Potential application of foveal structural measurements in treatment decision for retinopathy of prematurity: an OCT-based study.

PURPOSE: To investigate foveal changes in infants with ROP not requiring treatment(nROP) and ROP infants needing treatment (tROP) using a handheld SD-OCT device. METHOD: We performed horizontal SD-OCT scans through the fovea in 156 eyes of 81 infants diagnosed with ROP. Foveal immaturity indices including the presence of inner retinal layers (IRL), absence of foveal outer nuclear layers widening (ONL) and attenuation of hyperreflective outer segment layers (OS), presence and type of cystoid macular edema (CME), epiretinal membrane (ERM), foveal pit depth (FPD), foveal pit width (FPW) and central foveal thickness (CFT) were calculated. The multivariate logistic regression model was used to predict the need for treatment based on OCT measurements. RESULTS: The shape of the foveolar pit was not significantly different among tROP and nROP groups (P-value = 0.287, Chi-square test). IRL extrusion was incomplete in both tROP and nROP groups (P-value = 0.0.41, Chi-square test). Nevertheless, the presence of thicker IRL was more frequent in the nROP group in comparison with the tROP group (100% vs.64.8%, P-value = 0.001). CME was observed in 29% of eyes in the tROP group and 40% of eyes in the nROP group; however, this difference was not statistically significant (P-value = 0.32, Chi-square test). ERM was detected in 15 (75%) and 84 (65.6%) eyes in the nROP and tROP groups, respectively (P-value = 0.39, Chi-square test). Multivariate logistic regression analyses showed that the need for treatment was significantly associated with gestational age (GA), CFT and FPD (P-values 0.001 and 0.002 respectively). CONCLUSIONS: This study demonstrated GA, foveal pit depth and the central foveal thickness could accurately predict the need for treatment with sensitivity, specificity, and diagnostic accuracy of 97%, 65% and 91.7% respectively.

Comparison of Ocular and Brain Abnormalities Among Neonates With In Utero Exposure to Opium or Other Drugs.

Background There are growing concerns regarding ocular and brain abnormalities in infants who had in utero exposure to various kinds of substances/drugs. We compared the ocular and brain abnormalities among neonates based on the type of drug used by mothers. Methodology This prospective cohort study of 305 neonates included all neonates at Mahdieh Hospital, Tehran, Iran, who had their records for ophthalmic screening and brain sonography and were born to mothers with a history of substance use disorder (2014-2017). Demographic data, results for viral antibodies (human immunodeficiency virus, hepatitis C, and hepatitis B), and Apgar scores at one and five minutes were collected. We excluded neonates with Apgar score <8 at one minute, weight <1,800 g, gestational age <35 weeks, asphyxia, or anomalies. The neonates' eyes were examined using tropicamide 0.5%, phenylephrine 2.5%, and tetracaine. Results The prevalence of substance use disorder among pregnant women was 1.8%. The study included 305 neonates with a mean gestational age of 37.8 ± 1.6 weeks, while the mean age of their mothers with substance use disorder was 29.8 ± 6.4 years. Ophthalmologic examination showed that 37 (12%) neonates had abnormal incomplete retina vascularization, and brain abnormalities were seen in 29 (9.5%) neonates; however, no difference was identified based on the type of drug used by mothers. The birth weight (BW) of the neonates depended on the type of drugs used by the mothers (p = 0.027). Maternal use of cannabis and amphetamine were associated with the lowest and highest BWs (2,800 ± 283 and 3,750 ± 42 g), respectively. Conclusions The BW of neonates depended on the type of drugs used by the mothers, where cannabis and amphetamine use were associated with the lowest and highest BWs, respectively. However, our data could not identify if neonates' ocular and brain abnormalities differed based on the types of drugs. This study highlights the importance of a drug-free pregnancy and the need for addiction-prevention programs provided to women of childbearing age.

Evaluation of Neurodevelopmental Outcomes in Premature Twins (Multigestations) with Retinopathy of Prematurity Receiving Anti-VEGF: A Comparison Study.

Purpose: To assess possible neurodevelopmental delay (NDD) following intravitreal antivascular endothelial growth factor (VEGF) injection in neonates with retinopathy of prematurity (ROP). Methods: In this retrospective cohort study, neurodevelopmental milestones in patients with a history of ROP and intravitreal bevacizumab (IVB) injection were compared with other gestations that received either no treatment or only a laser for treatment. Results: One hundred and twenty-five neonates (of 59 multi-gestation pregnancies) were included in this study (with the range of age 1-7 years old). Sixty-five (51.18%) were male and sixty-two (48.81%) were female. The mean gestational age (GA) and birth weight of all neonates were 29.69 ± 1.57 weeks (ranges: 26-33 weeks) and 1312.50 ± 269.33 grs (ranges: 730-2100 grs). None of the neurodevelopmental outcomes were statistically different when two subgroups in group A (IVB vs. control) were compared. None of the differences between IVB and laser treated subgroups is statistically significant, except for "reaching for toys," which was delayed in the laser treated subgroup (6.6 ± 2.5 and 6.9 ± 2.5 months in IVB and laser treated subgroups, respectively). Conclusion: In neonates with ROP, there is no linear correlation between intravitreal anti-VEGF injection and neurodevelopmental delay.

Ketamine Analgesia as an Alternative to General Anesthesia During Laser Treatment for Retinopathy of Prematurity.

PURPOSE: To determine the safety and efficacy of ketamine analgesia as an alternative to general anesthesia during laser treatment for retinopathy of prematurity (ROP). METHODS: Eighteen premature neonates with ROP underwent laser treatment. The procedure was performed in the operating room, and the neonates were admitted to the neonatal intensive care unit (NICU) after the procedure. An initial dose of 1 mg/kg of ketamine was administered. If the neonate exhibited movement or distress during the procedure, incremental doses of ketamine were administered. Perioperative ventilation status, severity of pain during the procedure, surgeon satisfaction, and perioperative events were recorded. RESULTS: Eighteen premature neonates underwent ketamine analgesia during laser treatment for ROP. The procedure was performed in 16 patients with good tolerance and without events. The Premature Infant Pain Profile (PIPP) scores during the procedure were 5 or less in 12 neonates (44.4%), 5 to 10 in 4 neonates (22.2%), and greater than 10 in 2 (11.1%) neonates. Three neonates had perioperative events, which resolved completely with minimal intervention. None of the neonates needed intubation perioperatively, and hemodynamic instability, hypotension, and bradycardia were not recorded in any of the neonates during or after the procedure. CONCLUSIONS: The ROP laser treatment under ketamine sedation could be performed in premature neonates with few perioperative complications and provide satisfactory operative conditions. [J Pediatr Ophthalmol Strabismus. 2022;59(6):416-421.].

Comparison of Intravitreal Bevacizumab and Laser Photocoagulation in the Treatment of Retinopathy of Prematurity.

PURPOSE: To compare the outcomes of patients with type I retinopathy of prematurity (ROP) treated with either intravitreal bevacizumab (IVB) or retinal laser photocoagulation (RLP). DESIGN: Retrospective case series. PARTICIPANTS: Infants treated for type I ROP with IVB or RLP. METHODS: Patients who were born between January 2011 and December 2014 and were treated in Farabi Eye Hospital were included. The outcomes were stratified and analyzed, based on the treatment type and ROP zone. MAIN OUTCOME MEASURES: Need for retreatment, time to regression, refractive errors, retinal adverse anatomic outcomes, and rate of complications. RESULTS: Five hundred twenty-three patients were treated for type 1 ROP, of whom 493 (986 eyes) met inclusion criteria. Seven hundred twenty-four eyes (73.4%) received IVB, and 262 eyes (26.5%) received RLP. Re-treatment (because of recurrent or persistent retinopathy) occurred in 14.4% (106/724) of eyes initially treated with IVB and in 8.8% (23/262) eyes initially treated with RLP (P = 0.065). Re-treatment was not significantly different between the 2 groups for patients with zone I disease (P = 0.978). Re-treatment rate was considerably higher in patients with zone II disease treated with IVB (69/558 [12.3%]) compared with those treated with RLP (20/251 [7.9%]; P = 0.017). In the IVB group, 82.8% and 53.4% of eyes showed an avascular area in zone III (despite ROP regression) at 1 and 2 years after treatment, respectively. The spherical power and the spherical equivalent were significantly higher in eyes treated with RLP (-1.31±2.83 diopters [D] and -2.84±2.77 D, respectively) than eyes treated with IVB (0.19±3.21 D and -1.26±3.19 D, respectively; P = 0.016 and P = 0.007, respectively). Differences in astigmatic power were not significant. CONCLUSIONS: Both IVB and RLP are effective treatments for type 1 ROP. Longer follow-up time is necessary for infants treated with IVB. More patients with zone II disease treated with RLP achieved disease regression after a single treatment than those who received IVB, although outcomes after re-treatment were comparable except for a greater refractive error in patients treated with RLP.

Efficacy of intravitreal bevacizumab for zone-II retinopathy of prematurity.

PURPOSE: To assess the effect of intravitreal bevacizumab for Type 1 retinopathy of prematurity (ROP) in zone II ROP. METHODS: We conducted a randomized clinical trial. Preterm infants with a gestational age less than 34 weeks or birthweight less than 2000 g were examined at 4 weeks chronological age or 31 weeks postmenstrual age (whichever was later). Preterm infants with Zone-II/Stage 2 or 3 and plus disease were included. Eligible infants were randomized to receive either conventional indirect laser therapy or intravitreal bevacizumab injections (0.625 mg/0.025 ml). The primary outcome was defined as treatment failure: ROP persistence or recurrence by 90 weeks postmenstrual age. RESULTS: Our study population comprised 79 infants (158 eyes) with Zone-II ROP. Randomly, 43 infants (86 eyes) were assigned to receive intravitreal bevacizumab and 36 infants (72 eyes) to receive conventional indirect laser therapy. All the infants were followed up at least until 90 weeks postmenstrual age. Stage-3 ROP recurred in nine eyes (10.5%) in the bevacizumab group and one eye (1.4%) in the laser group (p value = 0.018). In recurrent cases after the second treatment, ROP in eight of the nine eyes (88.8%) in the bevacizumab group and the eye in the laser group regressed. CONCLUSION: Recurrence of neovascularization with bevacizumab monotherapy seems to be higher than that with conventional laser therapy among infants with Type 1 ROP in zone II ROP but reinjection of bevacizumab causes regression in most recurrent cases.

Retinopathy of prematurity: incidence, risk factors, and outcome.

BACKGROUND: This study was planned to determine the rate, the predisposing factors, and the outcome of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants hospitalized in the neonatal intensive care unit (NICU) of a tertiary care hospital in Tehran.  METHODS: All VLBW neonates admitted to the NICU, from April 2007 through March 2010 were enrolled. All relevant perinatal data, including the hospital course up to the time of discharge were documented. Repeated ophthalmologic examinations were done by a single ophthalmologist to observe the progression and subsequent resolution of ROP. RESULTS: Out of 414 infants undergoing ophthalmologic examination, ROP was detected in 71 infants (17.14 %); 3.4 % stage I, 8.7 % stage II, and 5.1 % stage III. ROP stages IV or V were not detected. After adjustment for different variables, the following independent risk factors were identified: VLBW (P = 0.002, OR = 4.89), multiple gestation (P = 0.001, R = 3.51), resuscitation at birth (P = 0.003, OR = 3), blood transfusion more than 45 mL/kg (P = 0.02, OR = 4.91), oxygen therapy for more than five days (P = 0.009, OR = 3.11), and age more than 10 days to regain birth weight (P = 0.008, OR = 1.06).Thirty-three patients with stages II and III ROP were treated with laser therapy, all of them improved and none progressed to blindness.  CONCLUSION: Our findings identify the major risk factors for ROP; skillful management of high-risk pregnancies, prevention of preterm births, appropriate neonatal care, high index of suspicion, routine screening, and prompt treatment are crucial to prevent the development and progression of ROP.