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1.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
2.
Middle East Afr J Ophthalmol ; 26(3): 158-162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619904

RESUMO

OBJECTIVE: The aim of this study is to assess the incidence of retinopathy of prematurity (ROP) in preterm infants and to compare the visual outcomes in babies with and without ROP. MATERIALS AND METHODS: A consecutive cohort of 812 preterm babies were recruited with gestational age ≤32 weeks and or birth weight ≤1500 g. The outcome was assessed at the end of 15 months by determining fixation behavior, cycloplegic refraction, and vision by Cardiff cards. Incidence of visual outcomes with 95% confidence limits and relative risks were estimated. Chi-squared test and t-test were used as tests of significance. RESULTS: The incidence of ROP was 25%. The incidence of myopia, hypermetropia, astigmatism, and strabismus were 15.8% (14.3-17.3), 6% (5.1-7.1), 55.6% (53.6-57.7), and 1.8% (1.4%-2.5%), respectively, in the cohort. The most common refractive error in terms of spherical equivalence was myopia (19.8% in ROP and 14.4% in non-ROP group). The mean visual acuity measured by Cardiff Acuity cards was 0.282 and 0.27 logarithm of the minimum angle of resolution units (right eye) and 0.293 and 0.277 (left eye) in patients with and without ROP, respectively. Strabismus was present in 5% of ROP group and 0.8% of non-ROP group babies. Babies with ROP had six times (risk ratio-6.02; 95% confidence interval 2.8-12.8) higher chance of developing strabismus than those without ROP. CONCLUSIONS: Ophthalmological morbidities in premature infants such as refractive errors and strabismus are high in addition to complications like ROP. The incidence of these conditions is more in infants with ROP when compared to non-ROP group.


Assuntos
Recém-Nascido Prematuro , Erros de Refração/epidemiologia , Retinopatia da Prematuridade/epidemiologia , Estrabismo/epidemiologia , Acuidade Visual/fisiologia , Peso ao Nascer , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Índia/epidemiologia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Triagem Neonatal , Erros de Refração/diagnóstico , Erros de Refração/fisiopatologia , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Estrabismo/diagnóstico , Estrabismo/fisiopatologia , Centros de Atenção Terciária
3.
Exp Eye Res ; 189: 107827, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31600486

RESUMO

Under cone-mediated (photopic) conditions, an "instantaneous" flash of light, including both stimulus onset and offset, will simultaneously activate both "ON" and "OFF" bipolar cells, which either depolarize (ON) or hyperpolarize (OFF) in response and, respectively, produce positive-going and negative-going deflections in the electroretinogram (ERG). The stimulus-response (SR) relationship of the photopic ON response demonstrates logistic growth, like that manifested in the rod-mediated (scotopic) b-wave, which is driven by a single class of depolarizing bipolar cell. However, the photopic b-wave SR function is importantly shaped by OFF responses, leading to a "photopic hill." Furthermore, both on and off stimuli elicit activity in both ON and OFF bipolar cells. This has made it difficult to produce meaningful parameters for ready interpretation of the photopic b-wave SR relationship. Therefore, we evaluated whether the sum of sigmoidal SR functions, as descriptors of the depolarizing and hyperpolarizing components of the photopic flash ERG, could be used to elucidate and quantitate the mechanisms that produce the photopic hill. We used a novel fitting routine to optimize a sum of simple sigmoidal curves to SR data in five groups of subjects: Healthy adult, 10-week-old infant, congenital stationary night blindness (CSNB), X-linked juvenile retinoschisis (XJR), and preterm-born, both without and with a history of retinopathy of prematurity (ROP). Differences in ON and OFF amplitude, sensitivity, and implicit time among the groups were then compared using parameters extracted from these fits. We found that our modeling procedure enabled plausible derivations of ON and OFF pathway contributions to the ERG, and that the parameters produced appeared to have physiological relevance. In adult subjects, the ON and OFF amplitudes were similar in magnitude with respectively longer and shorter implicit times. Infant, CSNB, and XJR subjects showed significant ON pathway deficits. History of preterm-birth, without or with a diagnosis of ROP, did not much affect cone responses.


Assuntos
Visão de Cores , Adaptação à Escuridão/fisiologia , Eletrorretinografia/métodos , Oftalmopatias Hereditárias/fisiopatologia , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Miopia/fisiopatologia , Cegueira Noturna/fisiopatologia , Células Fotorreceptoras Retinianas Cones/fisiologia , Retinopatia da Prematuridade/fisiopatologia , Adulto , Oftalmopatias Hereditárias/metabolismo , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/metabolismo , Humanos , Lactente , Recém-Nascido , Masculino , Miopia/metabolismo , Cegueira Noturna/metabolismo , Estimulação Luminosa , Retinopatia da Prematuridade/metabolismo
4.
Biomed Res Int ; 2019: 2095730, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380413

RESUMO

Currently, the use of assisted reproductive technology (ART) is increasing. Because of the poor prognosis of retinopathy of prematurity (ROP), the association between ART and the ROP has been explored in several studies, but the result was still inconclusive. Conducting a meta-analysis, we evaluated the risk of ROP in relation to the ART. Subgroup analysis as well as groups with different embryo numbers and different ROP stages was further analyzed. The PubMed, Embase, and Cochrane Library databases were searched for studies recording data about both the use of ART and ROP occurrence simultaneously. Odds ratios (ORs) and 95% confidence interval (95%CI) were calculated to analyze the association by using random- or fixed-effect models based on heterogeneity test. In total 15 observational studies containing 10392 ART cases and 39474 spontaneous conception cases were included. Results showed that there was a significant association between the use of ART and ROP occurrence in the offspring (OR = 1.34, 95% CI: 1.05 to 1.73, P = 0.02). With subgroup analysis, we found that the influence actually came from a subgroup of ART, the in vitro fertilization (IVF). Moreover, there was a significant association between ART and ROP in singletons. Though insignificant, the ORs were larger than 1 in the analysis between ART and stage 1 and 2 ROP. But ART showed significant association with stage 3 ROP. Our study preliminarily indicated that the use of IVF was associated with higher risk of ROP occurrence. And ART is more likely to result in severe ROP and ROP in singletons. Further specific, high-quality studies with large sample size are still needed to draw more precise conclusion.


Assuntos
Fertilização In Vitro/efeitos adversos , Reprodução/fisiologia , Técnicas de Reprodução Assistida/efeitos adversos , Retinopatia da Prematuridade/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/fisiopatologia , Fatores de Risco
5.
Exp Eye Res ; 187: 107766, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31425690

RESUMO

Angiotensin II and aldosterone are the main effectors of the renin-angiotensin aldosterone system (RAAS) and have a central role in hypertension as well as cardiovascular and renal disease. The localization of RAAS components within the retina has led to studies investigating the roles of angiotensin II, aldosterone and the counter regulatory arm of the pathway in vision-threatening retinopathies. This review will provide a brief overview of RAAS components as well as the vascular pathology that develops in the retinal diseases, retinopathy of prematurity, diabetic retinopathy and neovascular age-related macular degeneration. The review will discuss pre-clinical and clinical evidence that modulation of the RAAS alters the development of vasculopathy and inflammation in the aforementioned retinopathies, as well as the emerging role of aldosterone and the mineralocorticoid receptor in central serous chorioretinopathy.


Assuntos
Aldosterona/fisiologia , Angiotensina II/fisiologia , Retinopatia Diabética/fisiopatologia , Vasos Retinianos/fisiologia , Retinite/fisiopatologia , Retinopatia da Prematuridade/fisiopatologia , Degeneração Macular Exsudativa/fisiopatologia , Inibidores da Enzima Conversora de Angiotensina , Humanos , Receptor Tipo 1 de Angiotensina , Sistema Renina-Angiotensina/fisiologia
6.
Rev Bras Enferm ; 72(3): 592-599, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269121

RESUMO

OBJECTIVE: to describe the influence of oxygen in retinopathy of prematurity (ROP) in premature newborns (PTNB) hospitalized in neonatal units of intensive care and undergoing ophthalmological follow-up procedures after hospital discharge. METHOD: retrospective cohort study, from January 2014 to June 2016, whose data collection totaled 181 charts. Descriptive and inferential statistical analysis. RESULTS: when using oxygen (O2) in 148 PTNB (81.7%), both mask (n=141; 77.9%; p-value <0.001) and the tracheal tube predominated (n=100; 55.25; p-value <0.001) for 15 days in average. The time of use and O2 concentration of the tracheal tube (p-value <0.001), the time of mask use (p-value <0.001) and the time and concentration of O2 of the continuous positive airway pressure (CPAP) (p-value <0.001) were significant to cause ROP in 50 PTNB (11.31%). CONCLUSION: the oxygen therapy has influenced the development and severity of ROP, indicating the need to adopt protocols for its use.


Assuntos
Recém-Nascido Prematuro/fisiologia , Oxigênio/metabolismo , Retinopatia da Prematuridade/etiologia , Brasil , Estudos de Coortes , Idade Gestacional , Humanos , Recém-Nascido Prematuro/crescimento & desenvolvimento , Oxigênio/efeitos adversos , Retinopatia da Prematuridade/fisiopatologia , Estudos Retrospectivos
7.
Biomed Res Int ; 2019: 2721578, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231670

RESUMO

Objective: The objective was to study the risk and protective factors involved in retinal vascular development of preterm infants with retinopathy of prematurity. Methods: Between 2000 and 2017, 185 preterm infants were included in the protocol for retinopathy of prematurity. Risk factors associated with speed of retinal vascularization <0.5 disc diameter/week were studied in each of them. Results: The statistically significant variables related to retinal vascular development <0.5 DD/w were intubation days, degree 3 of bronchopulmonary dysplasia, weight gain at 4-6 weeks, avascular temporal area, gestational age, number of transfusions, sepsis, number of risk factors, apnea at birth, presence of ductus arteriosus, and days of continuous positive airway pressure therapy. After the multivariate logistic regression analysis, only three variables were found to be significant: intubation days (p=0.005), degree 3 of bronchopulmonary dysplasia (p=0.022), and weight gain at 4-6 weeks (p=0.031). Conclusion: In retinopathy of prematurity, degree 3 of bronchopulmonary dysplasia and intubation days cause delayed retinal vascular development, whereas greater postnatal weight gain favors an appropriate rate of retinal vascularization.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Neovascularização Retiniana/fisiopatologia , Vasos Retinianos/fisiopatologia , Retinopatia da Prematuridade/fisiopatologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Doenças do Recém-Nascido/fisiopatologia , Recém-Nascido Prematuro/fisiologia , Doenças do Prematuro/fisiopatologia , Masculino , Fatores de Risco
8.
Korean J Ophthalmol ; 33(3): 272-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179659

RESUMO

PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (-1.0 diopters in the laser group and -0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, -0.007 to -0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.


Assuntos
Bevacizumab/administração & dosagem , Fotocoagulação a Laser/métodos , Ranibizumab/administração & dosagem , Refração Ocular/fisiologia , Retinopatia da Prematuridade/terapia , Inibidores da Angiogênese/administração & dosagem , Pré-Escolar , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Oftalmoscopia , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Testes Visuais
9.
Indian J Ophthalmol ; 67(6): 871-876, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124505

RESUMO

Purpose: Ocular morbidities like high refractive error, strabismus, and amblyopia are common among laser-treated retinopathy of prematurity children (ROP). Long-term optical status and refractive outcomes including the sensory outcomes were less investigated in these children from this region. The purpose of our study is to evaluate the long-term outcome (refractive, biometric profile, sensory) of treatment for ROP using laser. Methods: This study is a retrospective, cross-sectional, observational, and intervention research among 6-15-year-old children who underwent laser for ROP with a minimum of 6-year follow-up. Results: Eighty lasered eyes of 41 children were assessed. Mean age was 9.71 years (±3.39). Seventy-three eyes (91.2%) achieved visual acuity better than 20/40. The mean visual acuity in LogMAR was 0.18 (20/30). The mean spherical equivalence was -5.29 D ± 4.9. Mean astigmatism measured was -1.53 DC (range: +0.50 DC to -4.5DC). Fifty-three eyes (66.25%) had significant astigmatism. The mean axial length was 23.5 ± 1.35 (21-26) mm. Mean lens thickness was 3.76 ± 0.30 (3.03-4.34) mm. Correlation analysis among the low and high spherical equivalent group signified that axial length (P value = 0.001), visual acuity (P value = 0.0002), and myopic shift (P value = 0.0006) were found to be statistically significant. Stereopsis better than 480 s of arc for near was observed in 41% children. Structural posterior pole sequelae developed in 3 eyes (3.75%). Conclusion: A significant number of children with high myopia, astigmatism, and strabismus had satisfactory visual outcome observed at long-term follow-up after treatment for ROP using laser. Our study revealed that myopia was influenced by an increase in axial length than the lens thickness.


Assuntos
Biometria/métodos , Sensibilidades de Contraste/fisiologia , Terapia a Laser/métodos , Refração Ocular/fisiologia , Retinopatia da Prematuridade/cirurgia , Centros de Atenção Terciária , Acuidade Visual/fisiologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
10.
Indian J Ophthalmol ; 67(6): 928-931, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124517

RESUMO

Purpose: To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation. Methods: A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality. Results: Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum. Conclusion: Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.


Assuntos
Cegueira/reabilitação , Conhecimentos, Atitudes e Prática em Saúde , Triagem Neonatal/métodos , Pediatras/normas , Retinopatia da Prematuridade/reabilitação , Acuidade Visual , Adolescente , Adulto , Distribuição por Idade , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/fisiopatologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
11.
Indian J Ophthalmol ; 67(6): 932-935, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124518

RESUMO

Purpose: To evaluate vision-related quality of life in children treated for retinopathy of prematurity. Methods: Cross sectional observational study of 54 treated ROP babies 2-7 years of age. The study excluded babies with chronic pediatric conditions and babies of parents suffering from mental illness. Detailed examination including visual acuity was done for all. Two versions of CVFQ questionnaire for children under 3 and above 3 years of age were posed to parents in this study. CVFQ contains six subscales: General health, vision health, competence, personality, family impact, and treatment difficulty. The scores ranged from 0 (worst score) to 1 (best score). Results: The study included 54 children with mean birth weight was 1194 grams, mean gestation age 30 weeks. The age, gender, birth weight, and gestational age didn't affect the overall quality of life (P > 0.05). The severity of ROP (stage 4 and 5) had poorer CVFQ scores (personality and family impact subscales). Competence and personality scores were significantly lower in zone I disease. The quality of life especially general vision, competence, personality, and treatment difficulty subscales had significantly lower values in ROP with higher clock hour involvement (P < 0.05). With myopia after ROP treatment, only personality subscale was significantly affected (P 0.02). Mean CVFQ score including the family impact and treatment difficulty subscale score was also significantly lower in amblyopic and anisometropic children (P value < 0.05). Family impact subscale and overall quality of life was significantly lower in children with strabismus than children without strabismus (P 0.001). Conclusion: ROP has negative effect on the vision-related quality of life of children and their parents. The overall quality of life worsened with the increase in the severity of disease and the occurrence of ocular sequelae of ROP. The vision of the baby may not be the only cause of low scores in the quality of life questionnaire in ROP.


Assuntos
Qualidade de Vida , Retinopatia da Prematuridade/fisiopatologia , Acuidade Visual/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Gerenciamento Clínico , Feminino , Humanos , Masculino , Estudos Prospectivos , Retinopatia da Prematuridade/psicologia , Retinopatia da Prematuridade/terapia , Inquéritos e Questionários
14.
Doc Ophthalmol ; 139(1): 59-65, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30972611

RESUMO

PURPOSE: The purpose of this study was to compare electroretinographic (ERG) responses of preterm schoolchildren, with and without a history of retinopathy of prematurity (ROP) with those of full-term schoolchildren by using a portable ERG device (RETeval system). METHODS: Twenty five prematurely born schoolchildren with a mean gestational age of 27 + 1/7w (range 23-30w) and a mean birth weight of 1030 g (range 580-1700 g) who were 6.9 ± 2.2 years old participated in the study (premature group). A further subdivision according to a history of ROP (ROP+ group) or its absence (ROP- group) was introduced. Twenty eight healthy full-term schoolchildren with an average age of 8.6 ± 1.9 years participated as the control group. 30-Hz flicker ERG responses were obtained, and implicit times and amplitudes were compared between the groups. RESULTS: 30-Hz flicker ERG implicit times showed a significant difference between all three groups of children. The mean value of the implicit time in the term group was 25.76 ± 0.9 ms, whereas in the preterm ROP + group it was 28.96 ± 1.0 ms and in the preterm ROP- group it was 26.87 ± 1.5 ms. 30-Hz flicker ERG amplitudes did not show significant difference between term children and children born prematurely with or without ROP. CONCLUSIONS: Prematurely born schoolchildren exhibit longer implicit time of the 30-Hz flicker ERG response compared to controls, suggesting a possible abnormality of the retinal cone system function. Under such circumstances, portable ERG device might be used clinically as a screening tool for retinal function evaluation in prematurely born children.


Assuntos
Eletrorretinografia/instrumentação , Células Fotorreceptoras Retinianas Cones/fisiologia , Retinopatia da Prematuridade/fisiopatologia , Peso ao Nascer , Criança , Feminino , Idade Gestacional , Humanos , Recém-Nascido Prematuro , Masculino , Estimulação Luminosa , Retina/fisiopatologia
15.
Invest Ophthalmol Vis Sci ; 60(5): 1614-1620, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30995318

RESUMO

Purpose: To correlate cone- and rod-mediated function with morphology of the macula in preterm-born children without and with spontaneously regressed retinopathy of prematurity (ROP). Methods: We performed spectral-domain optical coherence tomography (SD-OCT) single scans in the macular center of preterm-born children aged 6 to 12 years (mean ± SD, 7.4 ± 1.8) without ROP (noROP; n = 59) and with spontaneously regressed ROP (srROP; n = 34), documented with wide-angle digital imaging during routine screening for acute ROP, and compared the data from 14 age-matched term-born children. SD-OCT data were compared to functional cone- and rod-mediated results of scotopic and photopic chromatic pupillometry (cP) and two-color fundus-controlled perimetry (2C-FCP). Results: SD-OCT showed a shallowed foveal pit with significantly reduced outer nuclear layer to inner retinal layer ratio, indicating macular developmental arrest (MDA). MDA was present in 44% of the srROP and 27% of the noROP children. Pupil reaction to photopic red stimuli on blue background showed significantly lower values in all preterm-born children with MDA. In accordance, photopic light increment sensitivity (LIS) to red stimuli in the foveal center on the 2C-FCP was also significantly reduced in children with MDA. Under scotopic conditions, no significant differences were apparent in both pupil reaction with cP and LIS with 2C-FCP. Conclusions: Both objective pupillary response to cone-mediated photopic red stimuli and subjective central cone-mediated results in fundus-controlled perimetry were reduced in preterm-born children with MDA. MDA was present in a significant number of patients with srROP, but also without ROP.


Assuntos
Fóvea Central/patologia , Nascimento Prematuro , Células Fotorreceptoras Retinianas Cones/fisiologia , Retinopatia da Prematuridade/fisiopatologia , Peso ao Nascer , Criança , Visão de Cores/fisiologia , Feminino , Fóvea Central/diagnóstico por imagem , Idade Gestacional , Humanos , Masculino , Visão Noturna/fisiologia , Pupila/fisiologia , Retinopatia da Prematuridade/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Testes de Campo Visual
16.
J Pediatr Ophthalmol Strabismus ; 56(2): 116-123, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30889266

RESUMO

PURPOSE: To compare the time course of retinopathy of prematurity (ROP) in premature (≥ 28 to 34 weeks' gestational age) and extremely premature (< 28 weeks' gestational age) infants. METHODS: This study was a retrospective single-center chart review that included 582 eyes (122 premature, 464 extremely premature) of 299 infants (65 premature, 234 extremely premature) diagnosed as having ROP who were born between January 1, 2010, and December 31, 2015. Data collected were analyzed with shared frailty models, chi-square, and Fisher's exact tests. RESULTS: Extremely premature infants were diagnosed as having ROP earlier than premature infants at 33.6 weeks (95% CI [confidence interval]: 33.4 to 33.9) versus 36.0 weeks (95% CI: 34.7 to 36.4, P < .0001). The time from diagnosis to spontaneous regression was more than 4 weeks longer for extremely premature infants than premature infants with stage 1 ROP (82.0 vs 50.0 days, P < .0001), and more than 6 weeks longer for extremely premature infants than premature infants with stage 2 ROP (99 vs 55 days, P < .0001). Extremely premature infants had more bilateral ROP (96.6% vs 87.1%, P < .01) and were three times more likely to require treatment than premature infants (29.7% vs 9.9%, P < .0001). On average, infants who required treatment weighed 137 grams less at birth (P < .0001) and gained 37.7 grams less per week than infants who underwent spontaneous regression (P < .0001). CONCLUSIONS: Extremely premature infants developed ROP earlier, had more bilateral ROP, took longer to achieve spontaneous regression, and required treatment more often than premature infants. Infants who required treatment had a lower birth weight and rate of weight gain than infants who underwent spontaneous regression. [J Pediatr Ophthalmol Strabismus. 2019;56(2):116-123.].


Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido Prematuro , Retinopatia da Prematuridade/epidemiologia , Acuidade Visual , Progressão da Doença , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
17.
Jpn J Ophthalmol ; 63(3): 262-268, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30825009

RESUMO

PURPOSE: To evaluate the short-term changes in intraocular pressure (IOP) after intravitreal injection of bevacizumab (IVB) in premature infants with retinopathy of prematurity (ROP). STUDY DESIGN: Prospective cohort study. METHODS: Twenty-two eyes of 11 premature infants with ROP were evaluated. The control eyes were from adults who received an intravitreal injection of antivascular endothelial growth factor agent. The patients received a 0.025 mL (0.625 mg) IVB for the ROP. The IOP was measured with a rebound tonometer at baseline, immediately after the injection, and at 5, 10, 15, 20, and 30 minutes after the injection. The clinical data were collected. The main outcome measures were the IOP values at baseline, immediately after the injection, and at 5, 10, 15, 20, and 30 minutes after the injection. RESULTS: The mean IOP values at baseline, immediately after the injection, and at 5, 10, 15, 20, and 30 minutes after the injection were 12.3 ± 3.0, 40.1 ± 10.7, 20.8 ± 5.1, 15.1 ± 4.8, 11.9 ± 3.2, 9.9 ± 2.6, and 8.8 ± 2.1 mmHg, respectively. The IOP was significantly higher at 5 minutes after the injection (P < .01); however, the pressure in all the eyes normalized (< 21 mmHg) within 15 minutes. None of the clinical parameters, including axial length, was correlated with a high IOP after IVB. CONCLUSION: In premature infants with ROP, IVB is tolerable in terms of the short-term elevation in IOP, which returned to a safe range (< 21 mmHg) within 15 minutes of the injection in all the patients. Consecutive IOP measurement might not be necessary after IVB in premature infants with ROP.


Assuntos
Bevacizumab/administração & dosagem , Pressão Intraocular/fisiologia , Retinopatia da Prematuridade/tratamento farmacológico , Acuidade Visual , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Pressão Intraocular/efeitos dos fármacos , Injeções Intravítreas , Masculino , Estudos Prospectivos , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Retinopatia da Prematuridade/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
JAMA Ophthalmol ; 137(4): 417-423, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30763441

RESUMO

Importance: The Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) demonstrated that static low oxygen saturation decreased retinopathy of prematurity (ROP) but increased mortality compared with static high oxygen saturation cohorts. Objective: To compare outcomes of a biphasic oxygen protocol with static targets recommended by SUPPORT. Design, Setting, and Participants: Retrospective cohort study comparing biphasic vs static standards 41 months prior to and 42 months after a change from biphasic to static SUPPORT standards at a level III neonatal intensive care unit (Fairview Hospital, Cleveland, Ohio). The study included infants born at a corrected gestational age (CGA) of 31 weeks or younger or birth weight 1500 g or less. Data were analyzed between August 2010 and July 2017. Interventions: The pre-SUPPORT group underwent biphasic protocol target saturations of 85% to 92% at younger than 34 weeks' CGA and greater than 95% at 34 weeks' CGA or older. The post-SUPPORT group underwent a constant 91% to 95% target. Main Outcomes and Measures: Primary outcome was incidence of type 1 ROP. Secondary outcomes were incidence of any ROP, time to full vascularization, and mortality. Results: Of 596 eligible infants, 562 were included in ophthalmic analysis. Three hundred three patients were boys (54%); 399 were white (71%), 87 were black (15%), and 76 were of other or unknown race/ethnicity (14%). Mean (SD) CGA and birth weight were 29 (2) weeks and 1151 (346) g, respectively. Any ROP overall increased (53 [20%] pre-SUPPORT vs n = 86 [28%] post-SUPPORT; absolute difference, 8%; 95% CI, 1%-15%; odds ratio, 1.6; 95% CI, 1.05-2.3; P = .03). Type 1 ROP increased in the post-SUPPORT era (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; odds ratio, 2.7; 95% CI, 1.05-6.9; P = .03). There was a delay in vascularization in the post-SUPPORT group (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; P = .03). Conclusions and Relevance: Compared with static oxygen standards, biphasic oxygen targets are associated with decreased incidence and severity of ROP without increasing mortality.


Assuntos
Oxigenoterapia/métodos , Retinopatia da Prematuridade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Razão de Chances , Consumo de Oxigênio/fisiologia , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/terapia , Estudos Retrospectivos
19.
Invest Ophthalmol Vis Sci ; 60(1): 98-106, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30640977

RESUMO

Purpose: The purpose of this study was to prospectively investigate the association between retinopathy of prematurity (ROP) and ocular growth in premature infants during the earliest weeks of life. Methods: Premature infants in the national ROP screening program were recruited and examined at 1- or 2-week intervals between 30 and 38 weeks of postmenstrual age. One hundred infants with gestational age (GA) between 24 and 35 weeks (30.04 + 2.13), and birth weight (BW) between 550 and 2060 g (1251.45 + 317.19) were included in the study. At each examination, the presence, stage, and zone of ROP were recorded along with axial length (AL), central corneal thickness (CCT), and weight gain. Biometric parameters were measured by A-scan biometry. Study variables included GA, BW, AL, CCT, weight gain, relative weight (RW), and dif_AL, dif_CCT, and dif_weight, which are the differences between two consecutive recordings of the same infant. Multiple regression analysis models were used to determine the association between the study variables and ROP. Results: dif_AL, dif_CCT, and RW were the most appropriate variables to detect the optimal threshold points that discriminate ROP: weekly increase of AL < 0.095 mm, weekly reduction of CCT < 0.5 µm, or weekly weight gain < 7% is associated with ROP development. Conclusions: ROP is associated with delayed ocular development, as eyes of premature infants with ROP have shorter axial lengths and thicker corneas than eyes of premature infants without ROP. The association of AL, CCT, and weight gain with ROP could be of value for future development of predictive models for ROP.


Assuntos
Olho/crescimento & desenvolvimento , Retinopatia da Prematuridade/complicações , Biometria , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos , Retinopatia da Prematuridade/fisiopatologia
20.
Ophthalmology ; 126(1): 107-112, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30092239

RESUMO

PURPOSE: To quantify inner and outer retinal layer thicknesses and understand their relevance to visual function among young adults born extremely preterm (EP). DESIGN: Prospective observational study with 19 years of follow-up. PARTICIPANTS: A total of 354 eyes (226 eyes of former EP infants and 128 age-matched full-term control eyes) from 177 young adults were evaluated. Among EP participants, 50% of eyes (112/226) were not previously diagnosed with neonatal retinopathy of prematurity (ROP), 38% of eyes (84) had ROP not deemed to require treatment in the neonatal period, and 13% of eyes (30) had neonatal cryotherapy or laser ablation for ROP. METHODS: Subjects underwent eye examinations including best-corrected visual acuity (BCVA) and Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) macular spectral-domain (SD) OCT imaging. Retinal layers were auto-segmented and thickness profiles were computed at the fovea by the instrument software. MAIN OUTCOME MEASURES: Correlation between retinal sublayer thickness and BCVA. RESULTS: Compared with control eyes, the inner and outer retinal layers of EP eyes were significantly thicker and BCVA was significantly reduced. Retinal layer thicknesses and BCVA were similar for untreated EP eyes and those without neonatal ROP. In contrast, treated eyes had increased inner and outer retinal layer thickness and decreased vision. Inner retinal layer thickness was moderately correlated with worse BCVA (r = 0.30, P < 0.001), but outer retinal layer thickness was not (r = -0.01, P = 0.80). Multivariate regression indicated ganglion cell layer thickness was a significant independent predictor of BCVA. CONCLUSIONS: Extremely premature birth influences maturation of the fovea and visual outcomes into early adult life. Increased ganglion cell layer thickness was associated with worse BCVA. Eyes requiring neonatal treatment for ROP had associated worse BCVA at the age of 19 years.


Assuntos
Lactente Extremamente Prematuro , Retina/patologia , Retinopatia da Prematuridade/fisiopatologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Adolescente , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente Extremamente Prematuro/fisiologia , Estudos Longitudinais , Masculino , Tamanho do Órgão , Nascimento Prematuro , Estudos Prospectivos , Retina/diagnóstico por imagem , Células Ganglionares da Retina/patologia , Retinopatia da Prematuridade/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/diagnóstico por imagem , Adulto Jovem
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