a triagem de prematuros definido para o Brasil foi eficaz na detecção dos casos tratáveis da doença. Evitou-se a cegueira em 17 prematuros nesse período. A universalização deste programa em hospitais universitários ou nas redes de saúde pública e privada do país contribuiria para evitar uma das principais causas de cegueira infantil prevenível e tratável nos países em desenvolvimento. No momento atual, haveria risco em se modificar esse critério no Brasil.

OBJECTIVE: To describe the results of a program for the prevention of blindness caused by retinopathy of prematurity implemented in 2002 at a tertiary-care hospital, according to screening criteria adopted in Brazil, and to compare some aspects with the criteria adopted by other countries. METHODS: Descriptive observational study including all preterm infants born at this hospital weighing < 1,500 g at birth and/or gestational age < 32 weeks who survived up to the sixth week after birth, between October 2002 and June 2006. Ophthalmic examinations were performed from the sixth week of life and repeated as necessary until remission of the disease. RESULTS: A total of 300 newborns were included and there were 18 cases of treatable threshold disease (18/300, 6 percent) according to the Brazilian criteria. One patient was not treated because s/he developed the disease after hospital discharge and did not turn up for examination in order to initiate treatment. According to the criteria suggested by industrialized countries, the total number of exams would be reduced under the same circumstances, but 11.76 percent of the cases of threshold disease would not be detected. CONCLUSIONS: The Brazilian criteria for neonatal screening were efficient in detecting treatable cases. Blindness was averted in 17 preterm infants in the study period. The universal use of such program at teaching hospitals or in the public and private health networks could help prevent one of the main causes of preventable and treatable blindness among infants in developing countries. Currently, a change in these criteria in Brazil may compromise the diagnosis of some treatable patients.

Lens-sparing Vitrectomy for Stage 4 and Stage 5 Retinopathy of Prematurity

PURPOSE: To describe the results of lens-sparing vitrectomy for the correction of retinal detachment associated with retinopathy of prematurity (ROP) and its associated complications. METHODS: Seventeen patients who underwent a lens-sparing vitrectomy for stage 4 and stage 5 ROP with plus disease at Seoul National University Children's Hospital between 1999 and 2003 were enrolled in this study. The patients who had bilateral retinal detachment of ROP underwent a lens-sparing vitrectomy in one eye and a scleral buckling surgery or lensectomy-vitrectomy in the other eye. The patients who had a retinal detachment in one eye and a regressed ROP in the other eye underwent unilateral lens-sparing vitrectomies. A review of their preoperative clinical findings (including the status of retinal detachment and plus disease), post-operative results, and any complications encountered was performed. RESULTS: In 17 patients, the postoperative success rate of lens-sparing vitrectomy was 58.8%. However, lens-sparing vitrectomy as a treatment for stage 5 ROP (25.0%) produced more negative post-operative results than it did when used to treat either those for stage 4a (75,0%) or 4b (66.7%) ROP. Among the 10 eyes in which the retina was attached, form vision was shown in six eyes, light could be followed by three eyes, and no light perception was present in one eye. Intra- and post-operative complications included retinal break formation, cataracts, vitreous hemorrhages, and glaucoma in patients with stages 4b and stage 5 ROP. CONCLUSIONS: Lens-sparing vitrectomy resulted in encouraging surgical outcomes in the correction of retinal detachment of ROP, especially in stage 4 patients. Therefore, a lens-sparing vitrectomy for stage 4 ROP patient may be beneficial, although it is still associated with some intra- and post-operative complications.

Fulminate type of retinopathy of prematurity.

Routine ophthalmoscopic screening for retinopathy of prematurity (ROP) from the age of 2 weeks is necessary to detect and treat fulminate ROP.

Correlación clínico epidemiológico de la retinopatía del prematuro, en recién nacidos pretérminos de bajo peso al nace, Centro Nacional de Oftalmología enero del 200- junio del 2003 / Epidemiological clinical correlation of the retinopatía of the premature, in newborn pretérminos of under weight to born, National Ophthalmology Center January of the 200 - June of the 2003

La presente investigación tuvo como objetivo fundamental establecer la correlación clínico epidemiológica de la Retinopatía del Prematuro en los niños menores de un año, que asistieron al Centro Nacional de Oftalmología para su valoración oftalmológica, presentando antecedentes de prematuridad y bajo peso al nacer. Dicha retinopatía es una causa importante de ceguera en la infancia y se ha asociado a diversos factores de riesgo. Se realizó un estudio de tipo descriptivo, de corte transversal. El universo estuvo conformado por 80 pacientes menores de un año, con antecedentes de prematuridad y bajo peso al nacer que acudieron por primera vez al Centro Nacional de Oftalmología en el periodo del 1 de Enero del año 2000 al 30 de Junio del 2003. La muestra quedó conformada para los dos primeros objetivos por los niños con y sin retínopatía del prematuro que suman un total de 77 niños. Para el resto de los objetivos, la muestra estuvo constituída solamente por los niños que desarrollaron retinopatía del prematuro (63 pacientes), seleccionados por e! método no probabilístico o por conveniencia, de tipo intencional o deliberado. Los principales resultados del estudio fueron los siguientes : La Retinopatía del prematuro se desarrolló en el 81.8 porciento de los pacientes estudiados. En relación a los factores de riesgo, se observó que el 100 porciento de los niños con menos de 1000 gr de peso al nacer, así como el 100 porciento de los pacientes con menos de 28 semanas de edad gestacional desarrollaron Retinopatía del Prematuro. En cuanto a las patologías perinatales asociadas a Retinopatía del Prematuro se encontró que el 100 prociento de los pacientes que presentaron ya sea apnea o ictericia, o bien aquellos que desarrollaron hemorragia intraventricular, presentaron algún grado de retinopatía.En cuanto a la gravedad de la enfermedad los resultados reflejaron que en el 45.2 porciento de los casos se desarrollaron los estadios leves de la enfermedad, en comparación con el 54.8 porciento que desarrolló los estadios graves de la Retinopatía del Prematuro, de los cuales un 30.2 porciento de los casos alcanzó el estadio umbral, el estadio 4a se desarrolló en el 4 porciento de los ojos, el 0.8 porciento desarrolló el estadio 4b, y un 11.9 porciento desarrolló el estadio 5. Se realizó tratamiento en el 23.8 porciento de los casos, de los cuales a un 22.2 prociento se le aplicó crioterapia y al 1.6 porciento fotocoagulación con láser

Retinopatía del prematuro (ROP) en una unidad de cuidado intensivo del norte de Chile, Iquique, 1995-2002 / Retinopathy of prematurity (ROP) in a unit of intensive care in the north of Chile, Iquique, 1995-2002

Objetivo: Estudiar incidencia y factores de riesgo en niños con ROP. Material y métodos: Análisis de fichas de Recién Nacidos Muy Bajo Peso (RNMBP) <1.501g y/o edad gestacional (EG)≤34 semanas en neonatología del hospital de Iquique, período 1995-2002. Resultado: Nacieron 27.596 niños y 253 RNMBP ingresaron a neonatología. El 0,3 por ciento de neonatos y 33,6 por ciento (85/253) de RNMBP presenta ROP. Quedaron ciegos o severo daño visual el 1,18 por ciento (3/253). El 0,13 por ciento de neonatos, 14, por ciento (37/253) de RNMBP y 43,5 por ciento con ROP (37/85) presenta Etapa Umbral. La incidencia en ≤ 1.000g fue 81 por ciento y entre 1001-1500g 28 por ciento (Etapa Umbral 42, por ciento y 34,1 por ciento respectivamente). Factores de riesgo fue peso ≤ 1.000g, Apgar ≤5 5 min, EG ≤26 semanas, oxigenoterapia en 36ª semanas. Factores protectores fueron EG 33 semanas, peso > 1.000g Apgar >5. Conclusiones: La incidencia de ROP está dentro de los valores informados por otros estudios y el porcentaje niños con severo daño visual es bajo. Retinopatía del prematuro (ROP) es una unidad de cuidado intensivo del norte de Chile, Iquique 1995-2002.