Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study.

PURPOSES: To develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW). METHODS: A multicentre retrospective cohort study was conducted based on data from four tertiary neonatal intensive care units in Shanghai, China. The medical records of enrolled infants, born from 2012 to 2016 who underwent ROP examinations, were collected and analysed. The incidence and risk factors for ROP were analysed in all infants. Postnatal age (PNA) and postmenstrual age (PMA) of infants, detected to diagnose ROP for the first time, were compared with the present examination schedule. The predictive performance of screening models was evaluated by internally validating sensitivity and specificity. RESULTS: Of the 5606 eligible infants, ROP was diagnosed in 892 (15.9%) infants; 63 (1.1%) of them received treatment. The mean GA of ROP patients was 29.4±2.4 weeks, and the mean BW was 1260±330 g. Greater prematurity was associated with an older PNA at which ROP developed. The minimum PMA and PNA at which diagnosis of treatable ROP occurred were 32.43 and 3 weeks, respectively. The optimised criteria (GA <32 weeks or BW <1600 g) correctly predicted 98.4% type 1 ROP infants, reducing the infants requiring examinations by 43.2% when internally validated. CONCLUSIONS: The incidence of type 1 ROP and the mean GA and BW of ROP infants have decreased in China. The suggested screening threshold and schedule may be reliably used to guide the modification of ROP screening guideline and decrease medical costs.

Type 1 Retinopathy of Prematurity and Its Laser Treatment of Large Preterm Infants in East China.

PURPOSE: To describe Type 1 retinopathy of prematurity (ROP) and its laser treatment outcomes in premature infants with birth weight > 1250 g in Eastern China. METHODS: A retrospective review of 3175 ROP records was conducted at Shanghai Eye & ENT Hospital of Fudan University. The records were collected at the ROP clinic from 2006 to 2014, including their demographic and medical information such as gestational age, birth weight, supplemental oxygen therapy, systemic complications, ROP stage, location, presence of plus disease. All infants were examined by RetCam fundus camera. Those with Type 1 ROP were also examined by indirect ophthalmoscope before undergoing transpupillary laser treatment. RESULTS: A total of 12 infants (24 eyes) with Type 1 ROP and birth weight > 1250 g were enrolled. All infants enrolled had plus disease and ROP in zone II retina. Specifically, 16 eyes (67%) had stage 2 ROP. 8 eyes (33%) had stage 3 ROP. ROP regressed in 23 eyes (96%) following laser treatment. Partial retinal detachment developed in one eye (4%). No severe involution sequelaes or laser-related complications were recorded. Mean follow-up was 30±6 weeks. CONCLUSION: Type 1 ROP may occur in large premature infants who have undergone supplemental oxygen therapy. This Type 1 ROP is mainly located in zone II retina. Laser treatment is a safe and effective intervention for these infants.

Refractive status of Chinese with laser-treated retinopathy of prematurity.

PURPOSE: To analyze changes in myopia, astigmatism, and anisometropia after laser treatment of retinopathy of prematurity (ROP), including aggressive posterior retinopathy of prematurity (APROP), in Mainland Chinese children. METHODS: This was a retrospective study of children who had laser treatment for threshold or type 1 prethreshold ROP between January 2004 and October 2012 and age-matched control subjects with spontaneously regressed type 2 prethreshold ROP. One hundred fifteen eyes of 60 patients were included as the laser-treated group, which were further subdivided into APROP and non-APROP groups. Thirty-seven eyes of 20 patients who were diagnosed during the same period were included as the control group. Between 12 and 36 months postnatal age (PA) (mean [±SD], 22.9 [±8.1] months), cycloplegic retinoscopy was performed to measure refractive outcomes. A general linear model was used to analyze refractive changes among different groups at each PA. RESULTS: After adjusting for PA and the correlation between right and left eyes, the magnitude and proportion of astigmatism (p = 0.04 and p = 0.004, respectively) and myopia (p < 0.0001 and p = 0.006, respectively) were greater in the laser-treated group than in the control group. The differences in myopia were even greater in children with APROP than those with non-APROP, whereas the differences in astigmatism were not. Eyes with APROP had higher prevalence of high myopia and spherical anisometropia than the control (p = 0.002 and p = 0.02, respectively) and the non-APROP groups (p < 0.0001 and p = 0.04, respectively). CONCLUSIONS: Children with laser treatment for ROP, including APROP, tended to have higher myopia, astigmatism, and anisometropia, which may progress to amblyopia. These findings highlight the need for regular refractive screening after laser treatment of ROP.

Natural involution of acute retinopathy of prematurity not requiring treatment: factors associated with the time course of involution.

PURPOSE: We identified the timing of natural involution of acute retinopathy of prematurity (ROP) not requiring treatment and determined the risk factors associated with delayed involution. METHODS: In this retrospective case series, 82 eyes (the more severe eye) of 82 infants who developed at least one clock hour of acute ROP, stages 1 through 3, but who didn't progress to type 1 ROP, were selected for analysis. The location, extent, and severity of ROP were documented by investigators during serial retinal examinations. The onset and completion of the ROP's involution were determined from a review of these data. Two groups were classified by the involution pattern: Group 1 included infants whose ROP disease involuted before 50 weeks of postmenstrual age, and Group 2 included infants whose ROP disease involuted over 50 weeks (delayed involution). A total of 14 possible risk factors was included in the logistic regression analysis to assess the relationship between each factor and the involution pattern. RESULTS: Acute ROP not requiring treatment began to involute at a mean of 40.4 weeks of postmenstrual age and finished at a mean of 50.6 weeks. Involution began at the same mean postmenstrual age for each zone of disease (P = 0.48) and finished earlier in zone III than in zone II (P < 0.01). An analysis by severity of ROP found that involution began the earliest with the mildest disease (stage 1; mean, 38.1 weeks) and latest with the most serious disease (stage 3; mean, 42.3 weeks; P < 0.01). Zone II disease took longer to finish involution (16.04 ± 12.35 weeks) than zone III (8.30 ± 7.3 weeks), and stage 3 (23.88 ± 10.58 weeks) took longer to finish involution than stage 1 (2.03 ± 0.96 weeks) and stage 2 disease (7.69 ± 4.75 weeks, P < 0.01, respectively). No unfavorable outcome was found in our series. Multivariable logistic regression analysis showed that continuous positive airway pressure (CPAP, P < 0.0001), active stage 3 disease (P = 0.006), and anemia (P = 0.03) were significant risk factors associated with delayed involution. CONCLUSIONS: The natural involution of acute ROP not requiring treatment correlated better with severity than with ROP location. Active stage 3 disease, CPAP, and anemia were predictive risk factors for delayed involution of ROP.

AAV-mediated gene transfer of human X-linked inhibitor of apoptosis protects against oxidative cell death in human RPE cells.

PURPOSE: To determine whether human X-linked inhibitor of apoptosis (XIAP) enhances the survival of cultured human retinal pigment epithelial cells exposed to H(2)O(2). METHODS: ARPE-19 cells were exposed to H(2)O(2) to induce oxidative cell death. Intracellular reactive oxygen species (ROS) were measured using 2',7'-dichlorofluorescein diacetate. MTT assay was performed to quantify mitochondrial stress. Cell apoptosis was determined by TUNEL assay. Human XIAP was delivered with bicistronic expression of green fluorescent protein (GFP), using recombinant adeno-associated virus (AAV-XIAP-GFP). The null vector, containing identical sequences but without XIAP, was used as a control (AAV-NULL-GFP). Transduced cells underwent fluorescence-activated cell sorting. XIAP overexpression was examined by immunostaining and Western blot analysis. RESULTS: ARPE-19 cells exposed to 0.25 mM H(2)O(2) for 1 hour showed increased TUNEL staining compared with nonstressed cells (17 ± 1.4 vs. 1.8 ± 0.4 cells per 20 × field; P = 0.000006), accompanied by a significant increase in intracellular ROS (207 ± 46% vs. 100 ± 9.5%; P = 0.0002). The AAV-XIAP-GFP transduced cells had 11-fold higher XIAP expression than the AAV-NULL-GFP controls (1300 ± 126% vs. 120 ± 10%; P = 0.0006). XIAP over-expression significantly reduced the number of apoptotic cells after stress compared with the AAV-NULL-GFP controls (3.2 ± 0.6 vs. 18 ± 1.6 cells per 20 × field; P = 0.00003). Mitochondrial stress was reduced by AAV-XIAP-GFP, but did not reach a statistical significance (68 ± 3.5% vs. 74 ± 3.8%; P = 0.24). CONCLUSIONS: Overexpression of human XIAP protects ARPE-19 cells against H(2)O(2)-induced oxidative cell death by acting downstream on the apoptotic pathway. XIAP gene therapy using AAV may provide a means of reducing the effect of oxidative stress to RPE cells in age-related macular degeneration.

[Clinical therapeutic efficiency of chemoreduction and local therapy for children with retinoblastoma].

OBJECTIVE: To evaluate the therapeutic efficiency of customized combined therapy for retinoblastoma. METHODS: Retrospective case series. Twenty nine patients (40 eyes) with retinoblastoma were accepted customized combined therapy between Jan. 2005 and Dec. 2007 in our hospital. The combined therapy included chemoreduction using vincristine, etoposide, and carboplatin (VEC) combined with local cryotherapy and/or transpupillary thermotherapy (TTT). The average follow-up duration was 38 months and ranging from 12 to 50 months. RESULTS: Twenty five patients had bilateral retinoblastoma, 4 patients had unilateral retinoblastoma. The stages of 40 eyes were classified according to the International Intraocular Retinoblastoma Classification, 14 eyes (35%) were group A, 9 eyes (22.5%) were group B, 4 eyes (10%) were group C, 10 eyes (25%) were group D, and 3 eyes (7.5%) were group E. Seventeen eyes had vitreous and/or subretinal seeds. The overall globe preservation rate was 75% (30/40); and was 100% (14/14) in group A, 100% (9/9) in group B, 75% (3/4) in group C, 40% (4/10) in group D and 0% (0/3) in group E. A progressive decrease of globe preservation rate was observed in eyes with advanced stages. Tumor recurrence was detected in 4 eyes after chemoreduction, leading to the enucleation. Ten eyes were enucleated in the present series, with 1 eye in group C, 6 eyes in group D and 3 eyes in group E. None of 29 patients died during the follow-up. No patients had any serious side effect of chemotherapy such as leukemia. CONCLUSIONS: The customized combined therapy can effectively preserve certain patients' eyeballs and even obtain useful visual function. The International Intraocular Retinoblastoma Classification is useful in the clinical management of retinoblastoma.