Prevalence and Risk Factors of Retinopathy of Prematurity in Iran

Purpose: The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants. Methods: A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age ≤ 28 weeks), extremely low-birth-weight (≤ 1000 g), and multiplegestation (MG) infants. Results: The prevalence of ROP was 27.28% (n = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion (P < 0.0001, P < 0.0001, and P = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP (P < 0.0001) were observed in EP and ELBW infants. Birth weight (P = 0.088), history of transfusion (P = 0.066), and intubation (P = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age (P = 0.037) and history of transfusion (P = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight (P = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis. Conclusion: ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines

Intravitreal anti-VEGF therapy as an adjunct to laser photocoagulation for severe aggressive posterior retinopathy of prematurity

AbstractPurposeThe aim of the study was to evaluate the role of anti-VEGF therapy as an adjunct to laser ablation therapy in severe aggressive posterior retinopaty of prematurity (AP-ROP).MethodsMedical records of premature infants with a primary diagnosis of AP-ROP treated with 0.625mg/0.025ml intravitreal bevacizumab (IVB) in addition to standard laser photocoagulation as a salvage therapy or primarily combined with laser in a university clinic were reviewed, retrospectively. The anatomical results and complications were evaluated after treatment.Results15 eyes of 9 patients with a mean gestational age of 28.3 weeks (range, 26–31w) and mean birth weight of 1090g (range, 860–1330g) were included in the study. They all had Zone 1 or posterior Zone 2 plus disease staging between severe 3 and 4a. Twelve eyes were treatment naive at the beginning. The mean follow-up was 19.5±11.8 months (range, 11–40 months). The disease regressed totally in 6 eyes (40%), stayed stable as stage 4a in 1 eye (6.7%), progressed to and stabilized at stage 4a in 3 eyes (20%) and progressed to stage 5 in 3 eyes (20%) within 7–10 days. Two eyes (13.3%) developed hypotony and cataract.ConclusionThe association of IVB and laser ablation might decrease the progression rate in severe AP-ROP. Prompt regression of iris neovascularization encourages its use in cases with pupillary rigidity to allow for laser treatment. When used as a salvage therapy it may not change the overall result dramatically

Idiopathic macular telangiectasia type 2: A six-year study with multimodal imaging of a presumed unilateral case

Purpose: To present a rare manifestation of macular telangiectasia type 2 (MacTel type 2) followed up for over six years. Methods: A 61-year-old woman with one year history of blurred vision of her left eye was referred. Results: Whereas the funduscopy, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF) were normal in the right eye, they revealed noticeable findings typical of MacTel type 2 in the left eye. After over six years follow-up, OCT-angiography (OCTA) showed no remarkable difference between the two eyes, and en face OCT showed subtle abnormal change in the right eye as well as typical pathological changes in the left eye. Conclusion: MacTel type 2 can present unilaterally and remain so for a long time. The role of multimodal imaging in diagnosis and follow-up is of utmost importance. Keywords: Unilateral, Macular telangiectasia type 2, Multimodal imagin

Comparison of intravitreal bevacizumab injection and laser photocoagulation for type 1 zone II retinopathy of prematurity

Purpose: To compare the efficacy of intravitreal bevacizumab (IVB) injection with conventional laser photocoagulation in eyes with type 1 zone II retinopathy of prematurity (ROP). Methods: Preterm infants with type 1 ROP in zone II (stage 2 or 3 ROP with plus disease) were randomly assigned to intravitreal injection of 0.625 mg/0.025 ml bevacizumab (Group 1) or laser photocoagulation (Group 2). Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Also, spherical and cylindrical refractive errors were compared at 90 weeks postmenstrual age (PMA). Results: A total of 116 preterm infants (232 eyes) were treated and completed the follow-up period. IVB injection was done in 154 eyes (77 cases), and laser photocoagulation was done in 78 eyes (39 cases). ROP regressed after single IVB injection in 149 eyes (96.8%) and in 5 eyes (3.2%) after the second injection. Cataract developed in one eye (0.63%) after IVB injection. ROP regressed in 94.7% of treated eyes (76 eyes) in the laser photocoagulation group; however, retinal fold and traction developed in 2 eyes. Spherical and also cylindrical refractive errors had no significant difference. Conclusions: Both IVB injection and laser photocoagulation are effective methods for the treatment of type 1 zone II ROP. However, re-treatment requirement may be higher in the IVB injection group. IVB re-injection is an effective option for re-treatment in persistent cases. Keywords: Retinopathy of prematurity, Bevacizumab, Avastin, Laser photocoagulation, Zone I

Associations of refractive amblyopia in a population of Iranian children

Background: To determine the factors associated with amblyopia in a referral clinical population. Methods: In this cross-sectional study, 164 subjects who were referred to an amblyopia clinic were enrolled and divided into two groups: refractive amblyopia group and refractive non-amblyopia group. Visual acuity, refractive measurements, and information on birth parameter and delivery mode were compared between both groups. Results: We included 164 children (91 children in the non-amblyopic group and 73 children in the amblyopic group) aged 5–10 years. 50.6% of children with amblyopia had anisometropia, defined as a difference among eyes in spherical equivalent of 1.00 D or more. The regression analysis revealed that amblyopia was strongly associated with hyperopia ≥2.00 D (odds ratio, 10.0; 95% CI, 3.27–30.58), anisometropia ≥1.00 D (odds ratio, 7.78; 95% CI, 3.64–16.61), astigmatism ≥1.00 D (odds ratio, 5.23; 95% CI, 2.48–11.02), and myopia ≥−2 D (odds ratio, 6.96; 95% CI, 1.9–25.28). There were also significant associations of amblyopia with low birth weight (≤2500 g), preterm birth (≤37 weeks), and dystocia (all P < 0.001). Conclusion: Prematurity, low birth weight, and dystocia as well as refractive errors were associated with amblyopia in our select patient population

Comparison of breast milk and sucrose in neonatal pain relief and coping with stress of ROP examination using ALPS-Neo

Background: Examination for retinopathy of prematurity (ROP) is one of the procedures that can be stressful for neonates admitted to a neonatal intensive care unit. This study compared breast milk and sucrose in pain relief and coping with the stress of ROP examination using the Astrid Lindgren and Lund Children�s Hospital Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo). Methods: The present study was carried out on a total of 63 preterm infants (including breast milk group n=21, sucrose group n=21, and distilled water group n=21). The neonates were given 0.5 ml/kg of breast milk, sucrose, or distilled water 2 min before the examination. The ROP eye examinations were video recorded from 5 min before to 15 min after the examination, and infants� pain and stress levels were assessed using the ALPS-Neo by two blinded evaluators 5 min before, during, and 5, 10, and 15 min after the examination. Results: No statistically significant differences were observed during the examinations in the mean scores of the ALPS-Neo among the three groups (P>0.05). However, there were statistically significant differences among the three groups after the examinations (P<0.05) and in the mean duration of stress adaptation (P<0.05). The duration of stress adaptation in the breast milk group was 11.4 min on average which was lower than that reported for the other groups. Conclusion: Breast milk was more effective in the reduction of pain and stress after ROP examinations, compared to sucrose or distilled water. © 2021 Mashhad University of Medical Sciences. All rights reserved

Efficacy of intravitreal bevacizumab for the treatment of Zone I Type 1 retinopathy of prematurity

Purpose: To describe the efficacy of intravitreal bevacizumab for the treatment of type 1 retinopathy of prematurity (ROP) in zone I. Methods: Preterm infants with type 1 ROP in zone I (zone I ROP, any stage with plus disease or zone I ROP, stage 3 without plus disease) were enrolled in this prospective study. Intravitreal bevacizumab (0.625 mg/0.025 ml) was injected under topical anesthesia. Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Results: Seventy eyes of 35 patients with type 1 ROP in zone I were enrolled. At a gestational age of 90 weeks, ROP regressed with complete or near-complete peripheral retinal vascularization, in 82.9% of eyes after a single injection and in 92.9% of eyes after up to two injections. In five eyes (7.1%), ROP progressed to stage 4B or 5, so surgical management was required. There were no major complications such as endophthalmitis, cataract, or vitreous hemorrhage after injection. Conclusion: Intravitreal bevacizumab injection is an effective method for the management of patients with Zone I ROP requiring treatment; however, some cases may progress to more advanced stages and require surgical management. Close monitoring for recurrence or progression is necessary. Eyes with persistent zone I ROP may progress to advanced stages when treated with intravitreal bevacizumab injection and re-treatment may be needed

Comparison of Breast Milk and Sucrose in Neonatal Pain Relief and Coping with Stress of ROP Examination Using ALPS-Neo

Background: Examination for retinopathy of prematurity (ROP) is one of the procedures that can be stressful for neonates admitted to a neonatal intensive care unit. This study compared breast milk and sucrose in pain relief and coping with the stress of ROP examination using the Astrid Lindgren and Lund Children’s Hospital Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo). Methods: The present study was carried out on a total of 63 preterm infants (including breast milk group [n=21], sucrose group [n=21], and distilled water group [n=21]). The neonates were given 0.5 ml/kg of breast milk, sucrose, or distilled water 2 min before the examination. The ROP eye examinations were video recorded from 5 min before to 15 min after the examination, and infants’ pain and stress levels were assessed using the ALPS-Neo by two blinded evaluators 5 min before, during, and 5, 10, and 15 min after the examination. Results: No statistically significant differences were observed during the examinations in the mean scores of the ALPS-Neo among the three groups (P>0.05). However, there were statistically significant differences among the three groups after the examinations (P<0.05) and in the mean duration of stress adaptation (P<0.05). The duration of stress adaptation in the breast milk group was 11.4 min on average which was lower than that reported for the other groups. ConclusiConcluConclusion  Conclusion: Breast milk was more effective in the reduction of pain and stress after ROP examinations, compared to sucrose or distilled water