Patients' perspective on prostatic artery embolization: A qualitative study.

OBJECTIVES: The aim was to describe the patients' experience of undergoing prostatic artery embolization. METHODS: A retrospective qualitative interview study was undertaken with 15 patients of mean age 73 years who had undergone prostatic artery embolization with a median duration of 210 min at two medium sized hospitals in Sweden. The reasons for conducting prostatic artery embolization were clean intermittent catheterization (n = 4), lower urinary tract symptoms (n = 10) or haematuria (n = 1). Data were collected through individual, semi-structured telephone interviews 1-12 months after treatment and analysed using qualitative content analysis. RESULTS: Four categories with sub-categories were formulated to describe the results: a diverse experience; ability to control the situation; resumption of everyday activities and range of opinions regarding efficacy of outcomes. Overall, the patients described the procedure as painless, easy and interesting and reported that while the procedure can be stressful, a calm atmosphere contributed to achieving a good experience. Limitations on access to reliable information before, during and after the procedure were highlighted as a major issue. Practical ideas for improving patient comfort during the procedure were suggested. Improved communications between treatment staff and patients were also highlighted. Most patients could resume everyday activities, some felt tired and bruising caused unnecessary worry for a few. Regarding functional outcome, some patients described substantial improvement in urine flow while others were satisfied with regaining undisturbed night sleep. Those with less effect were considering transurethral resection of the prostate as a future option. Self-enrolment to the treatment and long median operation time may have influenced the results. CONCLUSIONS: From the patients' perspective, prostatic artery embolization is a well-tolerated method for treating benign prostate hyperplacia.

Extreme prematurity, treated retinopathy, bronchopulmonary dysplasia and cerebral palsy are significant risk factors for ophthalmological abnormalities at 6.5 years of age.

AIM: This study evaluated the contributions of various prenatal and postnatal predictive factors to a documented high prevalence of ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm. METHODS: We carried out a prospective population-based study of all children born in Sweden at a gestational age of 22 + 0 to 26 + 6 weeks based on the Extremely Preterm Infants in Sweden Study. The main outcome measures were a combined score of visual impairment, refractive errors and strabismus at 6.5 years of age. Models of univariate and multivariable regression were used to analyse potential prenatal and postnatal predictive factors at different clinically relevant time-points from one minute after birth to 30 months. RESULTS: We focused on 399 known extremely preterm survivors and compared them to 300 full-term controls. Significant antecedents for ophthalmological abnormalities included prematurity per se, retinopathy of prematurity that required treatment, severe bronchopulmonary dysplasia and cerebral palsy. Severe intraventricular haemorrhage was no longer a significant risk factor when we adjusted it for the 30-month cognitive and neuromotor development outcomes. CONCLUSION: This time-course risk analysis model showed a changing panorama of significant risk factors for ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.

Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register.

BACKGROUND/AIMS: Retinopathy of prematurity (ROP) is a sight-threatening disease, requiring efficient screening and treatment. The present study aims to describe various aspects on treatment for ROP in Sweden. METHODS: Data on treatment for ROP in infants born in 2008-2012 were extracted from Swedish national register for retinopathy of prematurity, a web-based national register. RESULTS: During 2008-2012, 3488 infants with a gestational age (GA) at birth of <31 weeks had been screened for ROP in Sweden. Altogether, 30.3% (1057/3488) of the infants developed ROP and 5.2% (181/3488) were treated. Type 1 ROP was found in at least one eye in 83.2% (149/179) of the treated infants. One third of the eyes (32.2% right, 29.9% left eyes) were treated more than once. Laser was the only treatment in 90% of the eyes. Mean number of laser spots at first laser session was 1177 and 1386 in right and left eyes, respectively. Number of laser spots correlated negatively with GA at birth (p=0.01). There was no change in frequency of treatment or number of laser spots during the 5-year period. Anti-vascular endothelial growth factor injections were performed in 28 eyes, encircling band was used in five eyes and vitrectomies were performed in seven eyes. Twenty-six retinal surgeons performed 9.4 (range 1-37) treatment sessions in the 181 infants. CONCLUSIONS: The present study reveals similar incidences of ROP and frequencies of treatment during the 5-year study period. Many surgeons were involved in treatment of a rather limited number of infants. The results call for national discussions on organisation of ROP treatment.

Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age: Extremely Preterm Infants in Sweden Study (EXPRESS).

IMPORTANCE: This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP). OBJECTIVES: To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP. DESIGN, SETTING, AND PARTICIPANTS: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study. MAIN OUTCOMES AND MEASURES: Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP. RESULTS: The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment). CONCLUSIONS AND RELEVANCE: In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.

Evaluation of new guidelines for ROP screening in Sweden using SWEDROP - a national quality register.

PURPOSE: To investigate whether recent Swedish guidelines for Retinopathy of Prematurity (ROP) screening, that is, a gestational age (GA) at birth of <31 weeks (w), are applicable in a new national cohort of prematurely born infants. METHODS: SWEDROP is a national register for ROP, initiated in 2006. The present paper reports on data from the register on various aspects of screening for ROP in infants born between 2010 and 2011 and compares the results with those for a previously published cohort born between 2008 and 2009. RESULTS: During the study period, 1744 infants were screened for ROP. Mean GA was 28.4 w (22-31), and mean birth weight was 1239 g (382-2615). Screening started at postnatal age (PNA) 5.4 w (0.4-13.3) and postmenstrual age (PMA) 33.8 w (24.9-50.1) Mean number of examinations was 5.4 per infant (1-38). Mild (stages 1-2) and severe (≥ stage 3) ROP was found in 15.4% and 8.7%, respectively. Treatment was performed in 4.2% (73/1744) of the infants, but in none with a GA of 30 weeks or more. The first treatment was performed at a mean PNA and PMA of 12.7 w (7.7-25.4) and 37.4 w (32.1-51.4), respectively. CONCLUSIONS: Recently introduced new guidelines for ROP screening in Sweden remain applicable. Reassuringly, in infants born between 2010 and 2011, incidence of ROP, frequency and timing of treatment, frequency and timing of examinations and national coverage of ROP screening remained almost identical to those for a previous cohort from 2008 to 2009. The two SWEDROP cohorts provide a basis for discussion among Swedish ophthalmologists and neonatologists on the question of further lowering the upper screening limit with 1 week.

Ophthalmologic outcome at 30 months' corrected age of a prospective Swedish cohort of children born before 27 weeks of gestation: the extremely preterm infants in sweden study.

IMPORTANCE: Follow-up at 30 months' corrected age reveals eye and visual problems in one-third of children born extremely prematurely (<27 weeks' gestation). OBJECTIVE: To investigate the ophthalmologic outcome of extremely preterm children at 30 months' corrected age. DESIGN, SETTING, AND PARTICIPANTS A prospective, population-based follow-up study (Extremely Preterm Infants in Sweden Study [EXPRESS]) was conducted in Sweden. The population included extremely preterm infants (<27 weeks' gestation) born in Sweden between 2004 and 2007, of whom 491 survived until age 2.5 years. Screening for retinopathy of prematurity (ROP) was performed in the neonatal period. At 30 months' corrected age, an ophthalmologic assessment was performed in 411 of 491 children (83.7%). MAIN OUTCOMES AND MEASURES: Visual acuity, manifest strabismus, and refractive errors were evaluated. RESULTS: Visual impairment was identified in 3.1% of the children, and 1.0% were blind. Refractive errors, defined as myopia less than -3 diopters (D), hypermetropia greater than +3 D, astigmatism 2 D or more, and/or anisometropia 2 D or more, were found in 25.6% of the children, and 14.1% had manifest strabismus. There were significant associations between visual impairment and treated ROP (P = .02), cognitive disability (P < .001), and birth weight (P = .02). Multiple regression analyses revealed significant associations between strabismus and treated ROP (P < .001), cognitive disability (P < .01), and cerebral palsy (P = .02). Refractive errors were significantly correlated with severity of ROP (right eye, P < .001; left eye, P < .01). Children who had been treated for ROP had the highest frequency (69.0%) of eye and visual abnormalities. CONCLUSIONS AND RELEVANCE: One-third of the extremely prematurely born children in this study had some kind of eye or visual problems, such as visual impairment, strabismus, or major refractive error. Despite being born extremely preterm, the present cohort has a similar prevalence of blindness and visual impairment as in previous Swedish cohorts of children born less prematurely.

Regional differences in screening for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden--the EXPRESS study.

PURPOSE: The primary aim was to analyse regional incidences of retinopathy of prematurity (ROP) and frequencies of treatment and their relation to perinatal risk factors during a 3-year period. A secondary aim was to study adherence to the study screening protocol in the different regions. METHODS: A population-based study of neonatal morbidity in extremely preterm infants in Sweden (EXPRESS) was performed during 2004-2007. Screening for ROP was to start at postnatal age 5 weeks and to continue weekly until the retina was completely vascularized or until regression of ROP. Logistic regression analyses were used for evaluation of differences in incidence of Any ROP, ROP 3 or more and ROP Type 1 between the seven regions of the country. RESULTS: The regional incidence of ROP varied between 54% and 92% for Any ROP, between 25% and 43% for ROP stage 3 or more and between 8% and 23% of infants with ROP Type 1, all of whom were treated. There was no significant difference between the regions regarding ROP Type 1, even when adjusting for known risk factors for ROP. CONCLUSION: The heterogeneity between the regions regarding the incidence of ROP was reduced with increasing severity of ROP, and there was no heterogeneity regarding frequency of treatment for ROP, which is the most important issue for the children. We cannot exclude observer bias regarding mild ROP and ROP stage 3 in this study.

Swedish national register for retinopathy of prematurity (SWEDROP) and the evaluation of screening in Sweden.

OBJECTIVES: To evaluate screening for retinopathy of prematurity (ROP) in Sweden and to investigate possible modifications of the present screening guidelines. METHODS: Infants in Sweden with a gestational age (GA) of 31 weeks + 6 days or less are screened for ROP. Data from the Swedish national register for ROP (SWEDROP) during 2008 and 2009 were extracted and compared with a national perinatal quality register. RESULTS: In SWEDROP, there were 1791 infants born before a GA of 32 weeks from January 1, 2008, through December 31, 2009. Another 70 infants were registered in the perinatal quality register but not in SWEDROP (dropout rate, 3.8% [70 of 1861 infants]). Seven infants died before termination of screening. In the final study cohort (1784 infants), 15.6% had mild ROP and 8.5% had severe ROP. Treatment was performed in 4.4% of the infants, none of whom had a GA at birth of more than 28 weeks. Nine infants with a GA of more than 28 weeks at birth developed stage 3 ROP, which regressed spontaneously. The total number of examinations was 9286 (964 in infants with a GA of 31 weeks), and the mean (range) number of examinations of each infant was 5.2 (1-30). CONCLUSIONS: The SWEDROP, a quality register for ROP, has a national coverage (ie, participation) of 96%. Data from 2008 to 2009 show that it seems possible to reduce the upper limit for screening in Sweden by 1 week, including only infants with a GA of 30 weeks + 6 days or less. However, such a change should be combined with a strong recommendation to neonatologists to refer also severely ill and more "mature" infants.

Screening for retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden.

OBJECTIVE: To analyze screening for retinopathy of prematurity (ROP) during a 3-year period in a national cohort of infants born before 27 weeks' gestation. METHODS: A national prospective study of neonatal morbidity in extremely preterm infants was performed in Sweden between April 1, 2004, and March 31, 2007. Screening for ROP was to start in the fifth postnatal week and to continue weekly until complete vascularization of the retina or until regression of ROP. RESULTS: The first eye examination was performed no later than the sixth postnatal week in 84.8% of 506 infants, and the last examination was performed at postmenstrual age (PMA) of 38 weeks or later in 96.2% of infants. The mean and median numbers of days between examinations in the total cohort were 8.6 and 7.9 days, respectively (range, 1-27.8 days), and the mean and median numbers of examinations were 12 and 10, respectively. Most infants were treated during a limited period (eg, at PMA of 39 weeks, 75.0% of infants had been treated). CONCLUSIONS: The objective of screening for ROP is timely detection of ROP before reaching treatment of criteria, ie, type 1 ROP, according to the Early Treatment for ROP recommendations. In our population of infants born before 27 weeks' gestation, the first examination could safely be postponed until PMA of 31 weeks because the onset of ROP stage 3 did not occur before then and criteria for treatment were not reached before PMA of 32 weeks. Gestational age at birth and PMA at the time of examination should be considered when deciding when and where the next examination should be performed.

Incidence of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden.

OBJECTIVE: To determine the incidence of retinopathy of prematurity (ROP) in extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. METHODS: A national, prospective, population-based study was performed in Sweden from April 1, 2004, to March 31, 2007. The ophthalmologic part of the study was separately organized, and screening for ROP was performed beginning postnatal week 5. The criteria for the treatment of ROP agreed with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: During the study, 506 of 707 live-born infants survived until the first eye examination. Of these, 368 (72.7%) had ROP: 37.9% had mild ROP and 34.8% had severe ROP. Ninety-nine infants (19.6%) were treated. Gestational age at birth was a stronger predictor of ROP than was birth weight. A log-linear relationship between severe ROP and gestational age at birth was found in the present cohort, and the risk of ROP was reduced by 50% for each week of increase in gestational age at birth. CONCLUSIONS: Today, extremely preterm infants are surviving, and this population-based study with ROP as a primary outcome shows a higher incidence of this condition than in previously reported national cohorts.

Fourier-analysed steady-state VEPs in pre-school children with and without normal binocularity.

Pre-school children aged 4-5 were examined with steady-state VEP in response to a sinusoidal grating pattern with a spatial frequency of 4 c/deg, reversing at rates 5, 10, and 15 Hz. Normal children (n = 10) were compared with subjects lacking stereo perception (n = 6) and with subjects showing significant unilateral amblyopia with visual acuity in the worse eye <0.5 (n = 7). Fast Fourier Transform was used for analysis of the crude steady-state VEP responses. Compared to normals, the subjects lacking stereo perception showed a significantly lower power of the second harmonic in the response evoked by binocular stimulation with gratings reversed at 15 Hz. The amblyopic group showed a significant difference between the dominant and the non-dominant eye regarding the first harmonic power in the responses evoked by gratings reversed at 5 and 10 Hz. These findings are discussed in relation to the magnocellular and parvocellular visual pathways and suggested models for linear and non-linear processing of visual signals.

[Complications during the neonatal period can cause visual impairment later in life. Only few of the children were born prematurely--a surprising result of the study]. / Komplikationer i nyföddhetsperioden kan ge synhandikapp senare i livet. Men få av barnen var för tidigt födda--ett studieresultat som förvånar.

Forty per cent of children known at our low vision centre at the Department of Ophthalmology, University Hospital, Linköping, Sweden, had been treated in a neonatal ward after birth. Only few of them were born prematurely. Half of the children had an additional neurological handicap. The present neonatal screening program detects most cases of congenital cataract and all cases with retinopathy of prematurity.

The frequency of amblyopia among visually impaired persons.

PURPOSE: To investigate the frequency of amblyopia among visually handicapped patients. METHODS: The study is a retrospective investigation of all living patients registered in four Visual Rehabilitation Centres in a region in southern Sweden. The area's total population numbered 865,612 persons of whom 11,365 were registered as visually handicapped (with visual acuity < or = 0.3 in the better eye). RESULTS: Amblyopia was the main cause of decreased visual acuity in one eye in 1.72% (195 of 11,365) of the patients. The average age of the patients with amblyopia was 69 years (9-95 years) and 28.2% of these patients were less than 65 years old (the age for retirement in Sweden). The median visual acuity in the amblyopic eye among these patients was 0.1. The median visual acuity in the nonamblyopic eye was 0.2. The most common cause of decreased vision in the nonamblyopic eye was macular degeneration (39.5%). Bilateral amblyopia was present in 13 (6.7%) of the amblyopic patients. By comparing this study with earlier studies, we can calculate that about 1.2% of the persons with amblyopia 0.3 or lower will eventually become visually handicapped. CONCLUSION: A small but considerable number of patients who attend the Visual Rehabilitation Centres have amblyopia as a cause of their visual impairment. Since amblyopia can be treated if detected in childhood, later visual rehabilitation of these patients can be avoided or delayed, thereby reducing rehabilitation costs for society.