Oxygen care and treatment of retinopathy of prematurity in ocular and neurological prognosis.
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SUBMITTER: Kang HG
PROVIDER: S-EPMC8748614 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PURPOSE:To determine the prevalence of treatment-related ocular complications and disease progression following treatment for retinopathy of prematurity (ROP). METHODS:This was a retrospective cohort study of eyes treated for ROP at 29 North American neonatal intensive care units in the Postnatal Growth and ROP (G-ROP) Study. Data from the time of treatment through 15 months were abstracted from medical records by certified data collectors. Treatment-related complication (cataract, hyphema, glaucoma, corneal abrasion/opacity), and disease-progression (retinal fold, dragging, or stage 4 or 5 detachment) were calculated by treatment modality. Vitreous hemorrhage was classified separately, because it can relate to treatment or disease progression. RESULTS:Of 7,483 infants included in the study, 1,004 eyes (512 infants) underwent ROP treatment: 970 eyes received laser as initial therapy; 34 eyes received intravitreal bevacizumab (IVB). Median follow-up after treatment was 18 weeks. Overall, one or more complications occurred in 2.6% (95% CI, 1.8%-3.8%) laser treated eyes and no (0%; 95% CI, 0.0%-10.1%) IVB eyes. Disease-progression occurred in 9.2% (95% CI, 7.6%-11.2%) laser treated eyes, no (0%; 95% CI, 0.0-12.9%) IVB-only eyes. Vitreous hemorrhage occurred in 5.4% (95% CI: 4.1% - 7.0%) laser treated eyes, no IVB-only eyes. CONCLUSIONS:Rates of complications are very low following ROP treatment with either laser or IVB. Of laser-treated eyes, 9% experienced disease progression despite treatment.
| S-EPMC5915915 | biostudies-literature
Project description:BackgroundRetinopathy of prematurity (ROP) is a multifactorial retinal disease, involving both environmental and genetic factors; The purpose of this study is to evaluate the clinical presentations and genetic variants in Chinese patients with ROP.MethodsA total of 36 patients diagnosed with ROP were enrolled in this study, their medical and ophthalmic histories were obtained, and comprehensive clinical examinations were performed. Genomic DNA was isolated from peripheral blood of ROP patients, polymerase chain reaction and direct sequencing of the associated pathogenic genes (FZD4, TSPAN12, and NDP) were performed.ResultsAll patients exhibited the clinical manifestations of ROP. No mutations were detected in the TSPAN12 and NDP genes in all patients; Interestingly, three novel missense mutations were identified in the FZD4 gene (p.A2P, p.L79M, and p.Y378C) in four patients, for a detection rate of 11.1% (4/36).ConclusionsThis study expands the genotypic spectrum of FZD4 gene in ROP patients, and our findings underscore the importance of obtaining molecular analyses and comprehensive health screening for this retinal disease.
| S-EPMC8753894 | biostudies-literature
Project description:ObjectiveTo identify achieved oxygen saturations (SpO2) associated with increased risk of severe retinopathy of prematurity (ROP).DesignThis is a secondary analysis of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT)randomised controlled trial. SpO2 was recorded up to 36 weeks' postmenstrual age. Saturations through 9 postnatal weeks were explored graphically, and logistic regression models were created to predict severe ROP.Setting20 centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.Patients984 surviving infants of 24-27 weeks' gestational age born in 2005-2009.InterventionsSUPPORT targeted SpO2 to a lower (85%-89%) or higher (91%-95%) range through 36 weeks' postmenstrual age or off respiratory support.Main outcome measuresSevere ROP defined as threshold ROP, ophthalmological surgery or bevacizumab treatment.ResultsThere were statistically significant interactions between duration of oxygen supplementation and percentage of time in certain achieved saturation ranges. Specifically, for infants who spent at least 2 weeks on oxygen in postnatal weeks 1-5, a higher percentage of time at 91%-96% SpO2 was associated with increased odds of severe ROP. For infants who spent at least 3 weeks on oxygen in postnatal weeks 6-9, a higher percentage of time at 97%-100% SpO2 was associated with increased odds of severe ROP. Other significant risk factors were lower gestational age and birth weight, non-Hispanic white versus black race, prospectively defined severe illness, late-onset sepsis or meningitis, and clinical centre.ConclusionsAmong extremely preterm survivors to discharge, the association between SpO2 and severe ROP depended on the timing and duration of oxygen supplementation.
| S-EPMC6925651 | biostudies-literature
Project description:BackgroundMore than 11 000 children are examined for possible retinopathy of prematurity in Germany each year, and 2-5% of them are treated for it. Even though screening and treatment programs are in place, the affected children can still suffer visual impairment.MethodsIn this article, we summarize the pathogenesis, screening, and treatment of retinopathy of prematurity on the basis of a selective review of pertinent literature, retrieved by a PubMed search. The article centers on publications from 2011 to 2015 on the new option of treatment with VEGF inhibitors and discusses it in comparison to laser therapy.ResultsAll premature neonates with a low gestational age at birth, low birth weight, or prolonged exposure to supplemental oxygen must undergo screening by an ophthalmologist. Laser therapy is effective for stages 1-3 and for aggressive posterior retinopathy of prematurity. Its disadvantages are the induction of scarring and the development of severe myopia in 17-40% of the children so treated. Anti-VEGF treatment (VEGF = vascular endothelial growth factor) does not induce any visible scarring and seems to cause less myopia, but long-term data on safety, dosing, and the choice of anti-VEGF drug are still lacking.ConclusionThe available evidence for anti-VEGF treatment is on a much lower level than the evidence for laser therapy. Anti-VEGF may be a way to avoid the disadvantages of laser therapy (scarring and severe myopia). Unlike laser therapy, however, the intravitreal injection of VEGF inhibitors may suppress systemic VEGF levels and potentially harm the developing brain, lungs, or other organs. The currently open questions about anti-VEGF treatment concern its dosing, choice of drug, and long-term safety.
| S-EPMC4647313 | biostudies-literature
Project description:To describe the workforce that provides retinopathy of prematurity (ROP) care.We surveyed a random sample of ophthalmologists' offices by telephone (n = 1504) and then sent a mail survey to those who were reported to provide care to infants (n = 486). Workforce estimates were based on the total number of ophthalmologists in the United States.Thirty percent of ophthalmologists were reported to care for children younger than 1 year of age; 11% of all ophthalmologists examine for (1815; 95% confidence interval [95% CI] 1340-2379) and 6% treat ROP (983, 95% CI 649-1421). ROP examinations are provided by an equal number who have completed fellowship training in pediatric ophthalmology and strabismus (254, 95% CI 182-327) as have not completed any fellowship training (236, 95% CI 163-345). Ophthalmologists with fellowship training in any subspecialty provide 86% of the ROP examinations, with those trained in pediatric ophthalmology providing 50% overall. Some (9%) of the ophthalmologists who examine for ROP, regardless of whether or not they completed a fellowship (p = 0.22), report that their training did not adequately prepare them to do so. In contrast to examinations, most treatment is provided by ophthalmologists who are fellowship trained in retina and vitreous diseases.ROP care is offered by ophthalmologists with different training backgrounds. Future work is needed to understand the relationship between the availability of ophthalmologists and ROP care delivery and the role of new modes of care delivery such as telemedicine.
| S-EPMC2566307 | biostudies-literature
Project description:IntroductionRetinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide.Areas coveredRecent methods to identify and manage treatment-warranted vascularly active ROP are recognized and being compared to standard care by laser treatment in prospective large-scale clinical studies. Pharmacologic anti-angiogenic (anti-VEGF) treatment has changed the natural history of vascularly active ROP by reducing stage 3 intravitreal neovascularization and extending physiologic retinal vascularization in many infants. Tractional retinal detachments in stage 4 ROP after treatment with anti-VEGF agents show additional fibrovascular complexity compared to eyes treated with laser only. We review current management and outcomes for vascularly active and fibrovascular retinal detachment in ROP (stages 3, 4, 5 ROP), highlighting the evidence from recent clinical studies. Included are technical details important in surgery for retinal detachment in ROP. Literature searches were employed through PubMed.Expert opinionMethods in pediatric imaging, safer pharmacologic treatments, and surgical techniques continue to advance to improve future ROP outcomes.
| S-EPMC6874220 | biostudies-literature
Project description:PurposeTo report 2-year ocular and developmental outcomes for infants receiving low doses of intravitreal bevacizumab for type 1 retinopathy of prematurity (ROP).MethodsA total of 120 premature infants (mean birthweight, 687 g; mean gestational age, 24.8 weeks) with type 1 ROP were enrolled in a multicenter, phase 1 dose de-escalation study. One eye per infant received 0.25 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg of intravitreal bevacizumab; fellow eyes when treated received one dosage level higher. At 2 years, 70 of 120 children (58%) underwent ocular examinations; 51 (43%) were assessed using the Bayley Scale of Infant and Toddler Development.ResultsCorrelation coefficients for the association of total dosage of bevacizumab with Bayley subscales were -0.20 for cognitive (95% CI, -0.45 to 0.08), -0.15 for motor (95% CI, -0.41 to 0.14), and -0.19 for language (95% CI, -0.44 to 0.10). Fourteen children (21%) had myopia greater than -5.00 D in one or both eyes, 7 (10%) had optic nerve atrophy and/or cupping, 20 (29%) had strabismus, 8 (11%) had manifest nystagmus, and 9 (13%) had amblyopia.ConclusionsIn this study cohort, there was no statistically significant correlation between dosage of bevacizumab and Bayley scores at 2 years. However, the sample size was small and the retention rate relatively low, limiting our conclusions. Rates of high myopia and ocular abnormalities do not differ from those reported after larger bevacizumab doses.
| S-EPMC10729831 | biostudies-literature
Project description:The immature retinas of preterm neonates are susceptible to insults that disrupt neurovascular growth, leading to retinopathy of prematurity. Suppression of growth factors due to hyperoxia and loss of the maternal-fetal interaction result in an arrest of retinal vascularisation (phase 1). Subsequently, the increasingly metabolically active, yet poorly vascularised, retina becomes hypoxic, stimulating growth factor-induced vasoproliferation (phase 2), which can cause retinal detachment. In very premature infants, controlled oxygen administration reduces but does not eliminate retinopathy of prematurity. Identification and control of factors that contribute to development of retinopathy of prematurity is essential to prevent progression to severe sight-threatening disease and to limit comorbidities with which the disease shares modifiable risk factors. Strategies to prevent retinopathy of prematurity will depend on optimisation of oxygen saturation, nutrition, and normalisation of concentrations of essential factors such as insulin-like growth factor 1 and ω-3 polyunsaturated fatty acids, as well as curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development.
| S-EPMC4389630 | biostudies-literature
Project description: Not available
| S-EPMC4020289 | biostudies-literature
Project description:Background/objectivesFluorescein angiography (FA) has been a pivotal tool to study the pathophysiology of retinopathy of prematurity (ROP) in vivo. We examined the course of ROP using FA in order to assess the predictive value of angiographic features.Subjects/methodsThis is an observational retrospective cohort multi-center study of eyes screened for ROP with binocular indirect ophthalmoscope and with FA. All infants undergoing screening examination for ROP who had retinal vasculature limited to Zone I and posterior Zone II vascularization underwent FA between 31 and 34 weeks postmenstrual age. RetCam fundus imaging and video digital fluorescein angiography were performed in the neonatal intensive care units. Masked grading of the FA images was retrospectively conducted by two ROP expert ophthalmologists. Ten criteria that describe retinovascular and choroidal features on FA were used to assess their predictive value for development of treatment-requiring ROP.ResultsA total of 98 eyes of 56 patients were included for this study. FAs of eyes of premature infants show a wide range of features either at the junction between the vascular and avascular retina and posteriorly to that. Among the angiographic features evaluated, leakage, shunts and hyperfluorescent lesions at the junction between vascular and avascular zone were predictive of the development of treatment-requiring ROP (p < 0.05), but findings in the posterior vascularized retina were not.ConclusionsFA can add to our understanding of the evolution of vascular abnormalities in the course of ROP and can help predict which eyes will go on to treatment.
| S-EPMC8526581 | biostudies-literature