Review of incidental ocular pathologies detected during the screening of retinopathy of prematurity in preterm infants.

AIM: The aim of the study was to report the spectrum of ocular pathologies other than retinopathy of prematurity (ROP) occurring in preterm babies, suggesting the need for universal screening in all babies. METHODS: Babies born before 34 weeks of gestational age (GA) and/or weighing <2000 g were screened at around 4 weeks of postnatal age and those born before 28 weeks of GA and weighing <1200 g were examined at 2-3 weeks of postnatal age. Babies between 34 and 36 weeks of GA or birth weight of 1750-2000 g with additional risk factors were also screened. Pupils were dilated using a fixed dose combination of 0.4% tropicamide and 2.5% phenylephrine. The babies underwent retinal imaging using the 3nethra neo camera, Forus, India, by a skilled ophthalmic photographer. RESULTS: A total of 1437 preterm babies were screened in an outreach project which spanned 18 hospitals equipped with neonatal intensive care centers (neonatal intensive care units) in an urban setting during the study period. A total of 4339 screening sessions were conducted. Of these infants, 754 (52.47%) were male and 683 (47.52%) were female babies. Among the enrolled infants, 165 (12.16%) had ocular findings other than ROP. Of the 165 cases, 70 (42.42%) were anterior segment and globe pathologies, whereas the remaining 95 (57.57%) were posterior segment pathologies. CONCLUSION: Timely screening helps in identifying and managing potentially vision-threatening pathologies including ROP. This will help reduce the burden of childhood blindness worldwide.

Retinopathy of prematurity in preterm infants born following assisted conception versus spontaneously conceived pregnancies - A 2-year retrospective observational study from an urban tertiary eye care referral center in South India.

Purpose: The aim of this study is to determine if in vitro fertilization (IVF) is associated with an increase in the incidence of retinopathy of prematurity (ROP) among preterm infants. Methods: This retrospective, comparative study included all the preterm babies who were screened under an urban multicentric outreach project between April 2019 and August 2022. Infant details including gender, birth weight, mode of conception, single or multiple gestation, gestational age and post-menstrual age in weeks, age at presentation, and any presence of risk factors were recorded and analyzed. Results: Among 444 preterm babies included in the study, 373 (84%) were conceived normally and 71 (16%) were conceived by IVF. ROP was found in 99 (22.29%) babies in total. There was no significant difference in the incidence of any stage of ROP between the two groups; however, higher stages of ROP were found to be relatively more frequent in the spontaneous conception group in our study. We also found a statistically significant difference in the presence of ROP among singletons, twins, and triplets. Conclusion: IVF was found not to independently increase the risk of ROP in preterm infants. More prospective studies and randomized controlled trials are needed to establish the relationship between the mode of conception and development of severe ROP in preterm infants.

Need for manual segmentation in optical coherence tomography angiography of neovascular age-related macular degeneration.

PURPOSE: To compare the characteristics of eyes that had manual vs. automated segmentation of choroidal neovascular membrane (CNVM) using optical coherence tomography angiography (OCTA). METHODS: All patients with CNVM underwent OCTA using the Zeiss Angioplex Cirrus 5000. Slabs of the avascular outer retina, outer retina to choriocapillaris (ORCC) region and choriocapillaris were generated. Manual segmentation was done when there were significant segmentation artifacts. Presence of activity of CNVM was adjudged by the presence of subretinal fluid (SRF) on structural OCT and was compared to activity detected on en face OCTA slabs based on well-defined criteria. RESULTS: Eighty-one eyes of 81 patients were recruited of which manual segmentation was required in 46 (57%). Eyes with automated segmentation had significantly more CNVM in the ORCC (75%) whereas those with manual segmentation had deeper CNVM (sub-RPE = 22%, intra-PED = 22%) (p<0.001). Twenty eyes (25%) were found to have active CNVM on both the structural OCT and OCTA while an additional 19 eyes were presumed to have active CNVM on OCTA alone. There was only modest concordance between disease activity detected using structural OCT and OCTA (Kappa = 0.47, 95% CI = 0.30 to 0.64). CONCLUSIONS: Manual segmentation of OCTA is required in more than 50% eyes with CNVM and this progressively increases with increasing depth of CNVM location from the ORCC to below the RPE. There is moderate concordance between OCTA and structural OCT in determining CNVM activity.

Macular edema in Asian Indian premature infants with retinopathy of prematurity: Impact on visual acuity and refractive status after 1-year.

PURPOSE: To report the impact of transient, self-resolving, untreated "macular edema" detected on spectral domain optical coherence tomography in Asian Indian premature infants with retinopathy of prematurity (ROP) on visual acuity (VA) and refraction at 1-year of corrected age. MATERIALS AND METHODS: Visual acuity and refraction of 11 infants with bilateral macular edema (Group A) was compared with gestational age-matched 16 infants with ROP without edema (Group B) and 17 preterms infants without ROP and without edema (Group C) at 3, 6, 9 and 12 months of corrected age using Teller Acuity Cards and cycloplegic retinoscopy. Sub-group analysis of the previously described pattern A and B macular edema was performed. RESULTS: Visual acuity was lower in infants with macular edema compared with the other two control groups throughout the study period, but statistically significant only at 3 months. Visual improvement in these infants was highest between the 3 rd and 6 th month and plateaued by the end of the 1 st year with acuity comparable to the other two groups. The edema cohort was more hyperopic compared to the other two groups between 3 and 12 months of age. Pattern A edema had worse VA compared to pattern B, although not statistically significant. CONCLUSION: Macular edema, although transient, caused reduced VA as early as 3 months of corrected age in Asian Indian premature infants weighing <2000 g at birth. The higher hyperopia in these infants is possibly due to visual disturbances caused at a critical time of fovealization. We hypothesize a recovery and feedback mechanism based on the principles of active emmetropization to explain our findings.