Analysis of the Recurrence of Plus Disease after Intravitreal Ranibizumab as a Primary Monotherapy for Severe Retinopathy of Prematurity.

PURPOSE: To assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II, and of aggressive posterior ROP treated with a single dose of intravitreal ranibizumab (IVR) as monotherapy. DESIGN: Retrospective study. PARTICIPANTS: The study included premature babies diagnosed with aggressive posterior ROP or ROP 3+ in zone I or posterior zone II. METHODS: Intravitreal injection of 0.25 mg (0.025 mL) ranibizumab was performed in the operating room. A disposable 1-mL syringe with a 30-gauge needle was used. MAIN OUTCOME MEASURES: Favorable outcome was considered regression of ROP after treatment (meaning regression of the retinal neovascularization and plus disease). Unfavorable outcome was progression to stages 4 and 5 of ROP. RESULTS: The study included 43 infants (85 eyes). The mean birth weight and gestational age were 1276±302 g and 29.7±2.0 weeks, respectively. The mean postmenstrual age at ROP diagnosis was 36±2.7 weeks and at treatment was 37.2±2.2 weeks. All 85 eyes demonstrated total regression of plus disease after a single dose of IVR. Twelve infants (29.2%) developed full vascularization of the peripheral retina in both eyes. Twenty-two infants (43 eyes [53.6%]) developed ROP reactivation at a mean interval of 7.1±3 weeks (range, 3-15 weeks) after IVR and needed rescue laser treatment of the peripheral avascular retina. The mean postmenstrual age at rescue laser was 43±3.2 weeks (range, 35.5-54.5 weeks). Six patients (11.6%) had persistent peripheral avascular retina in zone II for >6 months (or 24 weeks) after IVR treatment. CONCLUSIONS: Although there was complete regression of plus disease in all treated eyes, only 29.2% of the patients reached complete peripheral retinal vascularization. There was a disease reactivation in 53.6% of the patients and they needed additional laser therapy. The results of IVR treatment in severe ROP, even when initial control of the disease was achieved, did not eliminate the risk of late reactivation of the disease by retinal neovascularization. Some of the treated patients may achieve a permanent interruption in the development of the peripheral retinal vascularization.

Intravitreal ranibizumab as a primary or a combined treatment for severe retinopathy of prematurity.

PURPOSE: The aim of the study was to assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined treatment with laser photocoagulation. METHODS: This is a retrospective study analyzing clinical records of the included patients. Patients were divided into two groups: group 1 included patients who received only IVR treatment; and group 2 was subdivided into group 2A - including patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress, and group 2B - including patients with initial laser photocoagulation and IVR as rescue therapy. Favorable outcomes were regression of the retinal neovascularization and plus disease, meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP. RESULTS: Fifty-seven eyes were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. Group 1 comprised of 16 eyes, with favorable outcomes in 14 eyes (87.5%). Group 2 comprised of 41 eyes, with favorable outcomes in 29 eyes (70.7%), in a mean follow-up period of 12.8 months. CONCLUSION: IVR was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of the 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.

Phialemonium curvatum infection after phacoemulsification: a case report.

PURPOSE: A case of Phialemonium curvatum wound corneal infection after phacoemulsification is reported. METHODS: Case report. RESULTS: The marked aggressiveness of this fungus is demonstrated by the absence of therapeutic response to both medical and surgical treatment. CONCLUSIONS: The poor outcome resulted in evisceration of the affected eye.

Assessment of the contribution of cytokine plasma levels to detect retinopathy of prematurity in very low birth weight infants.

PURPOSE: To prospectively study the association of high cytokine plasma levels with later development of retinopathy of prematurity (ROP) in preterm infants with early-onset sepsis to assess a laboratory test to detect ROP. METHODS: A prospective cohort study was conducted of preterm infants with clinical early-onset sepsis whose birth weight (BW) was ≤1500 g and gestational age (GA) was ≤32 weeks. Plasma samples were assayed for cytokines IL-6, IL-8, IL-10, IL-1ß, and TNF-α. ROP was diagnosed in screening assessments. For the univariate analysis of the known risk factors for ROP, all infants without ROP were designated as the No ROP group, patients with any stage of ROP formed the ROP group, and all treated patients formed the Severe ROP group. The best cutoff points for all cytokine levels were determined by ROC curves. RESULTS: Seventy-four patients were enrolled. Mean GA and BW were 29.6 ± 2.1 weeks and 1110.3 ± 232.5 g, respectively; 49 patients (66.2%) had no ROP and 25 (33.8%) had any stage of ROP (17 had stage 1 or 2 ROP and 8 had stage 3 ROP). IL-6 >357 pg/mL, IL-8 >216 pg/mL, and TNF-α >245 pg/mL were significantly associated with treatable ROP. CONCLUSIONS: There is a relationship between high plasma levels of IL-6, IL-8, and TNF-α in the first days of life with the later development of ROP severe enough to treat in preterm infants with early-onset sepsis. Further epidemiologic studies are needed to explore other possible associations of high serum levels of cytokines with ROP in this population at high risk.

Prevalence of retinopathy of prematurity: an institutional cross-sectional study of preterm infants in Brazil / Prevalencia de retinopatía del prematuro: estudio transversal institucional de niños prematuros en Brasil

OBJECTIVE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in most developed countries. This study aimed to verify ROP prevalence among all very low birth weight (VLBW) preterm infants admitted to a level-3 teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil. METHODS: Institutional cross-sectional study of 407 premature infants with birth weight <1500 g or gestational age (GA) <32 weeks between 2002 and 2007. All infants screened for ROP were examined after the fourth week of life and followed up until the 45th week of adjusted GA. ROP prevalence was estimated at a 95 percent confidence level. RESULTS: Some degree of ROP in one or both eyes occurred in 25.5 percent (104) of all screened infants, and severe ROP (threshold stage 3 or higher, requiring treatment to prevent vision loss, as per the criteria of the U.S.-based Multicenter Trial of Cryotherapy for Retinopathy of Prematurity, CRYO-ROP) occurred in 5.8 percent (24). Based on the criteria of The International Classification for Retinopathy of Prematurity (ICROP, 1984/1987), the disease reached stages 1, 2, and 3 in 11.3 percent (46), 8.4 percent (34), and 5.4 percent (22), respectively. One infant developed the disease up to stage 4 (partial retinal detachment), and one progressed to stage 5 (complete retinal detachment, resulting in 0.2 percent overall prevalence for ROP-induced blindness). CONCLUSIONS: Overall incidence of ROP in this institutional study (25.5 percent) was comparable to international results from developed countries. A comprehensive countrywide survey on ROP in Brazil is recommended to determine any regional differences in disease prevalence.

OBJETIVO: La retinopatía del prematuro (RP) es la principal causa de ceguera infantil en la mayoría de los países desarrollados. El objetivo de este estudio fue verificar la prevalencia de esta afección en todos los niños prematuros de muy bajo peso al nacer ingresados en un hospital docente de tercer nivel de Porto Alegre, Rio Grande do Sul, Brasil. MÉTODOS: Estudio transversal institucional de 407 niños prematuros que nacieron entre 2002 y 2007 con un peso de 1500 g o menos, o 32 semanas de edad gestacional o menos. Todos los niños tamizados para RP se examinaron después de la cuarta semana de vida y tuvieron seguimiento hasta la semana 45 de edad gestacional ajustada. La prevalencia de RP se estimó con un intervalo de confianza de 95 por ciento. RESULTADOS: De los niños tamizados, 104 (25,5 por ciento) presentaron algún grado de RP en uno o ambos ojos, mientras 24 (5,8 por ciento) presentaron RP grave (estadio 3 o mayor; requerían de tratamiento para evitar la pérdida de la visión, según los criterios del Estudio Multicéntrico de Crioterapia para la Retinopatía del Prematuro, CRYO-ROP, realizado en los Estados Unidos de América). Según los criterios de la Clasificación Internacional de la Retinopatía del Prematuro (ICROP, 1984/1987), la enfermedad alcanzó los estadios 1, 2 y 3 en 46 (11,3 por ciento), 34 (8,4 por ciento) y 22 (5,4 por ciento) niños, respectivamente. Un niño desarrolló la enfermedad hasta el estadio 4 (desprendimiento parcial de la retina) y uno alcanzó el estadio 5 (desprendimiento completo de la retina), lo que representó una prevalencia general de ceguera por RP de 0,2 por ciento. CONCLUSIONES: La incidencia general de RP en este estudio institucional (25,5 por ciento) es similar a los resultados obtenidos en países desarrollados. Se recomienda realizar una encuesta exhaustiva nacional sobre RP en Brasil para determinar si existe alguna diferencia regional en la prevalencia de esta enfermedad.

Prevalence of retinopathy of prematurity: an institutional cross-sectional study of preterm infants in Brazil.

OBJECTIVE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in most developed countries. This study aimed to verify ROP prevalence among all very low birth weight (VLBW) preterm infants admitted to a level-3 teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil. METHODS: Institutional cross-sectional study of 407 premature infants with birth weight < or = 1,500 g or gestational age (GA) < or =32 weeks between 2002 and 2007. All infants screened for ROP were examined after the fourth week of life and followed up until the 45th week of adjusted GA. ROP prevalence was estimated at a 95% confidence level. RESULTS: Some degree of ROP in one or both eyes occurred in 25.5% (104) of all screened infants, and severe ROP (threshold stage 3 or higher, requiring treatment to prevent vision loss, as per the criteria of the U.S.-based Multicenter Trial of Cryotherapy for Retinopathy of Prematurity, CRYO-ROP) occurred in 5.8% (24). Based on the criteria of The International Classification for Retinopathy of Prematurity (ICROP, 1984/1987), the disease reached stages 1, 2, and 3 in 11.3% (46), 8.4% (34), and 5.4% (22), respectively. One infant developed the disease up to stage 4 (partial retinal detachment), and one progressed to stage 5 (complete retinal detachment, resulting in 0.2% overall prevalence for ROP-induced blindness). CONCLUSIONS: Overall incidence of ROP in this institutional study (25.5%) was comparable to international results from developed countries. A comprehensive countrywide survey on ROP in Brazil is recommended to determine any regional differences in disease prevalence.