A predictive score for retinopathy of prematurity in very low birth weight preterm infants

Aims This study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP.Methods A prospective cohort of preterm infants with BWp1500 g and/or GAp32 weeks was studied. the score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. the score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions.Results the sample included 474 patients. the area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately.Conclusions ROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. the scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP. Eye (2012) 26, 400-406; doi: 10.1038/eye. 2011.334; published online 23 December 2011Hosp Clin Porto Alegre, Dept Ophthalmol, BR-90035903 Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Dept Ophthalmol, Sch Med, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, Sch Med, São Paulo, BrazilUniv Fed Rio Grande do Sul, Dept Paediat, Newborn Sect, Sch Med, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, Sch Med, São Paulo, BrazilWeb of Scienc

Foetal haemoglobin, blood transfusion, and retinopathy of prematurity in very preterm infants:A pilot prospective cohort study

Purpose To identify if there is an association between foetal haemoglobin (HbF) concentration and retinopathy of prematurity (ROP) in very preterm infants. Patients and methods Prospective cohort study. Infants born <32 weeks’ gestational age or <1501 g in two tertiary neonatal units between January 2012 and May 2013 (n=42) were enrolled. HbF and adult haemoglobin (HbA) concentrations were measured using high-pressure liquid chromatography from blood samples sent as part of routine neonatal care once routinely requested laboratory tests had been performed. Clinical data were obtained from case notes. We calculated odds ratios (ORs) (95% confidence intervals (CIs)) to quantify the relationship between initial and mean %HbF with ROP severity (none, stages 1–3). Results A total of 42 infants were recruited: mean gestation 28.0 weeks (SD 1.91); mean birth weight 1042 g (SD 264). Six infants died before ROP screening; 14/36 developed ROP (39%); and 22/36 (61%) did not. Infants who developed ROP had similar initial %HbF (83.3 vs 92.3%, P=0.06), but significantly lower mean %HbF (61.75 vs 91.9%, P=0.0001) during their inpatient stay than those who did not develop ROP. In ordinal logistic regression models adjusted for birth weight, gestation and transfusion volume, mean post-natal %HbF was negatively associated with ROP severity: adjusted OR 0.94 (0.90–0.99), while initial %HbF at birth was not: adjusted OR 1.05 (0.97–1.16). Conclusion Replacing HbF by HbA during transfusion may promote ROP development by rapidly increasing oxygen availability to the retina. Conversely, maintaining a higher %HbF may be a protective factor against ROP

ICAR: endoscopic skull‐base surgery

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Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE: Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight ≤1,500 g and/or gestational age ≤32 weeks. METHODS: A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS: One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS: One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief

Multiple pregnancies and its relationship with the development of retinopathy of prematurity (ROP)

M&amp;aacute;rio Martins dos Santos Motta1, Jo&amp;atilde;o Borges Fortes Filho2, Jacqueline Coblentz1, Claudia Amaral Fiorot31Department of Ophthalmology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro RJ, Brazil; 2Department of Ophthalmology, Faculty of Medicine, Federal University of Rio Grande do Sul and Hospital de Cl&amp;iacute;nicas de Porto Alegre, Porto Alegre RS, Brazil; 3Hospital Naval Marc&amp;iacute;lio Dias, Rio de Janeiro RJ, BrazilBackground: The influence of multiple gestation on the occurrence of retinopathy of prematurity (ROP) is still not completely understood.Objectives: To verify the incidence of any stage of ROP and threshold ROP in singletons and in multiple gestation among preterm infants.Methods: This was an institutional, prospective, and descriptive cohort study, which included preterm newborns with birth weight (BW) of 1500 g or less and/or gestational age (GA) of 32 weeks or less, as admitted to the neonatal units at Laranjeiras and Amparo Hospitals in Rio de Janeiro, Brazil, between January 2001 and July 2005, and whom remained hospitalized for at least 28 days. There were no exclusion criteria. Patients were divided into two groups: Group 1 included multiples; and Group 2 consisted of singletons.Results: A total of 159 infants that remained in neonatal unit care for at least 28 days were included in this study. Group 1 comprised 56 (35%) multiples; and Group 2 comprised 103 (65%) singletons. Mean BW was 1072 g &amp;plusmn; 272 and 1089 g &amp;plusmn; 282 in Groups 1 and 2, respectively (analysis of variance [ANOVA] P &amp;gt; 0.05). Mean GA among multiple gestation (Group 1) was 29 weeks &amp;plusmn; 2.1; and 29 weeks &amp;plusmn; 2.4 among singletons (Group 2) (ANOVA P &amp;gt; 0.05). Days in oxygen therapy ranged from 0 to 188 days. Median among Group 1 was 15 days, while median in Group 2 was 10 days (Kruskal&amp;ndash;Wallis P &amp;gt; 0.05). Any stage ROP was detected in 66 (41.5%) of the whole cohort comprising 159 babies. Among the 56 multiples, 30 (53.6%) achieved any stage ROP, and among 103 singletons, 36 (35%) achieved any stage ROP (Chi-square test P &amp;lt; 0.05). Threshold ROP occurred in 12 (7.5%) of the 159 patients included. Three (5.3%) patients from Group 1 and nine (8.7%) patients in Group 2 reached threshold ROP needing laser treatment (Fisher&amp;rsquo;s exact test P &amp;gt; 0.05).Conclusion: This study showed higher frequency of any stage of ROP in twins and triplets but not regarding threshold disease. Because of the relatively small number of patients in this sample, other studies are necessary to determine if gemelarity plays a role in the occurrence of ROP.Keywords: prematurity, retinopathy of prematurity, gemelarity, prevalenc

Cataract surgery in Knobloch syndrome: a case report

Carmen S&amp;iacute;lvia Bongiovanni1, Carla Cristina Serra Ferreira1, Ana Paula Silv&amp;eacute;rio Rodrigues1, Jo&amp;atilde;o Borges Fortes Filho2, M&amp;aacute;rcia Beatriz Tartarella11Department of Ophthalmology, Congenital Cataract Section, Medical School, Federal University of S&amp;atilde;o Paulo, S&amp;atilde;o Paulo; 2Department of Ophthalmology, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, BrazilAbstract: Knobloch syndrome is an autosomal recessive disorder associated with early-onset ocular abnormalities and central nervous system malformations. Ocular abnormalities are usually severe, and include high myopia, vitreoretinal degeneration, retinal detachment, macular abnormalities, and cataract. The most frequent systemic changes are midline malformations of the brain, ventricular dilation, and occipital encephalocele. Cognitive delay may occur. We report a case of cataract in a child with Knobloch syndrome. Cataract surgery and follow-up are described.Keywords: Knobloch syndrome, cataract, phacoemulsification, vitreous, right eye, left eye, geneti

Intravitreal ranibizumab as a primary or a&nbsp;combined treatment for severe retinopathy of&nbsp;prematurity

Odalis Ar&aacute;mbulo,1 Gabriel Dib,1 Juan Iturralde,1 Fahir Duran,1 Miguel Brito,1 Jo&atilde;o B Fortes Filho2 1Department of Ophthalmology, University Hospital of Maracaibo, Maracaibo, Venezuela; 2Department of Ophthalmology, Hospital de Cl&iacute;nicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil Purpose: The aim of the study was to assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined treatment with laser photocoagulation.Methods: This is a retrospective study analyzing clinical records of the included patients. Patients were divided into two groups: group 1 included patients who received only IVR treatment; and group 2 was subdivided into group 2A &ndash; including patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress, and group 2B &ndash; including patients with initial laser photocoagulation and IVR as rescue therapy. Favorable outcomes were regression of the retinal neovascularization and plus disease, meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP.Results: Fifty-seven eyes were included in the study. Mean birth weight and gestational age were 1,281&plusmn;254&nbsp;g and 29.5&plusmn;2.1&nbsp;weeks, respectively. Group 1 comprised of 16 eyes, with favorable outcomes in 14 eyes (87.5%). Group 2 comprised of 41 eyes, with favorable outcomes in 29 eyes (70.7%), in a mean follow-up period of 12.8&nbsp;months.Conclusion: IVR was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of the 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes. Keywords: aggressive posterior ROP, bevacizumab, prematurity, ranibizumab, retinopathy of prematurity, therapy, treatment, VEG