Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity

Purpose: To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). Methods: The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type ? ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age?matched, full?term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Results: Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = ?2.89 ± 3.1, range = ?11.5 to ?0.5 D). There were 75 eyes (56%) with low?to?moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with?the?rule (WTR) astigmatism. In 134 eyes, the SE was ?1.78 ± 3.2 (range = ?11.5 to 4 D); the SE of the 75 eyes with low?to?moderate myopia was ?1.53 ± 1.2 (range = ?0.50 to ?5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low?to?moderate myopia was more than high myopia in patients with zone ? and zone ? ROP before treatment (60.0% and 54.5%, respectively). Conclusion: Myopia was the major refractive error seen in post?IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors

Validation of three weight gain-based algorithms as a screening tool to detect retinopathy of prematurity: A multicenter study

Purpose: Screening guidelines for retinopathy of prematurity (ROP) are updated frequently to help clinicians identify infants at risk of type 1 ROP. This study aims to evaluate the accuracy of three different predictive algorithms—WINROP, ROPScore, and CO?ROP—in detecting ROP in preterm infants in a developing country. Methods: This retrospective study was conducted on 386 preterm infants from two centers between 2015 and 2021. Neonates with gestational age ?30 weeks and/or birth weight ?1500 g who underwent ROP screening were included. Results: One hundred twenty?three neonates (31.9%) developed ROP. The sensitivity to identify type 1 ROP was as follows: WINROP, 100%; ROPScore, 100%; and CO?ROP, 92.3%. The specificity was 28% for WINROP, 1.4% for ROPScore, and 19.3% for CO?ROP. CO?ROP missed two neonates with type 1 ROP. WINROP provided the best performance for type 1 ROP with an area under the curve score at 0.61. Conclusion: The sensitivity was at 100% for WINROP and ROPScore for type 1 ROP; however, specificity was quite low for both algorithms. Highly specific algorithms tailored to our population may serve as a useful adjunctive tool to detect preterm infants at risk of sight?threatening ROP

Study to evaluate the relation between weight gain in infants and occurrence of retinopathy of prematurity

Purpose: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Capturing serial daily postnatal weight gain can act as an innovative, low?cost method of risk stratification. We aim to study the relation between weight gain in infants and occurrence of ROP. Methods: The prospective, observational study was conducted on 62 infants. ROP screening was done based on the Rashtriya Bal Swasthya Karyakram (RBSK) criteria. Infants were classified into no ROP (n = 28), mild ROP (n = 8), and treatable ROP (n = 26) groups. Average daily postnatal weight gain was measured and its relation to development of ROP was studied. All statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 21 version (SPSS Inc., Chicago, IL, USA) statistical program for Microsoft Windows. Results: Mean rate of weight gain in no ROP group, mild ROP group, and treatable ROP group was 33.12, 27.19, and 15.31 g/day, respectively (P = 0.001). Mean gestational age and birth weight in treatable group (n = 26) were 31.38 weeks and 1572.31 g, respectively. Receiver operating curve analysis revealed a cutoff of 29.33 g/day for ROP and 21.91 g/day for severe ROP. Conclusion: We concluded that, babies with poor weight gain of below 29.33 g/day are at high risk for ROP and babies with wight gain of 21.91 g/day are at high risk for severe ROP. These babies should be followed meticulously. So, the rate of weight gain of a preterm can help us to prioritize babies.

Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10

Purpose: To evaluate the effectiveness and future implications of COVID?related risk stratification for managing retinopathy of prematurity (ROP). Methods: A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low?risk babies developed in conjunction with the Indian ROP Society for care during the COVID?19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain. Results: New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty?seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low?risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up. Conclusion: New risk stratification during the COVID?19 pandemic was an efficient and safe strategy in managing low?risk ROP babies.

Evaluation of clinical profile and screening guidelines of retinopathy of prematurity in an urban level III neonatal intensive care unit

Purpose: To evaluate the clinical profile and screening guidelines of retinopathy of prematurity (ROP) in an urban level III neonatal intensive care unit (NICU). Methods: Infants with ?2000?gm birth weight or <34 weeks gestational age were prospectively screened for ROP in an urban level III NICU between January 2018 and December 2020, based on national screening guidelines. Standard guidelines were used for ROP classification and treatment. Results: In total, 211 infants completed screening; 46 (21.8%) infants developed ROP and 13 (6.2%) had type 1 (laser treatable) ROP. Of the 46 infants with ROP, 44 (95.65%) had zone 2 and two (4.34%) had zone 1 disease. In the 102 infants with ?1500?gm birth weight, the incidence of ROP and type 1 ROP were 41.18% and 11.76%, respectively. Out of the 109 infants with >1500?gm birth weight, four (3.67%) developed ROP and one (0.91%) infant (an outborn) required treatment. Conclusion: The majority of infants developing ROP in a level III urban NICU had ?1500?gm birth weight. Zone 1 ROP was uncommon. Incidence of ROP in heavier infants (>1500?gm birth weight) was low, and treatment was required in a rare instance. In an urban NICU, the burden of ROP screening and treatments shifts to small and low?birth?weight infants

Compassionate and standard operating procedure-based counseling and practice are essential in high-risk infantile anesthesia and managing death in eye surgery

Physicians have to play the role of a team leader and counselor and take written informed consent for high?risk surgeries in many cases. This is the first step toward initiating a mutually trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician?patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.

ROPs: Molecular Switches of Multiple Signal Pathways in Plant Cells / 中国生物化学与分子生物学报

RHO-related GTPases of plants (ROPs) are a class of signal transduction G proteins (alsoknown as GTP binding proteins) widely existing in plants. ROP proteins act as " molecular switches" toregulate the signal transduction process during cellular activities such as plant cell polarity regulation, plant morphological development, hormone level regulation, stress responses and many other life activitiesby shifting between inactive GDP-binding and active GTP-binding forms in the cells. In this review, thedomain structure, classification, the mechanism of activity regulation and biological functions of ROPproteins were summarize. Furthermore, ROP proteins from Arabidopsis, maize, rice and barley werephylogenetically analyzed. The results show that ROP proteins were classified into two types based on thedomain structure of the proteins. However, these ROP proteins were divided into 4 clades based on thesimilarity of protein sequences. Furthermore, the mechanism of ROP proteins as a molecular switchregulating various signaling pathways in cells, and the specific functions and mechanisms of ROPs in thepolarized growth of pollen tubes, root hairs and plant pavement cells and other stress responses werecharacterized. In addition, the research progress of the function of ROPs in plant hormones such as ABA, IAA and BR mediated signal transduction were described as well. At last, the unanswered questions suchas why different ROP proteins play distinct roles in the same signaling pathway and how ROPs coordinatedifferent signal pathways to jointly regulate a plant’ s development or physiological process werediscussed, which may shed light on future research.

Study on the correlation between maternal iron deficiency anemia and ROP in premature or low birth weight infants / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To explore the correlation between maternal iron deficiency anemia and retinopathy of prematurity(ROP)in premature infants or low birth weight infants so that to provide possible scientific basis for the prevention and control of ROP.<p>METHODS: This study was a case-control study. The clinical data of 317 premature or low birth weight infants who were diagnosed with ROP and their mothers in our hospital during January 2019 to July 2021 due to ROP screening for the first time(about 30d after birth)were analyzed. The relationship between maternal iron deficiency anemia and ROP and its stages were observed. And the relationship between Hb, blood value characteristics, mean gestational age, gestational weeks, infant birth weight of maternal iron deficiency anemia and ROP stage.<p>RESULTS: There were 235 mothers(74.1%)with iron deficiency anemia, 82 mothers(25.9%)without iron deficiency. Among them, there were 194 mothers(82.6%)with mild anemia according to anemia classification, 119 cases with stage Ⅰ ROP and 75 cases with stage Ⅱ ROP. There were 39 mothers(16.6%)with moderate anemia, 8 cases with stage Ⅱ ROP, 22 cases with stage Ⅲ ROP and 9 cases with stage Ⅳ ROP. There were 2 mothers(0.9%)of severe anemia, all of whom had stage Ⅳ ROP. No children with stage Ⅴ or threshold ROP and mothers with very severe anemia were found in this study. Compared with mothers with iron deficiency anemia, premature infants or low birth weight infants with normal iron levels were more likely to have stage Ⅰ ROP, but stage Ⅱ ROP was more pronounced in mothers with iron deficiency anemia, and the differences were statistically significant(all <i>P</i><0.05). Stage Ⅲ and stage Ⅳ ROP was not observed in the mothers with normal serum iron, but was 9.4% and 4.7% in the mothers with iron deficiency anemia, respectively. The differences were statistically significant(<i>P</i><0.05). Stage Ⅴ and threshold lesions ROP was not observed in preterm or low birth weight infants in mothers with normal serum iron values or iron deficiency anemia. Compared with mothers with normal iron levels, mothers with iron deficiency anemia had significantly lower hemoglobin, hematocrit, mean erythrocyte volume, serum iron and ferritin levels. At the same time, the higher mean gestational age, mean shorter gestational week and mean lower birth weight in the mothers with iron deficiency anemia, and the differences were statistically significant(all <i>P</i><0.05).<p>CONCLUSION:Pregnant iron-deficiency anemia is associated with the occurrence and development of ROP in premature or low birth weight infants. The more severe maternal anemia, the higher maybe stage of ROP. Therefore, monitoring and supplementation of iron during pregnancy can effectively prevent and reduce the risk of ROP.

Effectiveness of reverse kangaroo mother care position in decreasing adverse physiological events and pain during screening of premature infants for Retinopathy of prematurity

Background@#Retinopathy of prematurity (ROP) screening is uncomfortable and even painful in preterm infants. @*Objective@#To determine the effectiveness of the Reverse-Kangaroo Mother Care (R-KMC) position compared with the conventional position in decreasing adverse physiological events and pain during ROP screening. @*Methods@#This was a parallel randomized controlled trial with two arms- R-KMC position and conventional position (control). The primary outcomes included increased oxygen saturation, decreased heart and respiratory rates, and decreased pain intensity measured by Prematurity Infant Pain Profile (PIPP). @*Results@#There were 100 preterm infants recruited. There were no differences in baseline characteristics, mean ROP screening duration, mean physiological parameters after the mydriatic application and during ROP screening between the two. Only the mean respiratory rates were significantly lower among the R-KMC group during the application of mydriatric agent. (50.26 ± 6.18 vs. 51.6 ± 8.35; p=0.0191). Relative risk (RR) in the control group is 37 to 84 versus 40 to 68 in the R-KMC group. The R-KMC group had a significantly lower mean PIPP score (6.5±2.06 vs. 8.8±2.80; p<0.0001) after mydriatic application and during ROP screening (7.6±2.05 vs. 9.8±2.90; p<0.0001) compared with control. No apnea was observed after mydriatic application, but one apneic episode was in control during ROP screening. 26% of the ROP screeners recommended the R-KMC position during ROP screening, while a majority (70%) was neutral. @*Conclusion@#R-KMC position, a low-cost intervention, significantly reduces pain during ROP screening. It is recommended as a position of choice during ROP screening.

Outcomes of retinopathy of prematurity screening at National Center For Maternal And Child Health / Шинэ санаа Шинэ нээлт

Purpose@#To investigate the outcomes of ROP screening of retinopathy of prematurity (ROP).@*Methods@#This was a prospective of prematurity infants screened ROP from 2020 April 13th to April 28th 2020 and from 2020 June 08 th to June 22th 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery. Demographic factors, diagnosis and clinical course were recorded. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were taken. Each eye was evaluated by the pediatric ophthalmologist and aimag’s ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP).^2,13@*Results@#A total of 90 premature infants with BW ≤ 2000g and/or GA ≤ 34 weeks were screened for ROP during the study period. 8 (8.8%) of the 90 infants screened required treatment. The 8 infants who received ROP treatment had a mean GA of 28.5 ± 1.7 weeks, mean BW of 1237.5 ± 125.42g, mean PMA of 36 weeks and mean follow-up time of 2 months.@*Conclusion@#After treatment, resolution of ROP was noted in approximately 100 % of the patients who had treatment-requiring ROP.

Effect of different mydriatic regimens used for pupil dilation on the vital signs of premature infants for retinopathy of prematurity screening in a Philippine tertiary hospital: A randomized double-blind clinical trial

@#<p style="text-align: justify;"><strong>Objectives.</strong> To determine the safety and efficacy of three different mydriatic regimens in premature infants referred for retinopathy of prematurity (ROP) screening using (1) multiple alternate instillations of 0.5% cyclopentolate hydrochloride and 2.5% phenylephrine (MAI), (2) single instillation of 0.5%/0.5% tropicamide + phenylephrine (SI) and (3) single instillation of 0.5%/0.5% tropicamide + phenylephrine with a cotton wick placed in the inferior fornix (SIW) in a Philippine tertiary hospital.</p><p style="text-align: justify;"><strong>Methods.</strong> A randomized, double-blind, clinical trial included preterm infants for ROP screening at a Philippine tertiary hospital. After instillations via MAI, SI, and SIW, systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate, and oxygen saturation were monitored. Pupillary dilation was also measured.</p><p style="text-align: justify;"><strong>Results.</strong> Sixty preterm infants, 20 to each intervention, were included. The MAI group did not have significant changes relative to its baseline vital signs. The use of SI produced lower DBP (p<0.0106) and MAP (p<0.0027) compared to MAI. The use of SI produced lower DBP (p<0.01) and MAP (p<0.003) compared to MAI. The SIW group exhibited significant increases in SBP (p<0.002) and in MAP (p<0.04) compared to MAI. This increase in SBP exceeded the clinical normal values for <37 weeks old infants. Pupillary dilation did not have significant differences among groups (p=0.24).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Due to significant increase in SBP, it is recommended to discontinue SIW in preterm infants for ROP screening since it may promote the mydriatic's systemic absorption. Except for the clinically increased heart rate in infants aged ?37 weeks at examination, SI was found to be at par with the recommendation of the UK ROP Guidelines of May 2008.</p>

The principle of drop-on-powder 3D printing and its application and challenge in solid preparation / 药学学报

3D printing technology has the advantages of accurate spatial distribution, accurate drug release and personalized drug dosage, which can make up for the shortcomings of traditional pharmaceutical technology. In recent years drop-on powder (DoP) 3D printing technology has been widely used in pharmaceutical preparation. Compared with other types of 3D printing technology, it is more simple, flexible and easy to operate. In 2015, Aprecia Pharmaceuticals announced that the US Food and Drug Administration (FDA) approves the launch of its first instant tablet Spritam® (levetiracetam) made with DoP 3D printing. After the first 3D printed medicine was launched, people also saw the unique advantages and broad prospects of DoP 3D printing technology platform in pharmaceutical preparation. This review focuses on the technical principles and key factors of DoP 3D printing, its application in the preparation field and its future development challenges.

Risk factors for recrudescence of ROP after anti-VEGF treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the risk factors about recrudescence of retinopathy of prematurity(ROP)after anti-VEGF treatment. <p>METHODS: A retrospective study about all the infants diagnosed with ROP and treated with anti-VEGF from June 2016 to October 2019 in our hospital. They were divided into recrudescence group(8 cases)and non- recrudescence group(48 cases). The relationship between various clinical risk factors and the recrudescence of ROP after anti-VEGF treatment were considered. Those risk factors included birth weight, gestational age, thrombocytosis, anemia, coagulation disorder, sepsis, bronchopulmonary dysplasia, neonatal respiratory distress syndrome, asphyxia, pneumonia, intracranial hemorrhage, patent foramen ovale, and patency ductus arteriosus. <p>RESULTS: According to single-factor analysis, birth weight and intracranial hemorrhage showed statistically significant differences between recrudescence group and non-recrudescence group. Logistic regression analysis showed low birth weight(<i>OR</i>=9.800, <i>P</i>=0.039)and intracranial hemorrhage(<i>OR</i>=17.571, <i>P</i>=0.002)had relationship with recrudescence of ROP after anti-VEGF.<p>CONCLUSION: Low birth weight(<1 000g)and intracranial hemorrhage are the risk factors about recrudescence of ROP after anti-VEGF.

Risk factors for recrudescence of ROP after anti-VEGF treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the risk factors about recrudescence of retinopathy of prematurity(ROP)after anti-VEGF treatment. <p>METHODS: A retrospective study about all the infants diagnosed with ROP and treated with anti-VEGF from June 2016 to October 2019 in our hospital. They were divided into recrudescence group(8 cases)and non- recrudescence group(48 cases). The relationship between various clinical risk factors and the recrudescence of ROP after anti-VEGF treatment were considered. Those risk factors included birth weight, gestational age, thrombocytosis, anemia, coagulation disorder, sepsis, bronchopulmonary dysplasia, neonatal respiratory distress syndrome, asphyxia, pneumonia, intracranial hemorrhage, patent foramen ovale, and patency ductus arteriosus. <p>RESULTS: According to single-factor analysis, birth weight and intracranial hemorrhage showed statistically significant differences between recrudescence group and non-recrudescence group. Logistic regression analysis showed low birth weight(<i>OR</i>=9.800, <i>P</i>=0.039)and intracranial hemorrhage(<i>OR</i>=17.571, <i>P</i>=0.002)had relationship with recrudescence of ROP after anti-VEGF.<p>CONCLUSION: Low birth weight(<1 000g)and intracranial hemorrhage are the risk factors about recrudescence of ROP after anti-VEGF.

Validation of weight, insulin like growth factor 1, neonatal retinopathy of prematurity for detecting retinopathy of prematurity among Indian preterm neonates

Background: Among the premature infants, WINROP (weight, insulin like growth factor 1, neonatal retinopathy of prematurity), a web- based retinopathy of prematurity (ROP) risk algorithm, uses postnatal weight gain in predicting the risk of severe ROP. This retrospective study assess the sensitivity and specificity of WINROP algorithm to predict proliferative ROP (type 1, type 2).Methods: This was a tertiary hospital based retrospective study conducted in level 3 - NICU from February -November 2018. The data was entered in WINROP website. 45 neonates enrolled in the study, were classified as either alarm given (increased risk of severe ROP) or not given (no risk of severe ROP/ no ROP). Timing of alarm was also noted.Result: 10 neonates (22%) had severe ROP requiring treatment. The mean gestational age was 30 weeks and mean birth weight was 1275 grams. In this study, sensitivity to WINROP online system was found to be 90%, specificity of 48.6%, positive predictive value of 33.3% and negative predictive value of 94.4%. The median time from alarm to treatment was 6 weeks (3-8 weeks).Conclusion: WINROP algorithm has a good sensitivity in detection of treatable ROP.

India to gear up to the challenge of “third epidemic” of retinopathy of prematurity in the world

Many of the causes of childhood blindness are avoidable, being either preventable or treatable. Retinopathy of prematurity (ROP) remains one of the most preventable causes of childhood blindness worldwide. Currently, India is facing the third epidemic of ROP. In India, the health system involving the mother and child health services needs to be strengthened with a policy to cover the existing inadequacies in neonatal care and implementation of program covering newborn, especially premature. The access, availability, and affordability of services related to the care of premature babies need strengthening in India. ROP-trained ophthalmologists and neonatal care pediatricians and a professional togetherness is a big issue. Inadequacies in awareness of ROP among the parents, health care workers, counsellors add up to the problem. Community-based health workers such as Accredited Social Health Activist are a good dependable force in India and are needed to be trained in awareness and establishing a proper identification for prompt referral. ROP prevention needs a multidisciplinary team approach. ROP management stands as a good example of all the strategies for prevention, which includes primary prevention (improving obstetric and neonatal care), secondary prevention (screening and treatment programs), and tertiary prevention (treating complications and rehabilitation to reduce disability). Given its demographic and cultural diversity, India faces numerous challenges, with significant rural–urban, poor–rich, gender, socioeconomic, and regional differences. So, we need to gear up to face the present challenge of the third epidemic of ROP and prevent ROP-related childhood blindness as it is the need of the hour.

Results of surgery for late sequelae of cicatricial retinopathy of prematurity

Purpose: To report anatomical and functional results of vitreoretinal surgery in our case series of late cicatricial retinopathy of prematurity (ROP) patients with subtotal retinal detachment. Methods: This is a retrospective, consecutive case series. Eleven eyes of 10 patients presented with partial tractional retinal detachment secondary to late cicatricial ROP (cicatricial stage 4B) who underwent vitreoretinal surgery were retrospectively reviewed. Anatomical and functional outcomes were evaluated. Results: The mean gestational age at birth was 28.6 (26–32) weeks. The mean age at surgery was 79 (4–213) months. Patients were followed up for 21.7 (6–40) months. Six eyes (55%) had lens-sparing vitrectomy and five eyes (45%) had lensectomy + vitrectomy. Anatomical success was achieved in 10 eyes (91%). Improvement in visual acuity was noted in nine eyes (82%). Conclusion: Eye grows but fibrotic tissue does not grow with age, and during this period retinal traction may get worse. Relieving these tractions may lead to good anatomical and visual outcomes in selected late cicatricial ROP cases.

Surgical outcomes of vitreoretinal surgery for rhegmatogenous retinal detachment in eyes with regressed retinopathy of prematurity

Purpose: To report the anatomical and functional outcomes of vitreoretinal surgery in eyes with “regressed ROP” presenting with rhegmatogenous retinal detachment (RRD). Methods: In this retrospective interventional case series, twenty-two eyes (of 22 patients) with regressed ROP, who underwent surgery for RD. Primary outcome measures were final anatomical and visual outcome for scleral buckling and pars plana vitrectomy (PPV). Visual outcomes were categorized into three groups: improved, remained stable, and deteriorated. Univariate binary logistic regression analysis was used to determine the risk factors for RD. Results: Of 22 eyes in the study, overall anatomic success was achieved in 16 of 22 eyes (72.7%). The macula was attached in 17 of 22 eyes (77.3%) at final visit. In the scleral buckle (SB) group, overall anatomical success was achieved in six of seven eyes (85.7%). Overall, in the PPV group, anatomical success was seen in 10 of 15 eyes (66.7%) at final visit. At final follow-up, significant improvement in best-corrected visual acuity from baseline was seen in 11 cases (50%, P = 0.02), stable in 5 cases (22.7%), and significant visual deterioration was seen in 6 cases (27.3%, P = 0.02). The total mean follow-up duration of the patients was 45.5 months (range: 2.1 months to 11.2 years). Conclusion: Early recognition and surgical intervention in such cases can lead to a high rate of anatomical success and can prevent the development of profound visual impairment in some patients.

Retinal immaturity at first screening and retinopathy of prematurity: Image-based validation of 1202 eyes of premature infants to predict disease progression

Purpose: To use the extent of retinal immaturity at the first visit to predict progression to any stage and treatment-requiring retinopathy of prematurity (ROP). Methods: Retrospective, multicenter, nonrandomized, observational, clinical, validation study. In all, 601 Asian Indian preterm infants born < 2000 g and/or < 34 weeks of gestation completing ROP screening with RetCam images taken during each visit were included. A total of 1202 eyes of these infants were classified into three groups based on the retinal immaturity at the first screening visit into “mild” (Group 1), vessels reaching the posterior boundary of zone 3; “moderate” (Group 2), vessels entering zone 2 anterior; and “severe” (Group 3), vessels in zone 1 or zone 2 posterior. RetCam images at each subsequent visit were evaluated and the proportion of eyes that progressed to Type 1 or Type 2 ROP was correlated with the degree of retinal immaturity. Results: Of the 958 eyes in Group 1, 200 eyes in Group 2, and 44 eyes in Group 3, any stage ROP developed in 15% of eyes in Group 1, 46.5% of eyes in Group 2, and 100% of eyes in Group 3 (P < 0.001). Sixteen of 128 eyes (12.5%), 12 of 72 (16.6%), and 28 of 44 of eyes (63.6%) in Groups 1, 2, and 3, respectively, required treatment (P < 0.001). Conclusion: Retinal immaturity at first screening visit predicts Type 1 and Type 2 ROP. “Severe” immaturity is more likely to progress to “treatment-requiring” disease. This could be a useful tool for prognostication, counseling, and scheduling follow-up.

Prevalence, risk factors and pattern of severe retinopathy of prematurity in eastern Madhya Pradesh

Purpose: To describe the prevalence, characteristics including risk factors, and pattern of severe ROP from eastern Madhya Pradesh region of India. Methods: In this 5-year retrospective study, Baseline characteristics, systemic risk factors, and findings of ROP screening were noted. Factors associated with severe ROP including aggressive posterior ROP (APROP), stage IV and V ROP were analyzed. Statistical analysis was done using SPSS version 20. Results: Of 763 babies screened, 30% were diagnosed to have ROP. Prevalence of severe ROP was 14.2% (109) of which 60 (55.5%) were classic and 30 (27.7%) were APROP. Eighteen (16.6%) were diagnosed as advanced ROP (stage IV and V). Mean gestational age (GA) and birth weight (BW) for severe ROP were 31.05 weeks and 1.34 kg, respectively which were inversely associated with severe ROP. But a significant 10% of severe ROP were seen in late preterm babies, >34 weeks. Low GA and respiratory distress syndrome (RDS) were significant risk factors for APROP. Most important factor for stage IV and V ROP was late presentation for screening. Conclusion: The study found a high prevalence of severe ROP including APROP. Almost 7% severe ROP cases were outside screening guidelines of NNF. Late presentation for screening is the most important factor associated with ROP related blindness.