Microcornea and Thickened Lens in Angle Closure following Nonsurgical Treatment of Retinopathy of Prematurity
Ta Chen ChangKimberly D. TranLinda A. Cernichiaro-EspinosaElla H. LeungAlana L. GrajewskiElizabeth HodappMohamed Abou ShoushaAudina M. Berrocal
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To characterize the clinical features in young patients with angle closure and to determine the characteristics associated with acquired anterior segment abnormality following retinopathy of prematurity (ROP) treatment.We performed two retrospective case-control series. In the first series, we identified consecutive young angle closure patients without prior surgeries, with and without a history of ROP treatment; in the second series we identified consecutive patients who underwent ROP treatment, without and without anterior segment changes.In the first series, 25 eyes of 14 consecutive angle closure patients were included: 19 eyes (11 patients, 78.6%) had a history of treated ROP, while 6 eyes (3 patients) belonged to full-term patients. The treated ROP eyes had significantly shallower anterior chambers (1.77 ± 0.17 mm vs 2.72 ± 0.18 mm, P < 0.0001) and thicker lenses (5.20 ± 0.54 mm vs 3.98 ± 0.20 mm, P = 0.0002) compared to the full-term controls. In the second series, 79 eyes of 40 patients were included, with median gestational age of 24.6 weeks. Acquired iridocorneal adhesion was noted in the eight eyes (10.1%) at a mean age of 4.7 years and was associated with prior zone 1 and plus disease (P = 0.0013), a history of initial intravitreal bevacizumab treatment (IVB, P = 0.0477) and a history of requiring additional IVB after initial treatment (P = 0.0337).Many young angle closure patients may have a history of treated ROP and may present with the triad of increased lens thickness, microcornea, and angle closure.To evaluate the current French screening guidelines for retinopathy of prematurity (ROP) and to suggest modifications to it.In this multicentric retrospective, noncomparative, interventional case series we included infants with a gestational age (GA) ≤32 weeks who were screened for ROP by fundus examination between 2011 and 2018. Main Outcome Measures were the presence of ROP and the need for treatment.A total of 2246 children with a mean GA of 28.9 ± 2.0 weeks and mean birth weight (BW) of 1141.1 ± 332.0 g were screened. Retinopathy of prematurity (ROP) was found in 683 infants (30.4%), of whom 145 (6.5%) had type 2 ROP and 58 (2.6%) had type 1 ROP. Mean GA of infants with type 1 ROP needing treatment was 25.9 + 1.5 weeks (range: 23.6-30) and mean BW was 774.1 ± 173.7 g (range: 540-1400). Both GA and BW had an impact on the development of type 1 and 2 ROP. None of the infants needing treatment had a GA of 31 weeks or more. None of the children needed treatment before 33 weeks of postmenstrual age (PMA) or 6 weeks of postnatal age (PNA).It seems possible to decrease the screening of premature infants to ≤31 weeks of GA and to start screening at 31 weeks PMA for infants having a GA < 26 weeks and at 6 weeks PNA for more mature children.
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Background: In developing countries, data on the applicability of existing models to predict retinopathy of prematurity (ROP) are scarce. The study aimed to validate the Alexandria ROP (Alex-ROP) and high-grade Alex-ROP (Hg Alex-ROP) models retrospectively to identify treatable ROP in a cohort of preterm infants in Saudi Arabia. Materials and Methods: We reviewed and included the records of 281 infants born prematurely in 2015–2021. We recorded the infants' demographics, gestational age at birth (GA), birth weight (BW), and serial weight measurements (day 7, 14, 21, and 28). We determined whether the included met the Alex-ROP and Hg Alex-ROP detection criteria for treatable or any-stage ROP and calculated the specificity, sensitivity, negative and positive predictive values, and accuracy. Results: The median BW and GA was 1095 g (range: 426–1920 g) and 29 weeks (range: 23–36 weeks), respectively. ROP developed in 112 infants, of which 30 cases were treatable. The Alex-ROP sensitivity for correctly predicting any-stage ROP and treatable ROP was 77.7% and 80.0%, respectively, and its specificity for predicting any-stage ROP and treatable ROP was 49.7% and 41%, respectively. The Hg Alex-ROP had 36.6% and 50.0% sensitivity for detecting any-stage ROP and treatable ROP, respectively, and its specificity for detecting any-stage ROP and treatable ROP was 83.4% and 78.5%, respectively. Conclusion: Previously published accuracy parameters were not reproducible in this cohort and a significant number of children requiring treatment would have been missed if the Alex-ROP or Hg Alex-ROP were applied.
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This study aimed to assess the efficacy of the WINROP (Weight, IGF-1, Neonatal Retinopathy of Prematurity) screening algorithm in a South African population.A retrospective record review included infants born between 1 January 2013 and 1 December 2014 who underwent ROP (retinopathy of prematurity) screening. Outcomes of ophthalmology examinations were compared to alarms triggered on WINROP after gestational age, date of birth, and weekly weights were entered. Sensitivity, specificity, positive predictive, and negative predictive values and mean time of alarm were calculated.Rates of ROP were 5.9% for all stages of ROP and 2.3% for severe ROP in the 220 infants included. Mean gestation age was 29.1 ± 1.3 weeks and mean birth weight 1,115.5 ± 201 g. WINROP triggered high-risk alarms in 70.5% of infants at a mean of 30.7 weeks of gestational age. Sensitivity for severe ROP was 100 and 76.9% for all stages of ROP. Specificity was low for both severe ROP and all stages of ROP at 30.2 and 30.0%, respectively.Rates of ROP are low in this population. The high number of alarms with a low negative predictive value would reduce the number of screens by 29.5%. Alarms were triggered before scheduled screening, possibly helpful in planning discharges and follow-up visits.
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Objective : To investigate the natural history of retinopathy of prematurity (ROP) in 506 extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period.Methods: Anationalpopulation-basedstudywasperformed in Sweden from April 1, 2004, to March 31, 2007.According to the study protocol, initial eye examinations were to be performed at postnatal week 5, and examinations were repeated until the retina was completely vascularized or until criteria for treatment were met.The examinations were to be performed weekly, enabling study of the course and severity of ROP.In infants without ROP or with mild ROP without progression during the latest examinations, further examinations were performed weekly or every other week from postmenstrual age 35 weeks.Results: During the study, 368 infants (72.7%) developed ROP.Postmenstrual age at onset of ROP was significantly related to severity of ROP, even when controlling for gestational age (ie, the earlier the onset of ROP, the higher the risk of developing severe ROP).Site of onset of ROP was significantly related to gestational age at birth.The risk of nasal onset was almost doubled for every week of decrease in gestational age at birth.Nasal onset was associated with severe ROP, even after adjusting for gestational age at birth. Conclusion:This population-based study confirms results of the Cryotherapy for Retinopathy of Prematurity study and shows new correlations regarding time and site of onset of ROP, both of which are associated with disease severity.
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The age at which retinopathy of prematurity was first seen was determined in 143 infants. In all, the initial ophthalmological examination was normal. Birth weights varied from 630 to 2700 g and gestational ages from 24.5 to 40.0 weeks. The median postnatal age at which acute retinopathy of prematurity was first seen was 51 and 40 days for those less than 28 and greater than or equal to 28 weeks9 gestational age, respectively, and this difference is highly significant. Similar results were obtained when infants were grouped according to birth weight less than 1000 or greater than or equal to 1000 g. Using postmenstrual age as the variable, the first signs of retinopathy of prematurity were seen over a fairly narrow age range and 86% of infants developed retinopathy between 32.5 and 38.5 weeks of age. These findings suggest that the age (but not the occurrence or severity) at which retinopathy of prematurity is first seen is controlled predominantly by stage of development rather than neonatal events.
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