Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety.

Purpose: This study aimed to ascertain the efficacy and safety of an additional posterior to the ridge laser for treatable zone 2 stage 3 retinopathy of prematurity (ROP). Methods: This study was a retrospective chart review of infants undergoing laser treatment for ROP at a single center from March 2014 to March 2022. The chart review specifically searched for infants treated for zone 2 stage 3 ROP with plus disease, where additional posterior to the ridge laser was performed. Results: Seventy-eight eyes of 45 infants met the inclusion criterion. The mean birth weight and gestational age were 1166.09 ± 329.66 gm and 29 ± 2 weeks, respectively. Group 1 comprised 52 eyes treated for high-risk prethreshold stage 3 ROP, while group 2 comprised 26 eyes treated for threshold ROP. 532-nm frequency-doubled Nd:YAG laser (Nidek, Japan) was used in all eyes. Apart from the standard laser to the avascular retina, an additional three rows of laser were applied posterior to the ridge in all eyes during the primary laser sitting (except in two eyes where it was performed as a rescue treatment 2 weeks after the first sitting). No complications were observed during or immediately after the laser procedure. A favorable outcome was achieved in 98.07% of eyes with prethreshold ROP and 76.92% of eyes with threshold ROP. Overall, a favorable outcome was achieved in 71 (91.02%) of the 78 eyes. Conclusion: Posterior to the ridge laser performed in the primary sitting along with the standard laser for treatable stage 3 ROP in zone 2 is safe and effective. Further prospective studies are needed to study this underutilized approach.

Evaluation of clinical profile and screening guidelines of retinopathy of prematurity in an urban level III neonatal intensive care unit.

Purpose: To evaluate the clinical profile and screening guidelines of retinopathy of prematurity (ROP) in an urban level III neonatal intensive care unit (NICU). Methods: : Infants with ≤2000-gm birth weight or <34 weeks gestational age were prospectively screened for ROP in an urban level III NICU between January 2018 and December 2020, based on national screening guidelines. Standard guidelines were used for ROP classification and treatment. Results: In total, 211 infants completed screening; 46 (21.8%) infants developed ROP and 13 (6.2%) had type 1 (laser treatable) ROP. Of the 46 infants with ROP, 44 (95.65%) had zone 2 and two (4.34%) had zone 1 disease. In the 102 infants with ≤1500-gm birth weight, the incidence of ROP and type 1 ROP were 41.18% and 11.76%, respectively. Out of the 109 infants with >1500-gm birth weight, four (3.67%) developed ROP and one (0.91%) infant (an outborn) required treatment. Conclusion: The majority of infants developing ROP in a level III urban NICU had ≤1500-gm birth weight. Zone 1 ROP was uncommon. Incidence of ROP in heavier infants (>1500-gm birth weight) was low, and treatment was required in a rare instance. In an urban NICU, the burden of ROP screening and treatments shifts to small and low-birth-weight infants.

Posterior zone I retinopathy of prematurity: spectrum of disease and outcome after laser treatment.

OBJECTIVE: To report the morphological spectrum and outcome after laser treatment in posterior zone I retinopathy of prematurity. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Review of charts and RetCam images of preterm infants with posterior zone I retinopathy of prematurity (defined as area within a circle, the radius of which extends from the center of the optic disc to the center of the macula) treated with confluent laser at a tertiary care referral institute between January 2006 and December 2015. Data was analyzed and tabulated using frequency and descriptive statistics to describe the demography, morphology, and outcome after laser treatment. RESULTS: Fifty-six eyes (28 infants) with a mean gestational age of 28.65 ± 2.18 weeks and birth weight of 1153.04 ± 251.51 g were analyzed. Forty-two (75%) eyes had persistent tunica vasculosa lentis and 25 (44.6%) had preretinal hemorrhages. All eyes had circumferential ROP and a poorly developed foveal vasculature. Four distinct morphological patterns were encountered: I - typical aggressive posterior retinopathy was seen in 36 (64.3%) eyes; II - atypical aggressive posterior retinopathy (14 eyes; 25%) had raised fibrovascular proliferation always on the nasal retina close to the optic disc; III - hybrid retinopathy of prematurity (4 eyes; 8.7%) had a mat-like fibrous proliferation on vascularized posterior retina; and IV - threshold retinopathy of prematurity seen in 2 (4.4%) eyes. An unfavourable outcome was seen in 44 (78.6%) eyes. CONCLUSIONS: Retinopathy of prematurity in posterior zone I presents with atypical morphology and poor outcomes despite confluent laser photocoagulation.

WINROP algorithm for prediction of sight threatening retinopathy of prematurity: Initial experience in Indian preterm infants.

PURPOSE: To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants. METHODS: Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated. RESULTS: Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59-67.53) and negative predictive value was 83.3% (95% CI: 57.73-95.59). CONCLUSION: This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists.

A case of spontaneously resolved primary congenital glaucoma.

Primary congenital glaucoma usually presents as enlarged and hazy cornea at birth or early childhood. The diagnosis is based on a thorough clinical examination under anesthesia. Most cases require surgical intervention as the definitive treatment. In very rare instances, primary congenital glaucoma may arrest and resolve spontaneously. We describe a case of spontaneously arrested and resolved primary congenital glaucoma in a 37-year-old male presenting with large cornea, Haab's striae, and normal intraocular pressure in one eye. Such a case has not been previously described from the Indian subcontinent.

Aggressive posterior retinopathy of prematurity in infants ≥ 1500 g birth weight.

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥ 1500 g birth weight. Twenty-nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co-morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty-five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥ 1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co-morbidities could be a contributing factor.

Optical coherence tomography findings and retinal changes after vitrectomy for optic disc pit maculopathy.

PURPOSE: To study the optical coherence tomography (OCT) patterns in optic disc pit maculopathy and retinal changes after vitreous surgery. MATERIALS AND METHODS: Retrospective review of consecutive cases with optic disc pit maculopathy seen at two tertiary eye institutes from January 2005 to June 2009. RESULTS: Twenty-four eyes of 23 patients are included. The presenting visual acuity ranged from 20/400 to 20/20 (median:20/80). The median age at presentation was 24 years (range, 6-57 years). Optical coherence tomography demonstrated a combination of retinoschisis and outer layer detachment (OLD) in 19 (79.17%) eyes, OLD only in 3 (12.5%) eyes and retinoschisis only in 2 (8.33%) eyes. An obvious communication (outer layer hole) between the schisis and OLD was seen in 14 (73.68%) of the 19 eyes with both features. Of the 21 eyes with retinoschisis, schisis was present in multiple layers in 15 (71.43%) and single layer in 6 (28.57%) eyes. Eleven eyes underwent pars plana vitrectomy including creation of posterior vitreous detachment (PVD), fluid-air exchange, low intensity laser photocoagulation at the temporal edge of the optic disc pit and non-expansile perfluoropropane gas (14%) injection. Five (45.45%) of 11 eyes undergoing vitrectomy had complete resolution and 4 (36.36%) eyes had partial resolution of maculopathy. Visual acuity improved in 8 (72.72%) of 11 eyes. CONCLUSION: Optical coherence tomography demonstrates multiple layer schisis and outer layer detachment as main features of optic disc pit maculopathy. Vitrectomy with PVD induction, laser photocoagulation and gas tamponade results in anatomical and visual improvement in most cases with optic disc pit maculopathy.

Outcome of 23-gauge pars plana vitrectomy for pediatric vitreoretinal conditions.

PURPOSE: To evaluate the feasibility and short-term outcome of 23-gauge vitrectomy in children for various vitreoretinal conditions. METHODS: A retrospective chart review was conducted of consecutive children younger than 14 years who underwent 23-gauge transconjunctival sutureless vitrectomy for various vitreoretinal conditions from January 2008 to December 2011 at a tertiary care center. RESULTS: Thirty-seven eyes of 31 children were included. There were 20 boys and 11 girls, aged between 1.25 months and 14 years (median: 10 years, mean: 7.23 years). The surgical indications were subluxated crystalline lens, retinopathy of prematurity stage 4, post-traumatic cataract with ruptured capsule, vitreous hemorrhage, dislocated crystalline lens, endophthalmitis, retinal detachment with vitreous hemorrhage, dislocated intraocular lens, epiretinal membrane, and increased intraocular pressure after intravitreal steroid implantation. Postoperative complications included loose blood, retinal detachment, early postoperative hypotony, and preretinal bleeding. CONCLUSIONS: The 23-gauge transconjunctival sutureless vitrectomy approach in children appears safe and effective.

Aggressive posterior retinopathy of prematurity: risk factors for retinal detachment despite confluent laser photocoagulation.

PURPOSE: To analyze risk factors for retinal detachment in eyes with aggressive posterior retinopathy of prematurity (ROP) treated with confluent laser photocoagulation. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Infants undergoing laser treatment for aggressive posterior ROP from January 2006 through June 2010 participated. Eyes with retinal detachment (stage 4A, 4B, and 5) at presentation and those lost to follow-up after treatments were excluded. We defined 2 groups based on outcome after confluent laser photocoagulation: retinal detachment or favorable outcome. Two groups were compared for various factors, which included birth weight, gestational age, postconceptional age at laser treatment, zone of disease, preretinal hemorrhage, pre-existing fibrovascular proliferation, tunica vasculosa lentis, laser spots used for primary treatment, need for repeat laser treatment, and new-onset fibrovascular proliferation after laser treatment. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: One hundred nineteen eyes of 61 infants underwent laser treatment for aggressive posterior ROP. Ten (8.4%) eyes were excluded and 109 eyes (91.6%) were included. Nineteen (17.4%) of 109 eyes progressed to retinal detachment after laser treatment. On univariate analysis, multiple factors were associated with retinal detachment. Of these, all eyes with posterior zone 1 disease and all eyes demonstrating extensive fibrovascular proliferation (> 3 clock hours) after laser treatment progressed to retinal detachment. On multivariate logistic regression analysis, the most significant predictors of retinal detachment were gestational age of less than 29.5 weeks (P = .006), hemorrhages (P = .003), need for repeat laser treatment (P = .006), and new-onset limited fibrovascular traction (< 3 clock hours) after laser treatment (P = .042). CONCLUSIONS: A gestational age of less than 29.5 weeks, posterior zone 1 disease, and preretinal hemorrhages before laser treatment are the most significant risk factors for retinal detachment in aggressive posterior ROP. Of the events occurring after laser treatment, new-onset fibrovascular traction is associated significantly with development of retinal detachment.

Intersibling variability of retinopathy of prematurity in twins and its risk factors.

To study intersibling variability of retinopathy of prematurity (ROP) in twins and determine its risk factors. A retrospective chart review of twin neonates developing ROP at a tertiary center over a 5 year period (January 2004 to December 2008). Twin pairs with intersibling variability of ROP were retrieved based on one of the following criterion: (1) two-stage difference in ROP between siblings, (2) one sibling with treatable ROP and the other with spontaneously regressed ROP, or (3) one sibling with aggressive posterior ROP and the other with staged ROP. Babies with greater severity of ROP were included in group A (case group) and their siblings with less severity in group B (control group).The two groups were compared for birth weight, birth order and putative post-gestational risk factors. Thirty-five twin pairs developed ROP of which 28 pairs (80%) had severe intersibling variability. Twenty-one pairs with complete information about risk factors were analyzed. The birth weight of the case group was 1212.1 ± 248.3 g (mean ± SD) and control group 1172.1 ± 216.5 g (mean ± SD) (p = 0.33). In twelve of the 21 pairs the second born twin had more severe ROP. However, birth order was not a significant predictor (p = 0.664). Various post-gestational risk factors did not differ significantly between the two groups [oxygen administration (p = 1), sepsis (p = 0.625), exchange transfusion (p = 1), blood transfusion (p = 0.325), respiratory distress syndrome (p = 1), anemia (p = 0.125), apnea (0.375), neonatal jaundice (p = 1), patent ductus arteriosus (p = 0.5) and hypoglycemia (p = 1)]. The majority of the twins developing ROP had severe intersibling variability. Birth weight, birth order and post-gestational neonatal risk factor were not predictive of more severe ROP in a twin sibling.

A hybrid form of retinopathy of prematurity.

AIMS: To study a hybrid pattern of retinopathy of prematurity (ROP) demonstrating both ridge tissue (simulating staged ROP) and flat neovascularisation (simulating aggressive posterior retinopathy of prematurity (APROP)) in the same eye. METHODS: Retrospective chart review from January 2006 to June 2010. We reviewed the retinal drawings and Retcam images for a hybrid pattern of ROP, that is, presence of ridge tissue (characteristic of staged ROP) along with flat neovascular syncytium (characteristic of APROP) in the same eye. RESULTS: 28 eyes of 18 infants had hybrid characteristics. All eyes had severe plus disease, flat new vessels at the junction of the vascular and avascular retina and ridge tissue at variable locations. Three patterns were noted: I Ridge at the junction of vascular and avascular retina (14 (50%) eyes); II Ridge in the vascularised posterior retina (10 (35.71%) eyes); III Ill-defined ridge close to the optic disc, with mat-like fibrous proliferation into the vitreous (4 (14.29%) eyes). After confluent laser photocoagulation, we observed favourable outcome in 92.3% eyes with pattern I, 100% eyes with pattern II and 25% eyes with pattern III disease. CONCLUSION: Some eyes with ROP may have abnormal neovascularisation resembling both APROP and classical staged ROP. It is difficult to characterise these eyes according to the international classification of ROP. However, the presence of plus disease should serve as guide to treatment.

Structural sequelae and refractive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes.

AIM: The aim was to study the structural sequelae and refractive outcome after laser treatment for Type 1 prethreshold retinopathy of prematurity (ROP) in Asian Indian eyes. MATERIALS AND METHODS: A retrospective chart review of infants with Type 1 prethreshold ROP (defined according to the Early Treatment for Retinopathy of Prematurity study) undergoing laser treatment at a tertiary center between January 2004 and December 2008 was done. The 1-year outcome of infants was analyzed. RESULTS: Sixty-nine eyes of 36 infants were included. The mean birth weight was 1121.69 ± 254.81 g and the gestational age was 28.99 ± 2.03 weeks. Sixty-five eyes (94.2%) had zone 2 and 4 (5.8%) had zone 1 disease. Forty-four (63.77%) eyes had stage 2 ROP with plus disease and 25 (36.23%) eyes had prethreshold (fewer than five contiguous or eight cumulative clock hours) stage 3 ROP with plus disease. None of the eyes developed retinal structural sequelae. On cycloplegic retinoscopy, 59.4% eyes had nonsignificant hyperopia [spherical equivalent (SE) ≤ 4 D], 14.5% eyes had no refractive error (SE 0 D), 24.7% eyes had low myopia (SE < 5 D), and 1.4% eyes had high myopia (SE > 5.0 D). Eyes developing myopia were associated with a greater number of clock hours of ROP, greater number of laser spots used, and a longer time to disease regression . Two infants (5.6%) had esotropia and one (2.8%) had exotropia. CONCLUSION: Asian Indian infants treated for Type 1 prethreshold ROP did not develop retinal structural sequelae. Myopia was seen in nearly one-fourth of the eyes.The risk factors for myopia were a greater number of clock hours of ROP, greater number of laser spots, and a longer time to regression of ROP.

Demographic profile of infants with stage 5 retinopathy of prematurity in North India: implications for screening.

PURPOSE: To study demographic profile of infants presenting as stage 5 retinopathy of prematurity (ROP) at a tertiary referral center of North India. METHODS: A retrospective review of consecutive infants with stage 5 ROP from 1999-2008. Various parameters retrieved included the inborn (born at level III nursery of our institute) /outborn (born outside study center) status, birth weight, gestational age, age at presentation, screening details,treatment details and reasons for consultation. RESULTS: Sixty -six infants are included. All infants were outborn (born outside study center). Mean birth weight was 1250.23 ± 486.45 g and gestational age at birth was 28.5 ± 2.2 weeks. Ten (15.1%) infants were above 1500 g birth weight. Median age at presentation was 7 month (range, 2-84 months). Fifty-seven (86.4 %) infants were never screened for ROP and 2(3%) were lost to follow-up after single screening. Seven (10.6%) infants had screening and treatment. Forty-nine (74.2%) infants were self-referred (i.e brought by parents on their own) and 17(25.8%) were referred by ophthalmologists. Pediatricians referred none of the infants. CONCLUSION: Our study shows that lack of screening is responsible for stage 5 ROP in outborn infants. More needs to be done to spread awareness about the disease. Broader screening guidelines are needed to ensure screening for infants>1500 g birth weight.

Aggressive posterior retinopathy of prematurity in Asian Indian babies: spectrum of disease and outcome after laser treatment.

PURPOSE: To analyze the spectrum of aggressive posterior retinopathy of prematurity and outcome after laser treatment. METHODS: This is a retrospective review of 81 eyes of 44 consecutive infants diagnosed to have aggressive posterior retinopathy of prematurity and treated between September 2005 and March 2007 from a large tertiary care center in North India. Qualitative variables were tested for statistical significance using the chi-square test and independent samples with the student's t-test. RESULTS: Mean birth weight and gestational age were 1,259.66 +/- 310.51 g (range, 660-2,000 g) and 29.75 +/- 2.35 weeks (range, 26-36 weeks), respectively. Twenty-one infants (47.72%) had a birth weight > 1,250 g. Thirty-three (40.74%) eyes had Zone 1, and 48 (59.26%) had posterior Zone 2 disease. All eyes underwent confluent laser photocoagulation at a mean postconceptional age of 34.58 +/- 2.19 weeks (range, 31-40.5 weeks). Mean follow-up was 12.8 months (range, 6-24 months). At the last follow-up visit, 55 (71.4%) of 77 eyes had a favorable outcome. Eighteen eyes (23.4%) had a localized (1-3 clock hours) partial peripheral tractional detachment (Stage 4a), which remained stable at last follow-up. Two eyes (2.6%) developed falciform fold involving the macular area, and 2 (2.6%) developed Stage 5 retinopathy of prematurity. CONCLUSION: Aggressive posterior retinopathy of prematurity is encountered not only in low birth weight infants, but also in heavier and more mature Asian Indian infants. Early, aggressive confluent laser photocoagulation is necessary to maximize outcomes in these eyes.

Polyethylene foreign body on the cornea.

PURPOSE: To report polyethylene as an unusual cause of corneal foreign body. METHODS: Two patients presenting with ocular complaints showed a transparent foreign body on the cornea on careful slit-lamp examination. The foreign bodies were removed and subjected to chemical analysis by Fourier transform infrared spectrophotometry. Treatment was given in the form of topical antibiotics and tear substitutes. RESULTS: The foreign bodies were identified as polyethylene. There were no sequelae after foreign-body removal. CONCLUSIONS: Because of its transparent nature, polyethylene can be easily missed as a corneal foreign body. A meticulous slit-lamp examination is mandatory to identify it early for appropriate management.