Objective To explore the effect of polycythemia on retinopathy of prematurity (ROP). Methods The clinical data of 262 premature cases was analyzed retrospectively in Xi'an Children Hospital from January 2005 to January 2009. Polycythemia was found in 46 cases (17.56%), including 27 males and 19 females. In 216 infants without polycythemia (82.46%), 155 were male and 61 were female. The difference of the birth weight (t=0.730, P=0.466), gestational age (t=1.603,P=0.110), oxygen inhalation numbers (chi;2=0.04,P＞0.90) and times (t=1.225,P=0.223), and concentration (t=1.823,P=0.071) between polycythemia group and no polycythemia group were not significant. In order to diagnose ROP, the ocular fundus of all premature infants was examined with binocular indirect ophthalmoscope,and the stage of ROP was assessed.Results In all the premature infants,ROP was found in 120 cases (45.80%). In 46 cases of polycythemia, ROP was found in 25 cases (54.34%); in 216 infants without polycythemia, ROP was found in 95 cases (43.98%); the difference of ROP incidence between the two groups was not significant (chi;2=1.64, Pgt;0.1).In 120 ROP patients, 104 cases (86.67%) with ROP＜3 stage and 16 cases (13.33%) with ROP ge;3 stage were found. In 25 ROP patients with polycythemia, 18 cases (72.00%) with ROP ＜3 stage and 7 cases (28.00%) with ROP ge;3 stage were found. In 95 ROP patients without polycythemia, 86 cases (90.53%) with ROP ＜3 stage and 9 cases (9.47%) with ROP ge;3 stage were found. The difference of the incidence of ROP ＜and ge;3 stage between the two group was significant (chi;2=4.38, Plt;0.05). In 120 cases of ROP, prethreshold retinopathy was found in 106 cases (88.33%), while threshold and post-threshold retinopathy was in 14 cases (11.67%). In 25 ROP patients with polycythemia, prethreshold retinopathy was found in 19 cases (76.00%), and threshold and post-threshold retinopathy was in 6 cases (24.00%).In 95 ROP infants without polycythemia, pre-threshold retinopathy was found in 87 cases (91.58%),while threshold and post threshold retinopathy was in 8 cases (8.42%).The difference of the incidence of ROP with prethreshold, and threshold and post-threshold retinopathy between the two groups was not significant (chi;2=3.27,P＞0.05).Conclusion Polycythemia may not affect the incidence of ROP,but impact on the severity of ROP.
Retinopathy of prematurity (ROP) is the leading cause of blindness for children, early detection and treatment can prevent ROP progression and improve the visual prognosis. ROP prevention system, including advocacy, screening, diagnosis/treatment and follow-up, is the key to reducing the rate of blindness in children. The proposed tertiary ROP prevention network includes primary health centers in county-level, secondary health centers in municipal-level and tertiary health centers in provincial-level or national-level. The idea is to explore the greatest benefits in the ROP prevention process from the existing allocation of medical resources, but also to avoid wasting at the current stage of social development. We tested this idea in Shaanxi Province recently. The preliminary practice results indicated that ROP tertiary prevention network can increase the ROP screening coverage, promote the prevention and treatment of ROP. However this work is still in its infancy. We need to expand its scope and strength the advocacy efforts to find a way to prevent and treat ROP in China.
ObjectiveTo observe the effect of breastfeeding on the incidence of retinopathy of prematurity (ROP).MethodsA retrospective clinical study. From June 2017 to December 2019, 1256 eyes of 628 premature infants who were born in Ningbo Women and Children's Hospital and were screened for ROP were included in the study. Among them, there were in 325 males (650 eyes) and 303 females (606 eyes). According to the feeding situation, premature infants were divided into breastfeeding (research) group and formula feeding (control) group, with 390 cases of 780 eyes and 238 cases of 476 eyes, respectively. The changes in the retina of the fundus of the two groups of premature infants during the observation period were compared. The qualitative data comparison between groups was performed by the χ2 test; the quantitative data comparison was performed by the two independent sample t test.ResultsThe sex ratio of premature infants in the study group and control group (χ2=0.217), birth weight (t=0.728), gestational age at birth (t=0.351), Apgar score at birth (t=0.816), oxygen inhalation time (t=0.427), were compared with the length of stay in the neonatal intensive care unit (t=1.580), the difference was not statistically significant (P＞0.05). Among the 390 cases in the study group, 108 cases (27.7%, 108/390) and 282 cases (72.3%, 282/390) were with or without ROP, respectively; in the 238 cases in the control group, 86 (36.1%, 86/238) were with ROP, 152 (63.9%, 152/238) cases were without ROP. There was a statistically significant difference in the incidence of ROP between the two groups (χ2=4.934, P=0.026). Among the 108 cases of ROP in the study group, 50 (12.8%, 50/108), 35 (9.0%, 35/108), 23 (5.9%, 23/108) cases were in stage 1, 2 and 3, respectively. Among the 86 ROP cases in the control group, stages 1, 2 and 3 were 25 (10.5%, 25/86), 40 (16.8%, 40/86), and 21 (8.8%, 21/86), respectively. In the comparison of ROP staging between the two groups, the difference in stage 1 was not statistically significant (χ2=0.754, P＞0.05), and the difference in stage 2 and above was statistically significant (χ2=11.400, P＜0.05).ConclusionBreastfeeding may reduce the incidence and severity of ROP.
ObjectiveTo observe the effect of intravitreal injection of Conbercept with two different doses in the treatment of retinopathy of prematurity (ROP）and explore the clinical feasibility of ROP treatment by lower dose conbercept.MethodsThis was a prospective study. The premature infants were enrolled with pre-threshold type 1, threshold and acute aggressive posterior retinopathy of prematurity (AP-ROP) from March 2018 to June 2019, who received fundus screening in neonatal intensive care unit (NICU) of Henan Provincial People's Hospital, Henan Eye Hospital. They were randomly divided into two groups. The group A (lower dose group) were received intravitreal injection of conbercept with 0.15 mg/0.015 ml, and those in group B (control group) were received intravitreal injection of conbercept with 0.25 mg/0.025 ml. We checked and recorded the lesion area, stage, scope (according to the clock range), additional lesion (plus), etc. Fundus examination should be performed with the pediatric wide-field fundus imaging system within 7 days after treatment. It was used to observe the plus disese, ridge, regression of neovascularization on ridge, and development of retinal vessels to serrated edge or scarring. The follow-up period was at least 24 weeks. The effect evaluation was divided into recovery, improvement, recurrence and aggravation.ResultsThe 43 ROP subjects (84 eyes) were enrolled including 21 cases (40 eyes) in group A and 22 (44 eyes) in group B. There was no significant difference between the two groups in gender (χ2=1.169), birth age (t=0.283), birth weight (t=0.547), hospitalization days in NICU (t=1.187), first examination time (t=1.811), first injection time (t=0.492), follow-up time (t=0.899) and ROP condition (χ2=0.854) (P>0.05). In group A, 21 eyes (52.5%) were cured, 17 eyes (42.5%) were improved, 2 eyes (5.0%) were recurred, and no aggravating cases were found. In group B, 24 eyes (54.5%) were cured, 14 eyes (31.8%) were improved, 6 eyes (13.6%) were recurred, and no aggravating cases were found. There was no significant difference of the cure rate (χ2=2.210, P>0.05) and effective (recovery and improvement) rate (χ2=1.814, P=0.269）between two groups after the first injection.ConclusionIntravitreal injection of conbercept with the two doses should be effective in the treatment of ROP.
Retinopathy of prematurity (ROP) has become the leading blinding eye disease in children worldwide. In recent years, the recognition and treatment of acute stage lesions have achieved remarkable results. Fundus lesions could spontaneously regress in most of children with ROP, while the understanding of the law of spontaneous regression is still very limited. Although the fundus morphology is significantly improved after spontaneous regression, the long-term prognosis of visual function is not optimistic. The introduction of new technologies such as fundus fluorescence angiography and optical coherence tomography and angiography will help further understanding the nature of the spontaneous regression. To increase the study about spontaneous regression of ROP, which has significance for rationally arranging an economical and efficient screening time, formulating a scientific and individual treatment and follow-up plan, and improving the prognosis of visual function.
Objective To investigate the degree of retinal development in preterm infants.MethodsFlash electroretinography (ERG) was performed on 25 healthy preterm infants and 25 full-term ones, and the response of rod cells and cone cells and maximal mixed responses were recorded. The delitescence and amplitudes of a-and b-waves and the ratio of amplitudes of b-/a-wave of maximal responses were analyzed. ResultsCompared with the full-term infants, The delitescence of responses of rod cells in preterm infants was statistically longer（t=11.007，P=0.000）but without any significant changes of amplitudes （t=1.836，P=0.069）; statistically longer delitescence (t=2.44, P=0.010; t=10.800, P=0.000) and lower amplitude (t=5804，P=0.000; t=5.809,P=0.000) of a-and b-wave of maximal response were found in preterm infants group. In the response of cone cells, there were significant differences of the delitescence （t=4.444，P=0.000）and amplitude （t=3.819，P=0.000）of a-wave and delitescence of b-wave（t=2.850，P=0.005） between the two groups, and no statistical difference of amplitude of b-wave （t=0.486，P=0.628） between the two groups. The ratio of amplitudes of b-/a-wave of the maximal mixed response was not significantly different between the two groups （t=1.142，P=0.256）.ConclusionsThe development of retinal function is slower in preterm infants than that in full-term ones.(Chin J Ocul Fundus Dis, 2005,21:285-287)
ObjectiveTo analyze the clinical characteristics and evaluate the effect and safety of anti-vascular endothelial growth factor (VEGF) therapy in retinopathy of prematurity (ROP) in Sichuan province. MethodsA retrospective study. From January 2013 to January 2022, 156 patients (306 eyes) with ROP who received intravitreal anti-VEGF therapy for the first time in the Department of Ophthalmology, West China Hospital of Sichuan University were selected. According to the type of anti-VEGF drugs, the children were divided into intravitreal injection of ranibizumab (IVR) group and intravitreal injection of conbercept (IVC) group; IVC group was divided into hospital group and referral group according to the different paths of patients. After treatment, the patients were followed up until the disease degenerated (vascular degeneration or complete retinal vascularization) or were hospitalized again for at least 6 months. If the disease recurred or progressed, the patients were re-admitted to the hospital and received anti-VEGF drug treatment, laser treatment or surgical treatment according to the severity of the disease. Clinical data of these children was collected, including general clinical characteristics: gender, gestational age at birth (GA), birth weight (BW), history of oxygen inhalation; pathological condition: ROP stage, zone, whether there were plus lesions; treatment: treatment time, postmenstrual gestational age at the time of the first anti-VEGF drug treatment; prognosis: re-treat or not, time of re-treatment, mode of re-treatment; adverse events: corneal edema, lens opacity, endophthalmitis, retinal injury, and treatment-related systemic adverse reactions. The measurement data between groups were compared by t test, and the count data were compared by χ2 test or rank sum test. ResultsOf the 306 eyes of 156 children with ROP, 74 were male (47.44%, 74/156) and 82 were female (52.56%, 82/156). Each included child had a history of oxygen inhalation at birth. The GA was (28.43±2.19) (23.86-36.57) weeks, BW was (1 129±335) (510-2 600) g, and the postmenstrual gestational age was (39.80±3.04) (31.71-49.71) weeks at the time of the first anti-VEGF drug treatment. All patients were diagnosed as type 1 ROP, including 26 eyes (8.50%, 26/306) of aggressive ROP (A-ROP), 39 eyes (12.74%, 39/306) of zone Ⅰ lesions, and 241 eyes (78.76%, 241/306) of zone Ⅱ lesions. The children were treated with intravitreal injection of anti-VEGF drugs within 72 hours after diagnosis. Among them, 134 eyes (43.79%, 134/306) of 68 patients were treated with IVR, and 172 eyes (56.21%, 172/306) of 88 patients were treated with IVC. In IVC group, 67 eyes of 34 patients (38.95%, 67/172) were in the hospital group and 105 eyes of 54 patients (61.05%, 105/172) were in the referral group. 279 eyes (91.18%, 279/306) were improved after one treatment, 15 eyes (4.90%, 15/306) were improved after two treatments, and 12 eyes (3.92%, 12/306) were improved after three treatments. The one-time cure rate of IVR group was lower than that of IVC group, but the difference was not statistically significant (χ2=1.665, P=0.197). In different ROP categories, IVC showed better therapeutic effect in A-ROP, and its one-time cure rate was higher than that in IVR group, with statistically significant difference (χ2=7.797, P<0.05). In the hospital group of IVC group, the GA, BW and the postmenstrual gestational age at first time of anti-VEGF drug treatment were lower than those in the referral group, and the difference was statistically significant (t=－2.485, －2.940, －3.796; P<0.05). The one-time cure rate of the hospital group and the referral group were 94.94%, 92.38%, respectively. The one-time cure rate of the hospital group was slightly higher than that of the referral group, but the difference was not statistically significant (χ2=0.171, P=0.679). In this study, there were no ocular and systemic adverse reactions related to drug or intravitreal injection in children after treatment. ConclusionsCompared with the characteristics of ROP in developed countries, the GA, BW and postmenstrual gestational age of the children in Sichuan province are higher. Both IVR and IVC can treat ROP safely and effectively. There is no significant difference between the two drugs in the overall one-time cure effect of ROP, but IVC performed better in the treatment of A-ROP in this study.
ObjectiveTo observe the clinical features of retinopathy of prematurity (ROP) in multiple fetuses.MethodsRetrospective clinical study. From December 2009 to June 2018, 758 premature or low-weight multiple fetuses (multiple fetuses group) and 2363 simultaneous single fetuses (single fetuses group) who were admitted to the Department of Ophthalmology and Neonatal Department of Dongguan People’s Hospital and underwent ROP screening were included in the study. Among the multiple pregnancy group, there were 735 twins and 23 triplets; 441 males and 317 females. The mean gestational age was 32.22±2.14 weeks, and the mean body weight was 1.69±0.43 kg. There were 202 of natural births and 556 of cesarean sections. A total of 750 cases have a history of oxygen. Among the singleton group, 1421 were males and 942 were females. The mean gestational age was 32.06±2.52 weeks, and the mean body weight was 1.70±0.46 kg. There were 1146 of natural births and 1217 of cesarean sections. A total of 2333 cases have a history of oxygen. The detection rate of multiple ROP, gestational age, birth weight, sex composition ratio, mode of birth, time of first ROP diagnosis, and severity of ROP were observed. χ2 test was used to compare the rate between groups, and t test was used to compare the mean between groups.ResultsAmong the multiple pregnancy group, there were 68 cases (8.97%) of ROP. Among them, 64 twins (8.71%, 64/735), 4 triplets (17.39%, 4/23). Among the singleton group, there were 187 cases (7.91%) of ROP. With the increase of fetal number, the detection rate of ROP increased, but there was no significant difference (χ2=3.097, P=0.213). There was no significant difference in the detection rate of ROP between multiple fetuses and single fetuses (χ2=0.855, P=0.355). There was no significant difference in sex ratio (χ2=0.069), mode of production (χ2=1.900), birth weight (t=0.139), gestational age (t=－0.478), and time of first ROP diagnosis (t=0.371) between ROP cases of multiple fetuses and single fetuses (P=0.793, 0.168, 0.889, 0.633, 0.371). There was no significant difference in the constituent ratio of severity of ROP lesions between multiple fetuses and single fetuses (χ2=3.003, P=0.223).ConclusionThere is no significant difference in ROP incidence, gestational age, birth weight, diagnosis time and severity of ROP between multiple fetuses and single fetuses under the same conditions.
Objective To observe the effect of assisted reproductive technology (ART) on retinopathy of prematurity (ROP) in preterm infants. MethodsA retrospective clinical study. From January 2016 to January 2020, 639 preterm infants who were hospitalized at Children's Hospital of Zhengzhou University and underwent fundus screening at a gestational age ≤32 weeks were included in the study. There were 366 males and 273 females. Gestational age at birth were (28.3±1.4) weeks; birth weight were (1 153.8±228.8) g. Severe ROP was detected in 60 cases (9.4%, 60/639); 120 were ART recipients, and 519 were naturally conceived, and were divided into the ART group and the control group accordingly. The incidence of gestational diabetes mellitus (χ2=21.675), pulmonary surfactant application (χ2=13.558), and twin births (yes) (χ2=145.568) in mothers of the children examined in both groups were significantly higher than that of the control group, and the difference were statistically significant in all cases (P＜0.001). Comparison of quantitative data between groups was performed by t-test, and comparison of count data was performed by χ2 test; logistic regression was used to analyze the effect of ART on the incidence of ROP. ResultsOf the 60 cases of severe ROP, 18 (15.0%, 18/120) and 42 (8.1%, 42/519) cases were in the ART group and control group, respectively. The incidence of severe ROP was significantly higher in the ART group than in the control group, and the difference was statistically significant (χ2=4.680, P=0.024). Compared with the control group, the incidence of severe ROP was significantly higher in the ART group for gestational age at birth ＜28 weeks and birth weight ＜1 000 g, and the differences were statistically significant (χ2=10.116, 3.785; P=0.002, 0.037). Logistic regression analysis showed that ART was a non-independent risk factor for the occurrence of ROP (P＞0.05). ConclusionAssisted reproductive technology may have a certain influence on the occurrence of ROP, which is not an independent factor.
Objective
To determine the effect of methimazole (MMI) on retinal vascular development in neonatal rats, and to investigate the relationship between the concentration of insulin-like growth factor-I (IGF-I) in serum and the development of normal blood vessels and between the concentration of IGF-I and the formation of abnormal blood vessels.
Methods
There were 75 neonatal SpragueDawley rats in experimental group whose mothers were raised with water with 0.1% MMI at the first day of parturition. Another 50 neonatal rats were in the control group whose mothers were raised with normal water. The rats in the two groups were sub-divided into 4day and 10day subgroup, respectively. The retinal flatmount of the right eyes were stained with adenosine diphosphatase (ADPase); with the paraffin section of the left eyes, the number of nucleolus breaking through retinal inner limiting membrane was counted and the retinal blood vessels were evaluated. Serum IGF-I levels were detected by radioimmunoassay, and the weight of the neonatal rats in each group were observed and recorded.
Results
The incidence of retinal neovascularization in 10 day MMI group was 27%, and 0% in 4-day MMI group and control group. The serum IGF-I level in 4-day and 10-day MMI group (73.07 ng/ml, 175.13 ng/ml) was obviously lower than which in the 4-day and 10-day control group (168.73 ng/ml,306.38 ng/ml) （P=0.00）. Obvious slow growth of the neonatal rats was found in MMI group compared with which in the control group.
Conculsions
MMI may inhibit the normal growth of retinal blood vessels and lead neovascularization, which may relate to the initial decrease of the serum IGF-I level.
(Chin J Ocul Fundus Dis, 2007, 23: 198-201)
