RESUMEN
PURPOSE: To compare the results of intravitreal bevacizumab (IVB) monotherapy and combined intravitreal bevacizumab and laser photocoagulation (LPC) therapies applied in the same session to patients with aggressive retinopathy of prematurity (A-ROP) in our clinic. METHODS: The study included 67 eyes of 37 patients diagnosed with A-ROP and treated. Forty-nine eyes treated with anti-vascular endothelial growth factor agent injection monotherapy for A-ROP treatment were included in the first group. The second group consisted of 18 eyes that received injection therapy and LPC treatment. The clinical findings of the two groups were investigated, and their treatment results were compared. RESULTS: Recurrence was observed in 19 of the 49 (38%) eyes in the first group, but there was no recurrence in any of the cases in the second group. While only IVB was applied to eight cases with recurrence, the combination of LPC and IVB treatment was applied to 11 cases. A second recurrence was detected in two of the eight cases that had received IVB monotherapy as a treatment for recurrence and in three of the 11 cases that had received LPC and IVB. The treatment outcomes of the two groups did not statistically significantly differ (P = 0.181). CONCLUSION: We consider that the combined simultaneous LPC and IVB treatment we applied in A-ROP cases is an effective approach, particularly for cases where there are concerns about the patient's ability to attend follow-up appointments.
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Inhibidores de la Angiogénesis , Bevacizumab , Inyecciones Intravítreas , Coagulación con Láser , Retinopatía de la Prematuridad , Humanos , Bevacizumab/administración & dosificación , Bevacizumab/uso terapéutico , Retinopatía de la Prematuridad/tratamiento farmacológico , Retinopatía de la Prematuridad/terapia , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/cirugía , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Coagulación con Láser/métodos , Femenino , Masculino , Recién Nacido , Estudios Retrospectivos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Terapia Combinada , Edad Gestacional , Estudios de Seguimiento , LactanteRESUMEN
Premature infants have a risk of neurodevelopmental deficits. Little is known, however, about how retinopathy of prematurity (ROP) affects visual motor integration (VMI), which is necessary for both fine motor skills and further school abilities. Due to the systemic escape of bevacizumab in the treatment of ROP, concerns regarding the long-term neurodevelopmental effect of the drug have arisen. The aim is to evaluate VMI and motor development long-term outcomes after intravitreal bevacizumab (IVB) injection and laser treatment for ROP. Two groups of premature children were included: Bevacizumab group - 16 premature children who received IVB treatment and laser group - 23 premature children who underwent laser photocoagulation treatment in this single center cross-sectional study. At 2-6 years of age, VMI (Beery-Buktenica Developmental Test), motor development (Peabody Developmental Motor Scales-2), visual acuity, and refractive status were assessed. The incidence of abnormal visual function was significantly higher in bevacizumab group than in laser group (p = 0.022). The incidence of abnormal VMI skill was significantly higher in bevacizumab group than in laser group (p = 0.024). Incidences of abnormal gross, fine, and total motor skills were significantly higher in bevacizumab group compared to laser group (p < 0.05). Premature children who received bevacizumab for ROP demonstrated significantly lower VMI and motor development features than those with laser treatment at preschool age. Although our results suggest the relevance of bevacizumab injection in impaired VMI and motor development outcomes, general level of sickness rather than treatment might be the cause of delayed motor development.
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Bevacizumab , Desarrollo Infantil , Retinopatía de la Prematuridad , Humanos , Retinopatía de la Prematuridad/terapia , Retinopatía de la Prematuridad/fisiopatología , Retinopatía de la Prematuridad/cirugía , Masculino , Femenino , Bevacizumab/administración & dosificación , Bevacizumab/uso terapéutico , Preescolar , Estudios Transversales , Niño , Desarrollo Infantil/efectos de los fármacos , Desarrollo Infantil/fisiología , Recién Nacido , Recien Nacido Prematuro , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Destreza Motora/fisiología , Inyecciones IntravítreasRESUMEN
BACKGROUND: Retinopathy of prematurity (ROP) is a major cause of visual impairment in premature infants, often requiring surgical interventions in advanced stages. This retrospective case series study investigates non-surgical management for Stage 4A ROP, specifically the use of combined laser therapy and intravitreal anti-vascular endothelial growth factor (VEGF) injections. METHODS: Ten eyes from five infants with Stage 4A ROP were treated with a combined laser and anti-VEGF approach. Comprehensive follow-up examinations were conducted to evaluate the treatment outcomes. RESULTS: The study demonstrated successful retinal attachment without complications, showcasing the efficacy and safety of this non-surgical method. A comparison with surgical interventions highlighted the potential benefits in terms of reduced adverse effects. DISCUSSION: This combined treatment emerges as a promising first-choice option for Stage 4A ROP, offering rapid regression without surgical intervention, particularly in early stages. However, larger randomized clinical trials are necessary to validate these findings and establish definitive guidelines for managing this complex condition. CONCLUSION: Combined laser and anti-VEGF therapy proved to be an effective and safe non-surgical approach for Stage 4A ROP, with the potential to reduce the need for surgery, especially in its early presentation. Further research is required to confirm these findings and provide comprehensive recommendations for clinical practice.
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Inhibidores de la Angiogénesis , Retinopatía de la Prematuridad , Recién Nacido , Lactante , Humanos , Inhibidores de la Angiogénesis/uso terapéutico , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular , Estudios Retrospectivos , Coagulación con Láser/métodos , Recien Nacido Prematuro , Inyecciones Intravítreas , Edad GestacionalRESUMEN
Importance: Prospective long-term data after retinopathy of prematurity (ROP) treatment with anti-vascular endothelial growth factor injections vs laser therapy are scarce. The FIREFLEYE (Aflibercept for ROP IVT Injection vs Laser Therapy) next trial is prospectively evaluating the long-term efficacy and safety outcomes following ROP treatment with intravitreal aflibercept vs laser therapy. Objective: To evaluate 2-year ophthalmic and safety outcomes after 0.4-mg aflibercept injection or laser therapy in the 24-week randomized (2:1) FIREFLEYE trial (FIREFLEYE outcomes previously reported). Design, Setting, and Participants: This prospective nonrandomized controlled trial performed in 24 countries in Asia, Europe, and South America (2020-2025) follows up participants treated in the FIREFLEYE randomized clinical trial (2019-2021) through 5 years of age. Participants included children born very or extremely preterm (gestational age ≤32 weeks) or with very or extremely low birth weight (≤1500 g) who were previously treated with a 0.4-mg injection of aflibercept compared with laser therapy for severe acute-phase ROP. Data for the present interim analysis were acquired from March 18, 2020, to July 25, 2022. Interventions: Complications of ROP treated at investigator discretion (no study treatment). Main Outcomes and Measures: Efficacy end points included ROP status, unfavorable structural outcomes, ROP recurrence, treatment for ROP complications, completion of vascularization, and visual function. Safety end points included adverse events and growth and neurodevelopmental outcomes. Results: Overall, 100 children were enrolled (median gestational age, 26 [range, 23-31] weeks; 53 boys and 47 girls). Of these, 21 were Asian, 2 were Black, 75 were White, and 2 were of more than 1 race. At 2 years of age, 61 of 63 children (96.8%) in the aflibercept group vs 30 of 32 (93.8%) in the laser group had no ROP. Through 2 years of age, 62 of 66 (93.9%) in the aflibercept group and 32 of 34 (94.1%) in the laser group had no unfavorable structural outcomes. No new retinal detachment occurred during the study. Four children in the aflibercept group (6.1%) were treated for ROP complications before 1 year of age (2 had preexisting end-stage disease and total retinal detachment; 1 had reactivated plus disease; and 1 had recurrent retinal neovascularization not further specified). Most children were able to fix and follow a 5-cm toy (aflibercept group, 118 of 122 eyes [96.7%] among 63 children; laser group, 62 of 63 eyes [98.4%] among 33 children). High myopia was present in 9 of 115 eyes (7.8%) among 5 children in the aflibercept group and 13 of 60 eyes (21.7%) among 9 children in the laser group. No relevant differences in growth and neurodevelopmental outcomes by Bayley Scales of Infant and Toddler Development, Third Edition and Vineland Adaptive Behavior Scales, Second Edition were identified. Conclusions and Relevance: In this nonrandomized follow-up of a randomized clinical trial comparing treatment of severe acute-phase ROP with 0.4-mg injection of aflibercept and laser, disease control was stable and visual function was appropriate in children through 2 years of age. No adverse effects on safety, including growth and neurodevelopment, were identified. These findings provide clinically relevant long-term information on intravitreal aflibercept injection therapy for ROP. Trial Registration: ClinicalTrials.gov Identifier: NCT04015180.
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Inhibidores de la Angiogénesis , Inyecciones Intravítreas , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Retinopatía de la Prematuridad , Humanos , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/terapia , Retinopatía de la Prematuridad/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Proteínas Recombinantes de Fusión/efectos adversos , Proteínas Recombinantes de Fusión/administración & dosificación , Femenino , Masculino , Recién Nacido , Estudios Prospectivos , Resultado del Tratamiento , Inhibidores de la Angiogénesis/uso terapéutico , Inhibidores de la Angiogénesis/efectos adversos , Terapia por Láser/métodos , Terapia por Láser/efectos adversos , Lactante , PreescolarRESUMEN
BACKGROUND: Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. AIMS: To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. STUDY DESIGN: Retrospective, two-center, cohort study. SUBJECTS: Infants born at 22+0-25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). MAIN OUTCOME MEASURES: Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). RESULTS: Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. CONCLUSION: Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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Displasia Broncopulmonar , Conducto Arterioso Permeable , Retinopatía de la Prematuridad , Lactante , Femenino , Niño , Recién Nacido , Humanos , Recien Nacido Extremadamente Prematuro , Conducto Arterioso Permeable/epidemiología , Conducto Arterioso Permeable/cirugía , Edad Gestacional , Estudios Retrospectivos , Estudios de Cohortes , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/complicaciones , Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/cirugíaRESUMEN
PURPOSE: To evaluate stereopsis in term-born, preterm, and preterm children with and without retinopathy of prematurity (ROP) and its treatment. METHODS: The cross-sectional study included 322 children between 3 and 11 years of age born term or preterm, with or without ROP, and with or without treatment for ROP. The ROP treatments were laser therapy, intravitreal injection (IVI) of anti-vascular endothelial growth factor, or their combination. Stereoacuity was measured using the Titmus Stereo Test, and the results among various age groups were analyzed. RESULTS: Stereopsis was found to improve with increasing age at testing (P < 0.001) across the entire study population. The term group exhibited significantly better stereoacuity than the preterm group (P < 0.001). At 3-5 years and 6-8 years, the preterm children without ROP exhibited significantly better stereoacuity than did those with ROP (P < 0.001 and P = 0.02, respectively); however, at 9-11 years, both groups exhibited similar stereoacuity (P = 0.34). The stereoacuity in the children with untreated ROP was similar to that of the children with treated ROP in all age groups (P > 0.05). No significant differences in stereopsis were identified between children with ROP treated with laser versus with IVI (P > 0.05). From multivariate analysis, younger age at testing (P = 0.001) and younger gestational age (P < 0.001) were associated with poorer stereopsis. CONCLUSIONS: Stereopsis development gradually improved with age in all groups. The children born preterm exhibited poorer stereoacuity than those born term. Children with ROP treated with laser photocoagulation versus IVI may exhibit similar levels of stereoacuity. Younger age at testing and gestational age were independent risk factors for poorer stereoacuity.
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Percepción de Profundidad , Edad Gestacional , Recien Nacido Prematuro , Retinopatía de la Prematuridad , Agudeza Visual , Humanos , Retinopatía de la Prematuridad/fisiopatología , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/cirugía , Percepción de Profundidad/fisiología , Masculino , Femenino , Estudios Transversales , Preescolar , Niño , Agudeza Visual/fisiología , Estudios de Seguimiento , Recién Nacido , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Visión Binocular/fisiología , Inyecciones Intravítreas , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Coagulación con Láser/métodosRESUMEN
PURPOSE: To determine timing and rates of reactivation and retreatment of type 1 retinopathy of prematurity (ROP) after treatment with either 0.125 mg, 0.250 mg, or 0.500 mg of intravitreal bevacizumab (IVB). METHODS: Retrospective data, including demographic information, past medical history, and ROP characteristics were analyzed for babies with type 1 ROP treated with IVB at Riley Hospital for Children for the perioed 2014-2021. RESULTS: A total of 84 patients met inclusion criteria: 29 patients received 0.125 mg of IVB; 39, 0.250 mg; and 16, 0.500 mg. Of the 84, 67 (80%) had additional laser treatment because of late reactivation (n = 52) or persistent avascular retina (PAR) (n = 15). Subsequent laser treatment was more common with lower doses: 0.125 mg (n = 27 [93%]); 0.250 mg (n = 31 [80%]); 0.500 mg (n = 9 [57%]) (P = 0.012). There was no difference between groups with regard to reason for subsequent laser treatment (reactivation vs PAR). The 0.125 mg group required retreatment because of reactivation 3.8 weeks sooner than the other dosing groups (P = 0.047). CONCLUSIONS: The outcomes comparing three doses of IVB for severe ROP showed a difference in the timing of secondary treatment, with the lower dosing group requiring laser for reactivation earlier.
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Inhibidores de la Angiogénesis , Retinopatía de la Prematuridad , Recién Nacido , Lactante , Niño , Humanos , Bevacizumab/uso terapéutico , Inhibidores de la Angiogénesis/uso terapéutico , Retinopatía de la Prematuridad/cirugía , Estudios Retrospectivos , Coagulación con Láser , Inyecciones Intravítreas , Retratamiento , Edad GestacionalAsunto(s)
Coagulación con Láser , Hemorragia Retiniana , Retinopatía de la Prematuridad , Maniobra de Valsalva , Femenino , Humanos , Recién Nacido , Coagulación con Láser/métodos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiología , Hemorragia Retiniana/cirugía , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/diagnósticoRESUMEN
PURPOSE: To analyze the outcomes of eyes treated for retinopathy of prematurity in posterior Zone I. METHODS: In a part retrospective (9 years) and part prospective (1 year) interventional study, we analyzed eyes treated for retinopathy of prematurity in posterior Zone I with a minimum follow-up for 6 months. RESULTS: This study included 109 eyes of 56 infants; mean gestational age and birth weights were 29.3 (±2.1) weeks and 1112.5 (±381.9) g, respectively. The treatment included intravitreal anti-vascular endothelial growth factor as the initial treatment modality in 101 eyes (92.6%), either alone (27 eyes) or combined with laser or vitreous surgery (73 eyes). Laser was the initial treatment modality in eight eyes, either alone (n = 3) or in combination with surgery (n = 5). With anti-vascular endothelial growth factor alone, 30.68% (n = 27) eyes responded favorably, and the remaining 69.32% (n = 59) eyes needed retreatment (laser in the majority). At the final follow-up, 89.9% (out of 109) of eyes did well anatomically. Good outcome was significantly linked to no detachment at presentation ( P < 0.0001) and the presence of well-defined central vascular trunks ( P = 0.001). CONCLUSION: Treating the eyes before retinal detachment with bevacizumab followed by laser (and surgery, if needed) results in a favorable outcome in babies with posterior Zone I retinopathy of prematurity.
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Inhibidores de la Angiogénesis , Edad Gestacional , Inyecciones Intravítreas , Coagulación con Láser , Retinopatía de la Prematuridad , Factor A de Crecimiento Endotelial Vascular , Humanos , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/tratamiento farmacológico , Retinopatía de la Prematuridad/terapia , Retinopatía de la Prematuridad/diagnóstico , Inhibidores de la Angiogénesis/uso terapéutico , Inhibidores de la Angiogénesis/administración & dosificación , Estudios Retrospectivos , Femenino , Masculino , India/epidemiología , Recién Nacido , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Estudios Prospectivos , Coagulación con Láser/métodos , Estudios de Seguimiento , Vitrectomía/métodos , Resultado del Tratamiento , Bevacizumab/uso terapéutico , Bevacizumab/administración & dosificación , Peso al Nacer , Lactante , Agudeza VisualAsunto(s)
Inhibidores de la Angiogénesis , Retinopatía de la Prematuridad , Humanos , Lactante , Recién Nacido , Bevacizumab/uso terapéutico , Inhibidores de la Angiogénesis/uso terapéutico , Factor A de Crecimiento Endotelial Vascular , Fotocoagulación , Rayos Láser , Inyecciones Intravítreas , Coagulación con Láser , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/tratamiento farmacológico , Retinopatía de la Prematuridad/cirugía , Estudios Retrospectivos , Edad GestacionalRESUMEN
PURPOSE: To evaluate the outcome of 577 nm yellow solid krypton laser as an independent treatment modality for Retinopathy of Prematurity. DESIGN: Prospective, non-comparative, non-randomized, interventional. METHODS: A prospective pilot study was conducted on 30 treatment eyes with retinopathy of prematurity (ROP) who underwent treatment with a 577 nm yellow solid state krypton laser. 3nethraNEO pediatric retinal imaging system was used to screen these infants born between March to August 2022. Pre procedure data such as gestational age (weeks), birth weight (g), and exposure to risk factors were recorded. Power (mW), exposure duration (msec), and number of laser spots administered were noted. Pain was assessed using the Neonatal Pain/Agitation and Sedation Scale (N-PASS). Post procedure data such as regression, persistence or reactivation of disease, and adverse effects were looked for. All eyes were followed up for a period of 3 months. STATISTICAL ANALYSIS USED: Chi-square test, Fisher's exact test. RESULTS: Out of 30 eyes, 09 (30%) had type I and 21 (70%) had non-type I ROP. In type I disease, the mean power used was 88+/-10 mW with exposure duration of 130+/-27 msec and an average number of 890+/-260 burns were administered. In non-type I disease, the mean power used was 87+/-10 mW with an exposure duration of 150 ms and an average number of 900+/-290 burns were administered. The mean pain score calculated was 5 in type I and 6 in non-type I ROP. All eyes showed regression of disease after treatment. CONCLUSION: 577 nm yellow solid krypton laser was safe and effective in treating retinopathy of prematurity disease.
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Edad Gestacional , Coagulación con Láser , Retinopatía de la Prematuridad , Humanos , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/diagnóstico , Proyectos Piloto , Estudios Prospectivos , Femenino , Masculino , Recién Nacido , Resultado del Tratamiento , Coagulación con Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Estudios de Seguimiento , Agudeza VisualRESUMEN
We present the case of a patient with a history of laser-treated retinopathy of prematurity (ROP) who developed narrow angles and intermittent angle closure. Despite laser peripheral iridotomy/iridoplasty, 1 year later, the patient had recurrent narrowing that resolved following clear lens extraction with intraocular lens placement. This case highlights the importance of continued monitoring for narrow angles in patients with ROP history.
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Glaucoma de Ángulo Cerrado , Terapia por Láser , Retinopatía de la Prematuridad , Recién Nacido , Humanos , Glaucoma de Ángulo Cerrado/cirugía , Iris/cirugía , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/cirugía , Iridectomía , Presión IntraocularAsunto(s)
Retinopatía de la Prematuridad , Recién Nacido , Lactante , Humanos , Retinopatía de la Prematuridad/tratamiento farmacológico , Retinopatía de la Prematuridad/cirugía , Recien Nacido Prematuro , Proteínas Recombinantes de Fusión , Rayos Láser , Coagulación con Láser , Edad Gestacional , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
PURPOSE: To report on the anatomical and functional outcomes of a modified limbal lensectomy-vitrectomy (LV) approach for stages 4B and 5 retinopathy of prematurity (ROP) as defined in the International Classification of Retinopathy of Prematurity, 3rd Edition (ICROP 3). DESIGN: Retrospective, monocentric, consecutive case series. PATIENTS: Infants with ROP that underwent limbal LV for diffuse retrolental fibroplasia. METHODS: Clinical charts and Retcam photographs were reviewed. Surgical approach consisted of a limbal LV through peripheral iridectomies with centripetal dissection of the preretinal fibrosis. MAIN OUTCOME MEASURES: Anatomical success and visual function at last follow-up were evaluated. Multivariate logistic regression was used to explore potential prognostic factors affecting the anatomical outcome. RESULTS: A total of 128 eyes of 81 patients with a mean gestational age of 28.7 ± 3.0 weeks and a mean birthweight of 1244 ± 429 g were included. Eighteen eyes (14.1%) had a stage 4B, 24 (18.8%) a stage 5B, and 86 a stage 5C (67.2%) ROP. Mean age at surgery was 57.4 ± 36.3 weeks and mean postoperative follow-up was 22.7 ± 20.4 months. Only 5 eyes (3.9%) had prior peripheral retinal ablation. Macular reattachment was achieved in 74 eyes (57.8%). Controlling for other baseline factors, a stage 5C (versus stage 4B, odds ratio [OR] = 6.9 [1.5-32.1], P = 0.01 and versus stage 5B, OR = 7.4 [1.5-37.1], P = 0.02), the presence of vascular activity (OR = 6.4 [2.3-18.1], P < 0.001), and the presence of Schlieren sign (OR = 13.0 [2.1-82.2], P = 0.006) were associated with a failure of macular reattachment. Visual acuity was assessed in 92 eyes (71.9%), among which 59 eyes (64.1%) had light perception or better. CONCLUSIONS: Modified limbal LV resulted in macular reattachment in more than half of eyes with ROP-related retinal detachment and diffuse retrolental fibrosis. A stage 5C based on ICROP 3, the presence of vascular activity, and a Schlieren sign were significantly associated with a failure of macular reattachment. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Edad Gestacional , Retinopatía de la Prematuridad , Agudeza Visual , Vitrectomía , Humanos , Estudios Retrospectivos , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/complicaciones , Vitrectomía/métodos , Femenino , Masculino , Recién Nacido , Estudios de Seguimiento , Cristalino/cirugía , Resultado del Tratamiento , Limbo de la Córnea/cirugía , LactanteRESUMEN
PURPOSE: To investigate recent trends in the cumulative incidence and treatment patterns of retinopathy of prematurity (ROP) in Japan. METHODS: A retrospective multicenter cohort was conducted from 2011 to 2020 using the Diagnosis Procedure Combination inpatient database. Preterm newborns with birth weight <2,500 g were categorized by birth weight. The cumulative incidence of ROP, treatment patterns, and association between treatment and birth weight were investigated. RESULTS: A total of 82,683 preterm infants were identified, of whom 9,335 (11.3%) were diagnosed with ROP. The cumulative incidence of ROP increased by 15% in those with birth weight <500 g over the study period. Among the ROP infants, 20.2% received treatment, including laser photocoagulation (94.8%), intravitreal injection (3.8%), or both (1.8%). The proportion receiving laser photocoagulation decreased followed by an increase in intravitreal injection. This shift in intervention pattern was most conspicuous for those with birth weight 750 to 1,249 g. The risk ratio of receiving laser and intravitreal injection for those weighing <500 g was 24.7 (95% confidence interval, 10.5-58.2) and 28.4 (5.8-138.1), respectively, as compared with infants weighing >1,500 g. CONCLUSION: The cumulative incidence of ROP increased in infants with birth weight <500 g. A shift from laser photocoagulation to intravitreal injection was observed in the more recent years.
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Recien Nacido Prematuro , Retinopatía de la Prematuridad , Humanos , Recién Nacido , Peso al Nacer , Edad Gestacional , Incidencia , Japón/epidemiología , Coagulación con Láser , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/cirugía , Estudios RetrospectivosRESUMEN
PURPOSE: To investigate corneal refractive power (CR) and astigmatism (AS) in 6- to 18-year-old children with a history of retinopathy of prematurity (ROP) and birth weight of <1500 g who either did or did not undergo retinal photocoagulation (PC). STUDY DESIGN: Retrospective study. METHODS: We examined 143 eyes of 77 children in 2021. The children were divided into three groups for evaluation of CR and AS: those with a birth weight of ≥2500 g (normal birth weight [NBW] group, 13 eyes) as controls, those with spontaneously resolved ROP (sr-ROP group, 27 eyes), and those who underwent PC for treatment of ROP (PC-ROP group, 103 eyes). Swept-source anterior segment optical coherence tomography was used to analyze the cornea. RESULTS: The median CR in the NBW, sr-ROP, and PC-ROP groups was 42.2 (41.3, 42.8) diopters (D), 44.5 (43.2, 45.5) D, and 45.2 (43.8, 46.6) D, respectively. The median AS in the NBW, sr-ROP, and PC-ROP groups was 1.2 (1.0, 1.5) D, 1.1 (0.8, 1.6) D, and 2.1 (1.4, 2.7) D. In the PC-ROP group, the with-the-rule astigmatic axis was 97%. In all three groups, a strong positive correlation was found between the mean anterior and posterior CR (NBW: r=0.795, sr-ROP: r=0.842, PC-ROP: r=0.890) and AS (NBW: r=0.883, sr-ROP: r=0.841, PC-ROP: r=0.860). CONCLUSION: CR was significantly higher in the sr-ROP (p=0.013) and PC-ROP (p<0.001) groups than in the NBW group. The PC-ROP group had significantly more AS than the sr-ROP group. There was a strong correlation between the anterior and posterior CR and AS.
Asunto(s)
Astigmatismo , Errores de Refracción , Retinopatía de la Prematuridad , Recién Nacido , Niño , Humanos , Adolescente , Astigmatismo/diagnóstico , Astigmatismo/etiología , Peso al Nacer , Retinopatía de la Prematuridad/complicaciones , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/cirugía , Estudios Retrospectivos , Errores de Refracción/diagnóstico , Córnea/diagnóstico por imagen , Edad GestacionalRESUMEN
PURPOSE: Exudative retinal detachment (ERD) may result from laser photocoagulation for retinopathy of prematurity. Although risk factors have been hypothesized from case reports, comparative studies have not been reported. We sought to evaluate risk factors for ERD following laser, comparing affected and unaffected infants. METHODS: Retrospective cohort study of infants undergoing retinopathy of prematurity laser at the Children's Hospital of Philadelphia over 6 years. All received near-confluent laser of avascular retina. Demographic, medical, and procedural risk factors for ERD were evaluated in univariate analysis because of the rarity of ERD. RESULTS: Among 149 lasered infants, 6 infants (4%, 95% confidence interval [CI] 1.5%-8.6%) developed ERD. Race was a significant risk factor ( P = 0.01). Among 71 African American or Hispanic infants, 6 (8.5%, 95% CI 3.2%-17.5%) developed ERD. Among 78 non-African American or Hispanic infants, 0 (0%, 95% CI 0%-4.6%) developed ERD. There were no significant differences in the other studied factors. CONCLUSION: Exudative retinal detachment was uncommon (4%) following retinopathy of prematurity laser. Despite so few cases, darker pigmented race with likely increased pigmented fundi was significantly associated with an increased ERD risk. Further study may reveal whether increased choroidal pigment causes greater laser tissue damage or makes it difficult to discern the ora, resulting in inadvertent lasering of the ciliary body, leading to ERD.
Asunto(s)
Desprendimiento de Retina , Retinopatía de la Prematuridad , Recién Nacido , Lactante , Niño , Humanos , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/cirugía , Incidencia , Estudios Retrospectivos , Coagulación con Láser/efectos adversos , Factores de Riesgo , Edad GestacionalRESUMEN
PURPOSE: To investigate the 5-year treatment outcomes of retinopathy of prematurity in infants <500 g birth weight and compare laser and anti-vascular endothelial growth factor therapies. METHODS: A multicenter retrospective study comprised 24 eyes of 13 patients treated for Type 1 retinopathy of prematurity, followed for 5 years. Initial treatment was laser and anti-vascular endothelial growth factor in 13 and 11 eyes, respectively. Data collected included sex, birth characteristics, retinopathy of prematurity characteristics at the time of treatment, best-corrected visual acuity (BCVA), spherical equivalent, and astigmatism at 5 years posttreatment. RESULTS: Median BCVA was 0.15 logarithm of the minimum angle of resolution (interquartile range, 0.0-0.5). Snellen BCVA was ≥20/40 in 73% and ≥20/20 in 27% of eyes. Median spherical equivalent was -2.37 (interquartile range, -6.1 to -0.1); 75% had myopia (≤-0.5 D), and 25% had high myopia (≤-6.0 D). Median astigmatism was 1.25 (interquartile range, 0.9-3.0); 46% had ≥1.5 D. Anti-vascular endothelial growth factor-treated eyes showed less myopia ( P < 0.009), with no BCVA or astigmatism difference ( P = 0.997, P = 0.271) compared with laser-treated eyes. CONCLUSION: One-quarter of the eyes exhibited good visual acuity (Snellen BCVA of ≥20/20) 5 years after retinopathy of prematurity treatment. Refractive errors were common. Anti-vascular endothelial growth factor therapy may be superior to laser therapy in myopic refractive error.
Asunto(s)
Astigmatismo , Miopía , Errores de Refracción , Retinopatía de la Prematuridad , Recién Nacido , Lactante , Humanos , Astigmatismo/terapia , Retinopatía de la Prematuridad/cirugía , Estudios Retrospectivos , Factores de Crecimiento Endotelial , Resultado del Tratamiento , Coagulación con LáserRESUMEN
PURPOSE: Twin-twin transfusion syndrome (TTTS) is a condition wherein monochorionic twins share a common placenta with placental anastomoses between the two foetal circulations. Most infants who survive TTTS are born prematurely. This study aimed to determine whether fetoscopic laser ablation (FLA) can reduce the risk of retinopathy of prematurity (ROP) and whether TTTS was a risk factor for ROP. METHODS: This single-centre, retrospective, comparative study included 32 monochorionic twins with TTTS matched for gestational age, birthweight and sex to premature twins and singletons without TTTS (n = 68; twins, n = 34; and singletons, n = 34) born between 2003 and 2022. A single ophthalmologist recorded the fundus findings. FLA was performed using Solomon's technique to separate the vascular systems of the twins with TTTS. RESULTS: The gestational age and weight of premature infants with TTTS treated with FLA were significantly higher than those of untreated infants (p = 0.001 and p = 0.001, respectively); however, the hyaline membrane grade was lower (p = 0.004). A significant increase in weight (g/day) (p = 0.002) and lesser avascular area in the peripheral temporal retina (p = 0.045) was observed at postnatal week 4. The risk of ROP in the FLA group was 2.6 times (13.3% vs. 35.3%) lower than that in the non-FLA group; however, this difference was not significant. The incidence of any stage of ROP (25% vs. 18%) and treatment for ROP type 1 (6.25% vs. 5.9%) did not differ significantly between monochorionic twins with TTTS and premature infants without TTTS. CONCLUSION: The gestational age of premature infants with TTTS treated with FLA was higher than that of untreated infants. Moreover, a reduction in complications of prematurity was also observed. Laser fetoscopy in twin-twin transfusion syndrome may reduce the risk of ROP, but the difference was not statistically significant in this small study.
Asunto(s)
Transfusión Feto-Fetal , Fetoscopía , Edad Gestacional , Terapia por Láser , Retinopatía de la Prematuridad , Humanos , Transfusión Feto-Fetal/cirugía , Femenino , Retinopatía de la Prematuridad/cirugía , Retinopatía de la Prematuridad/diagnóstico , Estudios Retrospectivos , Embarazo , Fetoscopía/métodos , Recién Nacido , Masculino , Terapia por Láser/métodos , Factores de Riesgo , Incidencia , Peso al NacerRESUMEN
PURPOSE: The study aims to determine the indications and evaluate the results of primary vitrectomy in unfavorable progression of stage III active retinopathy of prematurity (ROP). MATERIAL AND METHODS: The control group consisted of 17 patients (28 eyes) with unfavorable progression of stage III ROP, who had the disease progress after coagulation of the avascular retina and underwent the second stage of treatment - vitrectomy. The main group consisted of 5 patients (10 eyes) with unfavorable progression of stage III ROP, who underwent primary vitrectomy. Gestational age at birth was 24-30 weeks, body weight ranged from 680 to 1250 g. According to spectral optical coherence tomography (SOCT) and OCT angiography (OCT-A), the initial state of the retina and vitreoretinal interface in patients of the main and control groups were identical. RESULTS: A retrospective analysis of control patients, according to SOCT and OCT-A data, showed the spread of neovascularization beyond the retinal plane, its interaction with the posterior hyaloid membrane and vitreous body structures in the early stages of the disease, traction changes in the underlying retina, areas of retinoschisis, as well as thickening of the posterior hyaloid membrane. The tactics of treating patients with unfavorable progression of stage III ROP has changed since 2020. Primary vitrectomy was performed in case the signs listed above were identified. The transition of the disease to the inactive stage was recorded in all cases one month after primary vitrectomy. After one year the pathological process did not reactivate in any of the cases, and no pathological changes were found in the projection of the former proliferation ridge. CONCLUSIONS: Extraretinal retinovitreal neovascularization, according to multimodal preoperative diagnostics, indicates the need for vitreoretinal surgery as a pathogenetically substantiated method of treatment for unfavorable progression of stage III active ROP.