The comparison of clinical characteristics of aggressive posterior retinopathy of prematurity and general retinopathy of prematurity / 中国新生儿科杂志

Objective:To study the differences of clinical features between aggressive posterior retinopathy of prematurity (APROP) and general retinopathy of prematurity (GROP) and to find the risk factors of APROP.Method:From January 2014 to December 2018, newborns with retinopathy of prematurity (ROP) hospitalized in our hospital were retrospectively studied. According to the diagnosis criteria of APROP, the newborns were assigned into GROP group and APROP group. Their clinical data, treatment and perinatal data were collected. SPSS 18.0 was used to compare the differences between the two groups.Result:A total of 127 newborns were included in the study, 107 in the GROP group and 20 in the APROP group. 91.6% (98/107) infants with gestational age (GA) <32 w were in the GROP group and 95.0% (19/20) in the APROP group. 84.1% (90/107) infants with birth weight (BW) <1 500 g were in the GROP group and 90.0% (18/20) in the APROP group. No significant differences existed of GA and BW between the two groups. 53.3% (57/107) infants in the GROP group received ≥2 times of blood transfusion, significantly lower than 85.0% (17/20) in the APROP group ( P<0.05). Mechanical ventilation (MV) was used in 81.3% (87/107) infants in the GROP group with most duration less than 7 days (69.2%, 74/107). MV was used in all infants in the APROP group with most duration longer than 7 days (65.0%, 13/20). The APROP group had significantly longer MV duration than the GROP group ( P<0.05). Some of the GROP group received laser photocoagulation therapy and all had good prognosis. Most of the APROP group received intravitreal injection and some of them combined with laser photocoagulation. The majority of them had favorable prognosis. Conclusion:The APROP group and the GROP group have similar general clinical characteristics. Increased blood transfusion and elongated MV duration may be risk factors for APROP.

Recent treatment advances in aggressive posterior retinopathy of prematurity / 国际眼科杂志(Guoji Yanke Zazhi)

@#The most severe form of rapidly progressing posterior retinopathy of prematurity(ROP)is aggressive posterior retinopathy of prematurity(AP-ROP). It is a rare disease, usually progresses to stage 5 without through the classic stage 1-3, eventually leading to irreversible loss of vision. The therapeutic approaches mainly include laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs and vitrectomy. In this article, we reviewed the above advances of AP-ROP treatment.

Successful treatment of aggressive posterior retinopathy of prematurity with diode laser in ocular albinism: A case report

Oculocutaneous albinism is characterized by partial or complete absence of melanin in retinal pigment epithelium (RPE) and uveal melanocytes. Absence of typical fundal background from RPE and choroid makes it difficult to diagnose retinal disorders in ocular albinism. Lack of melanin in RPE makes the laser photocoagulation very challenging in these cases. This report presents a unique case of preterm infant of oculocutaneous albinism diagnosed as aggressive posterior retinopathy of prematurity (APROP), which was successfully treated with diode laser photocoagulation. The parameters of the laser used in this case were higher than usual, just enough to achieve blanching of retina. This report highlights the fact that the diagnosis of APROP and its treatment with laser is challenging in the presence of oculocutaneous albinism, but it is possible to achieve complete regression using diode laser at higher parameters.

Profile of retinopathy of prematurity in late preterm newborn in a district level special newborn care unit of Eastern India

Background: The aim of this study was to analyse the incidence, severity and risk factors of retinopathy of prematurity in late preterm newborn at a district level SNCU in eastern India.Methods: The initial examination was carried out at 3 weeks of postnatal age or at 31weeks of post-conceptional age, whichever was later. Retinopathy was graded into stages and zones as per the ICROP classification. Those who had ROP were examined every week till regression occurred or till they reached criteria for laser treatment which was type I Prethreshold ROP as per ET ROP guideline. Risk factors for the development of ROP were determined by reviewing maternal and perinatal history and hospital case records.Results: 212 late ptreterm newborn were examined. The incidence of ROP in late preterm was 16.51% (35 out of 212 newborn). Incidence of stage I ROP was 6.60 % (14 newborn had stage I ROP). Incidence of stage II ROP was 6.60% (14 had stage II ROP). None had stage III ROP. 7 had APROP. Incidence of APROP was 3.30 %. 5 out of 14 newborns with stage II ROP (35.71%) required laser treatment. All newborn with APROP required both laser and Anti VEGF treatment. Overall 34.28% of late preterm with ROP required treatment. There was no difference in gestational age and birth weight in late preterm with and without ROP. There was significant difference in the duration of oxygen therapy in late preterm with and without ROP (6.657'2.531days vs 0.694'1.397 days, p<0.001). In stepwise logistic regression analysis-use and duration of oxygen, birth asphyxia and anemia were found to be significant risk factors of ROP in late preterm.Conclusions: ROP is common in late preterm newborn in developing country like India.

Risk factors of aggressive posterior retinopathy of prematurity:a retrospective,longitudinal study / 实用医学杂志

Objective To analyze the risk factors of aggressive posterior retinopathy of prematurity (AP-ROP). Methods A retrospective case-control study was applied. Questionnaire was designed through literature research to collect data of AP-ROP and ordinary ROP(except for AP-ROP)from March,2012 to September, 2014 in the department of neonatology in Guangdong Women and Children′s Hospital. Based on the ratio of 1:2 , the two groups were selected with the matching conditions:the closest date of admission in hospital,ordinary ROP children,collection and analysis of the data. Results Univariate analysis:gestational age(P<0.05),birth weight(P<0.05),oxygen therapy days(P<0.05),days of mechanical ventilation(P<0.05),gestational age<32 w(P<0.05),birth weight<1250 g(P<0.05),oxygen(P<0.05),oxygen≥14 d(P<0.05),mechanical ven-tilation(P < 0.05),mechanical ventilation ≥ 14 d(P < 0.05),PS(P < 0.05),neonatal anemia(P < 0.05), blood transfusion≥2 times(P<0.05),RDS(P<0.05),neonatal pneumonia(P<0.05),apnea(P<0.05), BPD(P < 0.05),intracranial hemorrhage(P < 0.05),metabolic acidosis(P < 0.05),and retinal hemorrhage (P < 0.05) were related to AP-ROP. Multivariate analysis with conditional logistic regression analysis indicated that blood transfusion ≥2 times(OR:14.956,95%CI:4.328~51.684)and apnea(OR:7.590,95%CI:2.507~22.978)were regarded as the independent risk factors for AP-ROP. Conclusions AP-ROP is associated with low gestational age,low birth weight,oxygen therapy and related complications including RDS and retinal hemorrhage. Blood transfusion and apnea are important independent risk factors of AP-ROP.

Aggressive posterior retinopathy of prematurity in infants ≥1500 g birth weight.

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty‑nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co‑morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty‑five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co‑morbidities could be a contributing factor.

Capillary-free Vascularized Retina in Patients with Aggressive Posterior Retinopathy of Prematurity and Late Retinal Capillary Formation

PURPOSE: To report the clinical features, clinical course, and treatment outcomes after laser photocoagulation in infants with aggressive posterior retinopathy of prematurity (APROP) and capillary-free zones in vascularized retina. METHODS: Six patients (12 eyes) with APROP and capillary-free zones in vascularized retina were retrospectively reviewed. Twelve eyes of six infants were included and were treated with laser photocoagulation for avascular retina and for capillary-free zones in vascularized retina, except for the posterior pole, and fundus findings were photographically-documented in sequence. In addition, anatomic and visual outcomes were evaluated with complications of APROP. RESULTS: Among all of the consecutive infants with APROP, capillary-free zones in vascularized retina were demonstrated in 24% of the infants. All of the infants were >27 weeks of gestation age and had birth weights >1,000 g. After laser treatment, 7 eyes (58.3%) had favorable outcomes, and late capillary filling in capillary-free zones of vascularized retina were noted, however 4 eyes (33.3%) progressed to retinal detachment and 1 eye (8.3%) was complicated by a retinal fold-distorting posterior pole. The visual outcomes were associated with anatomic outcomes. CONCLUSIONS: The anatomic outcomes in infants with APROP who had capillary-free zones were comparable to previously reported infants with APROP. The late capillary filling of capillary-free zones in vascularized retina was noted, and angiogenesis was considered to be involved. This process toward normal capillary formation or neovascularization in APROP, might determine its outcome.

Capillary-free Vascularized Retina in Patients with Aggressive Posterior Retinopathy of Prematurity and Late Retinal Capillary Formation

PURPOSE: To report the clinical features, clinical course, and treatment outcomes after laser photocoagulation in infants with aggressive posterior retinopathy of prematurity (APROP) and capillary-free zones in vascularized retina. METHODS: Six patients (12 eyes) with APROP and capillary-free zones in vascularized retina were retrospectively reviewed. Twelve eyes of six infants were included and were treated with laser photocoagulation for avascular retina and for capillary-free zones in vascularized retina, except for the posterior pole, and fundus findings were photographically-documented in sequence. In addition, anatomic and visual outcomes were evaluated with complications of APROP. RESULTS: Among all of the consecutive infants with APROP, capillary-free zones in vascularized retina were demonstrated in 24% of the infants. All of the infants were >27 weeks of gestation age and had birth weights >1,000 g. After laser treatment, 7 eyes (58.3%) had favorable outcomes, and late capillary filling in capillary-free zones of vascularized retina were noted, however 4 eyes (33.3%) progressed to retinal detachment and 1 eye (8.3%) was complicated by a retinal fold-distorting posterior pole. The visual outcomes were associated with anatomic outcomes. CONCLUSIONS: The anatomic outcomes in infants with APROP who had capillary-free zones were comparable to previously reported infants with APROP. The late capillary filling of capillary-free zones in vascularized retina was noted, and angiogenesis was considered to be involved. This process toward normal capillary formation or neovascularization in APROP, might determine its outcome.