PUBLICATIONS ON ROP BY SP-ROP MEMBERS

2017

RETINOPATIA DA PREMATURIDADE

Retinopatia da Prematuridade - Artigo de Atualização

Publicado en E-Oftalmo en 2017

 

Autores: Marcia Beatriz Tartarella, João Borges Fortes Filho

 

ABSTRACT


This study discusses current aspects regarding retinopathy of prematurity (ROP), a clinical disorder that leads to the highest number of children in the world becoming blind. This emphasizes the importance of screening for the disease in all preterm infants with a very low birth weight, identifying retinopathy at a proper time, and treating it using laser at about 37 weeks post-conception while there is still a chance for treatment, which should preferably be conducted during the child stay at the Neonatology Center. The first ophthalmic examination should be performed using binocular indirect ophthalmoscopy, with dilated pupils, between 4 and 6 weeks after birth in all newborns weighing 1,500 g or less and/or at the gestational age of 32 weeks or less, as proposed by the Brazilian Guidelines for ROP Screening and Detection. The follow-up of children with or without retinopathy should be conducted periodically until vascularization of Zone 3 temporal retina is normalized, and this normalization should be maintained during the first years of life for the prevention of amblyopia and strabismus and for the correction of refractive errors related to prematurity.

 

RESUMEN

 

Este artículo aborda aspectos actuales sobre a retinopatía de la precocidad (ROP), entidad clínica responsable por la mayor cantidad de niños ciegos en todo el mundo en la actualidad. Busca llamar la atención a la importancia de un sistema de clasificación (triaje) en la búsqueda de la enfermedad en todos los prematuros de muy bajo peso y la necesidad de que la retinopatía se identifique en el momento adecuado y se trate por medio de láser alrededor de la 37ª semana de edad post-concepción, cuando aún hay oportunidad para el tratamiento que deberá hacerse, preferencialmente, durante el tiempo de permanencia del niño en el Centro de Neonatología. El análisis oftalmológico inicial se debe realizar bajo oftalmoscopia binocular indirecta y dilatación de las pupilas, entre la 4ª y la 6ª semana de vida, en todos los recién nacidos con peso igual o menor que 1500 gramos y/o con edad gestacional igual o inferior a 32 semanas, según lo proponen las Directrices Brasileñas de Triaje y Detección de ROP. El acompañamiento de los niños con o sin retinopatía deberá seguir periódicamente hasta la normalización de la vascularización de la retina temporal en la zona III y deberá mantenerse los primeros años de vida para la prevención de la ambliopía y del estrabismo, y para la corrección de las altas ametropías relacionadas a la precocidad.

 

 

 

 

2017

Assessment of a Tele-education System to Enhance Retinopathy of Prematurity Training by International Ophthalmologists-in-Training in Mexico

 

Publicado en 2017 en Ophthalmology

 

Authors: Samir N. Patel, Maria Ana Martinez-Castellanos, David Berrones-Medina,Ryan Swan, Michael C. Ryan, Karyn E. Jonas, Susan Ostmo, J. Peter Campbell, Michael F. Chiang, R.V. Paul Chan, on behalf of the GEN-ROP* and the i-ROP Research Consortium

 

Purpose: To evaluate a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmologists-in-training in Mexico. Design: Prospective, randomized cohort study.

Participants: Fifty-eight ophthalmology residents and fellows from a training program in Mexico consented to participate. Twenty-nine of 58 trainees (50%) were randomized to the educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest), and 29 of 58 trainees (50%) were randomized to a control group (pretest and posttest only). Methods: A secure web-based educational system was created using clinical cases (20 pretest, 20 posttest, and 25 training chapterebased) developed from a repository of over 2500 unique image sets of ROP. For each image set used, a reference standard ROP diagnosis was established by combining the clinical diagnosis by indirect ophthalmoscope examination and image-based diagnosis by multiple experts. Trainees were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters.

Main Outcome Measures: The accuracy of ROP diagnosis (e.g., plus disease, zone, stage, category) was determined using sensitivity and specificity calculations from the pretest and posttest results of the educational intervention group versus control group. The unweighted kappa statistic was used to analyze the intragrader agreement for ROP diagnosis by the ophthalmologists-in-training during the pretest and posttest for both groups.

Results: Trainees completing the tele-education system had statistically significant improvements (P < 0.01) in the accuracy of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (APROP). Compared with the control group, trainees who completed the ROP tele-education system performed better on the posttest for accurately diagnosing plus disease (67% vs. 48%; P ¼ 0.04) and the presence of ROP (96% vs. 91%; P < 0.01). The specificity for diagnosing AP-ROP (94% vs. 78%; P < 0.01), type 2 ROP or worse (92% vs. 84%; P ¼ 0.04), and ROP requiring treatment (89% vs. 79%; P < 0.01) was better for the trainees completing the tele-education system compared with the control group. Intragrader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the educational intervention.

Conclusions: A tele-education system for ROP education was effective in improving the diagnostic accuracy of ROP by ophthalmologists-in-training in Mexico. This system has the potential to increase competency in ROP diagnosis and management for ophthalmologists-in-training from middle-income nations.

 

 

 

2017

Neurodesarrollo en pacientes con retinopatía del prematuro tratados con bevacizumab intravítreo. Serie de casos

 

Publicado en  Cirugía y Cirujanos en 2017

 

Autores: Sarah Melania Martínez-García, Sergio Eustolio Hernández-Da Mota, Araceli Rubio-Rangel, Ignacio Rojas-Flores, Mayra Edith Vieyra-López, María Ana Martínez-Castellanos, María Teresa Zavala-Martínez, Anel Gómez García

 

ABSTRACT

 

Background: Retinopathy of prematurity (ROP) is an eye disease caused by an alteration inretinal vasculogenesis that may lead to partial or complete vision loss with a harmful impactin terms of neurodevelopment. The purpose of the present study was to determine the neu-rodevelopment in patients with type i retinopathy of prematurity treated with intravitrealbevacizumab.Material and methods:

 

Case series. The inclusion criteria were: patients with type I ROP trea-ted with a dose of 0.625 mg/0.025 ml of intravitreal bevacizumab. Demographic data andcomorbidities were documented. Neurodevelopment was evaluated with the screening testof the Bayley Scale of Infant Development (BSID) in all patients between 11 and 28 weeks ofage.

 

Results: Seven patients were included in the study. Four patients showed normal neurodeve-lopment according to the overall scores of the BSID scale. The distribution of high risk forneurodevelopmental delay in the different areas evaluated were as follows: 3 patients presen-ted it in the cognitive area, one in the receptive communication area, one in the expressivearea, one in the fine motor skills and 3 patients in the gross motor skills area.

 

Conclusions: In these case series, the majority of patients treated with intravitreal bevacizu-mab for ROP showed normal neurodevelopment scores.

 

2017

Vascular changes on fluorescein angiography of premature infants with low risk of retinopathy of prematurity after high oxygen exposure

 

Publicado en el International Journal of Retina and Vitreous en 2017

 

Autores: Maria Ana Martinez-Castellanos, Raul Velez-Montoya, Kenneth Price, Andree Henaine-Berra, Gerardo García-Aguirre, Virgilio Morales-Canton, Linda Alejandra Cernichiaro-Espinosa

 

ABSTRACT

 

Purpose: To describe a wide array of peripheral vascular changes using fluorescein angiography in preterm neo? nates, without high risk characteristics for developing retinopathy of prematurity, that were exposed to high oxygen concentration.

 

Methods: Retrospective, two center, case series. Newborns at two different hospitals with ≥1500 g or gestational age of ≥32 weeks, fluorescein angiography performed, and with high oxygen exposure without adequate control were included.

 

Results: 294 infants diagnosed with ROP were analyzed. Only 28 eyes from 14 patients with peripheral vascular abnormalities in older and heavier babies were included. Two distinct type of peripheral vascular changes were observed: group 1 or non-proliferative: areas of capillary non-perfusion along with widespread arteriovenous shunt? ing between adjacent primary vessels, tortuosity of primary vessels, abnormal budding of tertiary vessels and capillar? ies, abnormal capillary tufts and absence of foveal avascular zone; group 2 or proliferative: all of the characteristics of group 1 plus leakage of dye from the boundary between perfused and non-perfused retina and/or optic disc.

 

Conclusion: Peripheral vascular abnormalities different from retinopathy of prematurity are observed in older than 32 weeks of gestational age, and heavier than 1500 g babies. This makes the authors classify these patients as having a disease caused solely by oxygen dysregulation at the neonatal intensive care unit similarly to the oxygen induced retinopathy in experimental studies.

2016

New insights in diagnosis and treatment for Retinopathy of Prematurity

 

Publicado en el International Ophthalmology en 2016

Authors: Linda A. Cernichiaro-Espinosa,  Francisco J. Olguin-Manriquez, Andree Henaine-Berra, Gerardo Garcia-Aguirre, Hugo Quiroz-Mercado, Maria A. Martinez-Castellanos

 

Abstract

The purpose of this study was to review current perspectives on diagnosis and treatment of Retinopathy of Prematurity (ROP).

 

We performed a systematic review of how much has been produced in research published online and on print regarding ROP in different settings around the world. Early Treatment for ROP (ETROP) classification is the currently accepted classification of ROP. Fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) may eventually lead to changes in the definition of ROP, and as a consequence, they will serve as a guide for treatment. Intravitreal anti-VEGF therapy has proven to be more effective in terms of lowering recurrence, allowing growth of the peripheral retina, and diminishing the incidence of retinal detachment when proliferative ROP is diagnosedResults:.

 

2016

Higher prolactin and vasoinhibin serum levels associated with incidence and progression of retinopathy of prematurity


Publicado en el Pediatric Research en 2016

Authors: Luz Consuelo Zepeda-Romero, Miguel Vazquez-Membrillo, Elva Adan-Castro, Francisco Gomez-Aguayo, Jose Alfonso Gutierrez-Padilha, Eusebio Angulo-Castelanos et al.
 

Abstract
 

Background: Retinopathy of prematurity (ROP) is a potentially blinding, retinal neovascular disease. Systemic prolactin accesses the retina to regulate blood vessels. Prolactin is proangiogenic and can be cleaved to antiangiogenic vasoinhibins. We investigated whether circulating prolactin and vasoinhibins associate with incidence and progression of ROP.

 

METHODS: A prospective, longitudinal, case-control study covering postnatal weeks 1 to 9 measured serum prolactin, vasoinhibins, and vascular endothelial growth factor (VEGF) weekly in 90 premature infants diagnosed as ROP or control.

 

RESULTS: Prolactin levels were higher in ROP than in control patients before (106.2 ± 11.3 (SEM) vs. 64.7 ± 4.9 ng/ml, postnatal week 1) and during (120.6 ± 10 vs. 84.7 ± 7.5ng/ml, postnatal week 5) ROP diagnosis. Prolactin, but not gestational age, birth weight, Apgar score, sepsis, or ventilation time, correlated with ROP. The relative risk (RR) of developing ROP increased if Prolactin (PRL) levels were higher than thresholds of 80 ng/ml (RR = 1.55, 95% CI: 1.06-2.28), 100 ng/ml (RR = 1.63, 95% CI: 1.14-2.34), or 120 ng/ml (RR = 1.95, 95% CI: 1.41-2.68). Vasoinhibin levels were 39.7% higher (95% CI: 4.5-77.5) in the circulation of ROP than in control patients at postnatal week 1 and similar thereafter, whereas VEGF serum levels were always similar.

CONCLUSION: High serum prolactin and vasoinhibin levels predict and may impact ROP progression.Pediatric Research (2017); doi:10.1038/pr.2016.241.

 

2016

A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean


Publicado en la Revista Panamericana de Salud Pública en 2016

Authors: Lauren Arnesen, Pablo Durán, Juan Silva, Luísa Brumana
 

Abstract

Objective. To consolidate available information from the Latin American and Caribbean

(LAC) region on 1) national incidence of retinopathy of prematurity (ROP) and 2) national-

level government inputs on ROP (existing national policies, guidelines, programs, and financing

for ROP prevention, detection, and treatment, including ROP screening) in 2014.


Methods. In March and April 2015, a multi-country online survey was distributed to 56 medical

and public health experts working on ROP in LAC countries. Respondents were instructed to provide

quantitative and qualitative information representative of the national situation in 2014 for ROP

incidence and national-level government inputs (existing national policies, guidelines, programs, and

financing for ROP prevention, detection, and treatment, including ROP screening) in their country.


Results. The survey was completed in full by a total of 11 experts from 10 LAC countries

(Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Mexico,

Nicaragua, and Panama). According to the survey results, six countries had a national policy

that includes ROP prevention, detection, and treatment, with screening and treatment covered

by national/federal funding. Eight countries had national guidelines for ROP. Four countries

had legislation mandating eye examination of preterm infants. Most countries had Level 3 and

4 neonatal intensive care units with ROP programs in public sector health care facilities. Five

countries had a data collection or monitoring system to track the number of newborn babies

screened for ROP within hospital settings. On average, countries with three or four of the

above-mentioned ROP elements screened 95% of eligible newborns in 2014, while those with

only one or two of the ROP elements screened 35% of eligible newborns.


Conclusions. National government buy-in and involvement in ROP screening and

treatment legislation is related to a higher proportion of eligible premature newborns being

screened and treated for ROP. Further research should include more countries and assess

national-level engagement with ROP, including ROP screening and treatment.

 

2016

Use and abuse of anti-angiogenic drugs for Retinopathy of Prematurity treatment in Argentina in 2015

 

Publicado en los Archivos Argentinos de Pediatría en 2016

 

Author: Ernesto Raúl Alda 

 

 

2016

Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment


Publicado en el Archives Disease Child Fetal & Neonatal Edition en 2016

 

Authors: Clare Gilbert, Richard Wormald, Alistair Fielder, Ashok Deorari , Luz Consuelo Zepeda-Romero, Graham Quinn, Anand Vinekar, Andrea Zin, Brian Darlow

 

2016

Perfil epidemiológico dos recém -nascidos prematuros com retinopatia da prematuridade no Hospital Regional de São José Dr. Homero de Miranda Gomes

 

Publicado en la Revista Brasileira de Oftalmologia en 2016

 

Autores:  Mara Barreto Theiss, Astor Grumann Júnior, Marise Regina Wiethorn Rodrigues

 

RESUMO


O estudo foi realizado no Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ), localizado no município de São José (Santa Catarina), Brasil.

Objetivo: A valiar a prevalência da retinopatia da prem aturidade (ROP) em recém -nascidos (R N ) prem aturos (Idade Gestacional (IG ) <37 semanas) e/ou peso ao nascimento (PN) <1500g e os que possuem fatores de risco, nascidos no HRSJ entre janeiro de 2007 e janeiro de 2011.

 

Método: Estudo transversal, retrospectivo, analítico e observacional. Os dados foram obtidos a partir de prontuários no HRSJ.

 

Resultados: Observou-se a presença de retinopatia em 37,81% dos R N s, sendo o estágio 1 o mais prevalente. Verificou-se que não houve diferença estatística entre os sexos (p=0,993). A presença da ROP foi maior no grupo com PN <1000 gramas (83,33% ), avaliados com mais de 6 semanas de vida e com IG menor que 32 semanas (49,48% ). Os fatores de risco com significado estatístico foram: oxigenioterapia, ventilação mecânica, persistência do canal arterial, asfixia perinatal, síndrome do desconforto respiratório, transfusão sanguínea, hemorragia intraventricular, sepsis, infecção neonatal e doença da membrana hialina.

 

Conclusão: Conclui-se que o fator sexo e gestação múltipla não tiveram significância estatística. O s RNs com menor PN e IG tem um maior risco de desenvolver ROP. Em relação à oxigenioterapia, a prevalência nos expostos é maior e proporcional ao tempo de utilização de oxigênio.

 

2015

Implementation and evaluation of a tele-education system for the diagnosis of ophthalmic disease by international trainees


Publicado en los AMIA Annual Symposium Proceedings en 2015

 

Authors: J. Peter Campbell, Ryan Swan, Karyn Jonas, Susan Ostmo, Camila V. Ventura, Maria A. Martinez-Castellanos, MD5, Rachelle Go Ang Sam Anzures, Michael F. Chiang, Paul Chan

 


Abstract
 

Tele-education systems are increasingly being utilized in medical education worldwide. Due to limited human resources in healthcare in low and middle-income countries, developing online systems that are accessible to medical trainees in underserved areas potentially represents a highly efficient and effective method of improving the quantity and quality of the health care workforce. We developed, implemented, and evaluated an interactive web-based tele-education system (based on internationally accepted, image-based guidelines) for the diagnosis of retinopathy of prematurity among ophthalmologists-in-training in Brazil, Mexico, and the Philippines. We demonstrate that participation in this tele-education program improved diagnostic accuracy and reliability, and was preferred to standard pedagogical methods. This system may be employed not only in training, but also in international certification programs, and the process may be generalizable to other image-based specialties, such as dermatology and radiology.

 

2015

Intravitreal ranibizumab as a primary or a combined treatment for severe retinopathy of prematurity (ROP)


Publicado en 2015 en Clinical Ophthalmology

Authors: Odalis Arámbulo, Gabriel Dib, Juan Iturralde, Fahir Duran, Miguel Brito, João Borges Fortes Filho

Abstract 

Purpose: This study aims to assess outcomes of severe ROP in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined with laser photocoagulation.

Methods: Study included patients in two groups: Group 1 included patients that received only IVR treatment. Group 2, divided in Group 2A included patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress; Group 2B included patients with initial laser photocoagulation and IVR as rescue. 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. Mean birth weight and gestational age were 1,281 ± 254 grams and 29.5 ± 2.1 weeks, respectively. Sixteen eyes included group 1 with favorable outcomes in 14 eyes (87.5%). Forty-one eyes comprised group 2 with favorable outcome in 29 eyes (70.7%), in a mean follow-up period of 12.8 months.

Conclusion: Intravitreal ranibizumab was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.


 

2015

Limitations in ROP programs in 32 Neonatal Intensive Care Units in five states in Mexico


Publicado en el BioMed Research International en 2015
 

Authors: Luz Consuelo Zepeda-Romero, Clare Gilbert

 

Abstract
 

Retinopathy of prematurity (ROP) is the main cause of avoidable blindness in children in Mexico despite National ROP Guidelines and examination of preterminfants being a legal requirement.

Objective. To assess coverage of ROP programs and their compliance with national guidelines. Study Design. Thirty-two neonatal intensive care units (NICUs) in five of the largest states were visited.

Methods: Staff were interviewed to collect information on their ROP programs which were defined as (1) compliant, if National Guidelines for screening and treatment were followed, (2) noncompliant, if other approaches were used, or (3) no program.

Results: Only 10 (31.2%) had fully compliant programs and 11 (34.4%) had no program. In the remaining 11 (34.4%) different screening criteria were used (7 units): screening was undertaken by an ophthalmologist in unsalaried time (4), was not undertaken in the NICU (2), and was undertaken by a neonatologist (1) and/or Avastin was used as first-line treatment (7). Poorer states had poorer programs.

Conclusions:  Despite legislation mandating eye examination of preterm births, many ROP programs in the largest cities in Mexico  require improvement or need to be established. Prevention of blindness due to ROP needs to be prioritized in Mexico to control the epidemic of ROP blindness.

 

2015

Spectral-Domain Optical Coherence Tomography of the macula in preterm infants treated with bevacizumab for Retinopathy of Prematurity


Publicado en el Ophthalmology en 2015

 

Authors: Paola Dorta, Andres Kychenthal

  

Abstract
 

PATIENTS AND METHODS: Twenty eyes (of 11 pa­tients) treated with Avastin only or in addition to photocoagulation and vitreous surgery were in­cluded. Imaging was performed with a portable spectral-domain optical coherence tomography (OCT) device. Macular measurements, including the foveal and parafoveal index were calculated. RetCam (Clarity Medical Systems, Pleasanton, CA) photographs were obtained for all patients.

CONCLUSION: Vision tends to be better in Avastin-treated eyes when an FC is present. Morphologi­cal characteristics of retinal anatomy may predict visual function.


 

2015

Vision-related quality of life in children with retinopathy of prematurity


Publicado en los Arquivos Brasileiros de Oftalmologia en 2015

 

Authors: Luz Alcione Aparecida Messa, Ricardo Belfort Mattos, Kelsy Catherina Nema Areco, Juliana Maria Ferraz Sallum

 

Abstract
 

Purpose: To evaluate the effect of retinopathy of prematurity (ROP) on vision-related quality of life in children.

Methods: The Children’s Visual Function Questionnaire (CVFQ), an instrument that evaluates vision-related quality of life in children, was used. It is divided into 6 subscales: General Health, Vision Health, Competence, Personality, Family Impact, and Treatment. The sample consisted of parents of premature children up to 3 years of age who had ROP and no neurological damage (ROP group) and parents of premature children up to 3 years of age who had normal vision and absence of other diseases (control group).

Results: There were 88 subjects in total, 43 in the ROP group and 45 in the control group. The ROP group had lower scores on the CVFQ than the control group. The Total Index and all CVFQ subscale scores and for were significant lower in the ROP group than in the control group. The ROP group was divided according to the severity of the disease. The Total Index, Vision Health, and Competence scores in children with more severe ROP were significantly lower than those in children with less severe ROP.

Conclusion: ROP was shown to have a negative effect on vision-related qualityas shown to have a negative effect on vision-related quality<span style="font-size:9.0pt;Arial" ,"sans-serif";"=""> of life in children.

 

2015

National survey of blindness and avoidable visual impairment in Argentina, 2013


Publicado en la Revista Panamericana de Salud Pública en 2015

 

Authors: Rosario Barrenechea, Inés de la Fuente, Roberto Gustavo Plaza, Nadia Flores,  Lía Segovia, Zaida Villagómez, Esteban Elián Camarero, Luz Consueloi Zepeda-Romero, Van C. Lansingh, Hans Limburg, Juan Carlos Silva

 


Abstract


Objectives: Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, the coverage of cataract surgery, and the barriers that hinder access to these services.

Methods: Cross-sectional population study conducted between May and November 2013 using the standard methodology for rapid assessment of avoidable blindness (RAAB), with a random cluster sampling of 50 people aged 50 years or more, -representative of the entire country. Participants' visual acuity (VA) was measured and the lens and posterior pole were examined by direct ophthalmoscopy. An assessment was made of the causes of having VA < 20/60, the coverage and quality of cataract surgery, and the barriers to accessing treatment.

Results: 3 770 people were assessed (92.0% of the projected number). The prevalence of blindness was 0.7% (confidence interval of 95%: 0.4-1.0%). Unoperated cataract was the main cause of blindness and severe visual impairment (44.0% and 71.1%, respectively), while the main cause of moderate visual impairment was uncorrected refractive errors (77.8%). Coverage of cataract surgery was of 97.1%, and 82.0% of operated eyes achieved VA ≥ 20/60. The main barriers to receiving this treatment were fear of the surgical procedure or of a poor result (34.9%), the cost (30.2%), and not having access to the treatment (16.3%).

Conclusions: There is a low prevalence of blindness in the studied population and cataract is the main cause of blindness and severe visual impairment. Efforts should continue to extend coverage of cataract surgery, enhance preoperative evaluation, improve calculations of the intraocular lenses that patients need, and correct post-operative refractive errors with greater precision.

 

 

2015

Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity


Publicado en el Ophthalmology en 2015


Authors: Michael A. Klufas, Samir N. Patel, Michael C. Ryan, Mrinali Patel Gupta, Karyn E. Jonas,Susan Ostmo, Maria Ana Martinez-Castellanos, Audina M. Berrocal, Michael F. Chiang, Paul Chan

 

Abstract
 

Prospective cohort study. To examine the influence of fluorescein angiography (FA) on the diagnosis and management of retinopathy of prematurity (ROP).

 

Results: diagnosis of stage 3 or worse disease (39.8% vs. 74.1%; P ¼ 0.008), type 2 or worse ROP (69.4% vs. 86.8%; P ¼ 0.013), and pre-plus or worse disease (50.5 vs. 62.6%; P ¼ 0.031).

 

There was a nonsignificant trend toward improved sensitivity for diagnosis of ROP requiring treatment (22.2% vs. 40.3%; P ¼ 0.063). Using the k statistic, addition of FA to color fundus photography significantly improved intergrader agreement for diagnosis of ROP  requiring treatment. Addition of FA to color fundus photography did not affect intergrader agreement significantly for the diagnosis of stage, zone, or plus disease. 

 

Compared with color fundus photography alone, FA may improve the sensitivity of diagnosis of ROP by experts, particularly for stage 3 disease. In addition, intergrader agreement for diagnosis of ROP requiring treatment may improve with FA interpretation.

 

 

 

2015

Tamizado oftalmológico neonatal


Publicado en la Acta Pediátrica Mexicana en 2015

Author: Juan Carlos Juárez-Echenique


 

2015

Case series of infants presenting with end stage Retinopathy of Prematurity to two tertiary eye care facilities in Mexico: Underlying reasons for late presentation


Publicado en el Ophthalmology en 2015

 

Authors: Michael A. Klufas, Samir N. Patel, Michael C. Ryan, Mrinali Patel Gupta, Karyn E. Jonas,Susan Ostmo, Maria Ana Martinez-Castellanos, Audina M. Berrocal, Michael F. Chiang, Paul Chan

 

Abstract
 

To describe the characteristics of infants with bilateral Stage 4b or 5 ROP (i.e. with subtotal or total retinal detachment) who presented to eye departments in two major cities in Mexico, to identify reasons why they may have become blind in order to recommend how programs could be improved.

 

A large case-series of infants with Stage 4b or 5 ROP in both eyes confirmed by ultrasound who attended the ROP Clinic, Hospital Civil de Guadalajara from September 2010 to November 2012, and the Department of Ophthalmology, Hospital Infantil de Mexico Federico Gomez from December 2011 to December 2012 were identified from the diagnostic databases of each hospital. Mothers of infants in Guadalajara had a telephone interview. 89/94 eligible infants were included in the study, 48 in Guadalajara and 41 in Mexico City. Cases came from 22 of the 32 states in Mexico.

 

Half of the infants attending Guadalajara 24/48 (50 %) had been cared for in NICUs without ROP screening programs and were not examined. Among the 24 infants cared for in NICUs with ROP programs, 7/24 (29.1 %) mothers reported that their infant had not been examined while in the NICU, and a further 9/24 (37.5 %) were either not referred for screening Conclusions: There is an urgent need to expand the coverage and quality of ROP programs, to ensure that existing screening guidelines are better adhered to, and to improve communication with parents.

 

2015

Retinopatía del prematuro

 

Publicado en la Revista Cubana de Pediatría en 2015

 

Autores:  Luvia Curbelo Quiñones, Raisa Durán Menéndez, Débora Mercedes Villegas Cruz, Aimeé Broche Hernández, Antonio Alfonso Dávila

 

Hospital General Universitario “Dr. Enrique Cabrera Cossío”. La Habana, Cuba.

 

RESUMEN

Introducción: después de un parto pretérmino, múltiples factores pueden provocar, primero una detención, y luego un crecimiento anormal de los vasos de la retina, y producir la retinopatía del prematuro.

 

Objetivo: caracterizar el patrón clínico epidemiológico de la retinopatía del prematuro en recién nacidos menores de 35 semanas de gestación y peso al nacer inferior o igual a 1700 g.


Métodos: estudio observacional, descriptivo, transversal y retrospectivo de los nacidos con menos de 35 semanas de edad gestacional y peso inferior o igual a 1700 g, en el período comprendido entre 2006 y 2011, ambos inclusive, en el Hospital General Universitario “Dr. Enrique Cabrera Cossío”. Se analizaron como factores de riesgo asociados a la retinopatía del prematuro: la edad gestacional, el peso, el sexo, la apariencia racial, la oxigenoterapia, el método de administración del oxígeno, la sepsis, el distrés respiratorio, la administración de esteroides, las transfusiones de sangre, la apnea y la hemorragia intraventricular. Se utilizó el estadígrafo chi cuadrado para verificar la posible asociación entre las variables y la presencia de retinopatía.


Resultados: se incluyeron en el estudio 89 pacientes. Presentó retinopatía el 20,2 % de la muestra, y el 72,2 % de los que desarrollaron retinopatía nació antes de las 32 semanas de gestación; con mayor frecuencia el peso al nacer osciló entre 1000 y 1500 g, y predominó el sexo masculino. En los menores de 1000 g el 66,6 %  presentó retinopatía. El 88,2 % de los que desarrollaron retinopatía recibieron ventilación con presión positiva intermitente como método de la oxigenoterapia. Un paciente (5,6 %) no recibió oxígeno y desarrolló retinopatía. Las afecciones que más se presentaron relacionadas con la prematuridad fueron el síndrome de distrés respiratorio y las infecciones.

 

2014

Experimental Histopathological Study on Retinal and Renal Cellular Response to Intravitreous Antiangiogenic Drugs


Publicado en 2014 en el International Journal of Ophthalmology


Autores: João Borges Fortes Filho, Maurício Maia, Márcia Beatriz Tartarella, Fabíola Schons Meyer, Bárbara Gastal Borges Fortes, Lúcia Maria Kliemann


ABSTRACT

AIM: To evaluate histopathological retinal and renal response after one single dose of intravitreous injection of antiangiogenic drugs ranibizumab and bevacizumab in rats.

METHODS: Experimental study in 60 days of life adults Wistar rats. Ten animals were included. Group 1 included 5 animals that were injected with 1µL ranibizumab 1.25mg in the right eye and with 1µL of balanced salt solution (BSS) in the left eye, as control; Group 2 included 5 animals that were injected with 1 µl of bevacizumab in the right eye and with 1µL of BSS in the fellow eye. All injections were performed with Hamilton syringes. After 15 days of the interventions, all animals were sacrificed in CO 2 chamber. Both eyes were enucleated and one kidney was removed, fixed and embedded in paraffin for histopathological analysis by optic microscopy. For statistical purposes the initial expected abnormal histopathological responses were defined as 0%.

RESULTS: Atypical histopathological retinal response was detected in 2 eyes injected with ranibizumab (40%) as well as in 2 control eyes in group 1. Same was detected in 1 eye injected with bevacizumab (20%) as well as in1 control eye, in group 2. The noted atypical findings were lymphocytes and eosinophils in the vitreous posterior cavity and mild retinal inflammatory reaction with ganglion cell layer edema but without clinical significance. No atypical histopathological renal response was detected.

CONCLUSIONS: Unexpected atypical histopathological retinal response without clinical significance was observed in 3 eyes injected with antiangiogenic drugs (2 in group 1 and 1 in group 2) as well as in 3 control eyes (2 in group 1 and 1 in group 2). No atypical renal response was detected suggesting no extra ocular involvement of the intravitreous injected antiangiogenic drugs. 

 

2014

Comparison of iridocorneal angle in infants with retinopathy of prematurity and healthy infants using spectral domain optical coherence tomography


Publicado en el Journal of American Academy of Pediatric Ophthalmology and Strabismus en 2014

 

Authors: Linda A. Cernichiaro-Espinosa,Maria M. Garc?a-Huerta,Veronica E. Giordano, MD, Samantha M. Salinas-Longoria,Rafael Romero-Vera, Gerardo Garc?a-Aguirre, Guillermo Salcedo-Villanueva,Hugo Quiroz-Mercado, Maria A. Martinez-Castellanos

 


Abstract

 

To compare measurements and morphologic characteristics of the iridocorneal angle in preterm infants with retinopathy of prematurity (ROP) and healthy infants using spectral

Methods:controls under 1 year old were imaged using SD-OCT without sedation to capture the

Resultsincluded. The mean gestational age of children in the ROP group was 30 weeks; of the

Conclusions:ROP.

 

<span style="font-size:10.0pt;Arial" ,"sans-serif";font-weight:normal;"=""> J AAPOS 2014;18:344-346

 

2014

Retinopathy of prematurity screening and treatment cost in Brazil


Publicado en la Revista Panamericana de Salud Pública en 2014

 

Authors: Andrea Araújo  Zin, Cynthia Magluta, Márcia F. T. Pinto, Aline P. Entringer, Maria A. Mendes-Gomes,  Maria E. L. Moreira, Clare Gilbert

 

 

Abstract
 

To assess the additional cost of incorporating the detection and treatment of

System (SUS).

 

A deterministic decision-tree simulation model was built to estimate the direct

data for 869 preterm infants with birth weight less than 1 500 g examined in six governmental

treated. All of the parameters from this study were extrapolated to Brazilian newborn estimates

maintenance, and training based on published data and expert opinion. A budget impact

and the incidence of treatable ROP. One- and two-way sensitivity analyses were performed.

 

In Rio de Janeiro, unit costs per newborn were US$ 18 for each examination,

treatment for all at-risk infants NICUs was US$ 80 per infant. The additional cost to the SUS

US$ 856 320 for 80% coverage, and US$ 1.07 million or 100% coverage.

 

The results of this study indicate that providing ROP care is affordable

considering the evidence of the effectiveness of ROP treatment and the social benefits achieved.

 

2014

Bevacizumab intravítreo como monoterapia de la retinopatía del prematuro en 12 pacientes

 

Publicado en los Archivos Argentinos de Pediatría en 2014

 

Autores: Aldo Bancalari M, Ricardo Schade Y, Rubén Peña Z, Nicolás Pavez P

 

RESUMEN


Comunicamos los resultados oftalmológicos en una serie de niños tratados con bevacizumab intravítreo con retinopatía del prematuro (RDP) en etapa umbral. Se evaluaron doce recién nacidos pretérmino de muy bajo peso (RNMBP) que recibieron bevacizumab intravítreo como monoterapia en el tratamiento de la retinopatía del prematuro en etapa umbral y que presentaban contraindicación para la terapia estándar con fotocoagulación con láser. Se realizaron controles oftalmológicos y se evaluó la respuesta al tratamiento, reintervenciones y complicaciones. La edad gestacional de estos pacientes fue 26,3 ± 1,8 semanas y el peso de nacimiento de 845 ± 153 g. Hubo buena respuesta en ocho casos, mientras que cuatro pacientes requirieron reintervención con fotocoagulación con láser. No se detectaron complicaciones inmediatas y no hubo pacientes fallecidos.

 

2014

Retinal fluorescein angiographic changes following intravitreal anti-VEGF therapy

 

Publicado en el JAAPOS en 2014

 

Autores: Andree Henaine-Berra, Gerardo Garcia-Aguirre, Hugo Quiroz-Mercado, Maria Ana Martinez-Castellanos

 

 

ABSTRACT

 

Objectives: To describe the retinal vascular morphology in eyes injected with intravitreal bevacizumab for treatment-requiring retinopathy of prematurity (ROP).

 

Methods: In this prospective, nonrandomized case series, fundus photographs and fluorescein angiography in patients diagnosed with stage 3 threshold or prethreshold ROP, were obtained immediately before and 1 month after injection of 0.03 cc (0.75 mg) of intravitreal bevacizumab using wide-field digital pediatric imaging system.

 

Results: A total of 47 eyes of 26 patients were included. Before treatment, fluorescein angiography showed vascular abnormalities, including capillary nonperfusion throughout and shunting in the vascularized retina, demarcation line, limited vessel development, new vessels leakage, avascular periphery and absence of foveal avascular zone. After intravitreal bevacizumab, fluorescein angiography showed involution of the neovascularization, flattening of the demarcation line and subsequent growth of vessels to the capillary-free zones. During the following weeks large areas devoid of microvessels were seen as well as vascular remodeling with uneven spacing of the retinal capillaries and vascular loops in the areas that were previously devoid of vessels. In some patients, retinal vessels in the far periphery never developed: patients with these findings did not subsequently develop pathological neovascularization.

 

Conclusions: In this study cohort, patients showed improvement of their abnormal vascular findings after intravitreal bevacizumab, however even when the vascular pattern remained abnormal, there was creation of small vessels, establishment of directional flow, maturation of retinal vessels, and adjustment of vascular density. 

 

2013

Early retinopathy of prematurity findings identified with fluorescein angiography


Publicado en el Graefes Archive for Clinical and Experimental Ophthalmology em 2013

 

Authors: Luz Consuelo Zepeda-Romero, Aldo A. Oregon-Miranda, Dalia S. Lizarraga-Barrón, Oscar Gutiérrez-Camarena, Alonso Meza-Anguiano, José Alfonso Gutiérrez-Padilla


 

Abstract


BACKGROUND: Fluorescein angiography has been fundamental for the understanding and description of vascular disorders affecting the retina and choroid. The aim of this report is to assess the early anatomic retinal changes visible with angiography, and their relation with the clinical findings of retinopathy of prematurity.

METHODS: Ten babies were included in the study, the initial examination being at 2 weeks after birth. Two cycles of tropicamide 0.8 % and phenylephrine 5 % eye drops were instilled into both eyes 30 min before examination. A RetCam II was used to obtain digital retinal images, after instilling topical anesthesia (tetracain 0.5 %) and using a contact gel. Fluorescein angiography was undertaken following administration of an intravenous bolus of 0.1 ml/kg saline fluorescein 10 % followed by a 3.0-ml isotonic saline flush, with the assistance of the neonatologist; the right and left eyes were imaged.

RESULTS: We observed that some of the vascular abnormalities described for threshold disease by Lepore were already present at the second week of life, preceding the diagnosis of threshold disease by 3-4 weeks in two cases. The main findings in our cases were arterio-venous shunts, surrounded by areas of capillary non-perfusion, rosary-bead-like hyper-fluorescence, tortuosity and leakage from distal arterioles, none of which were detectable in the digital fundus pictures.

CONCLUSIONS: Early ROP screening at the NICU that includes FA is a safe procedure, and gives the examiner details of vascular changes that are not detectable by indirect ophthalmoscopy, which could predict the progression to threshold disease, and provide an alert about the need of therapeutic interventions.

 

2013

Retinopatía del prematuro: controversias en el uso de antiangiogénicos intraoculares


Publicado en el Boletin Médico del Hospital Infantil  de Mexico en 2013

 

Authors: Luis Jasso-Gutiérrez, Leyla Carolina Padilla-Sierra, Violeta Robredo-Torres, Juan Carlos Bravo-Ortiz, José Alfonso Gutiérrez Padilla, Eusebio Angulo Castellanos, Javier Mancilla Ramírez, Manuel Bernardo Salgado-Valladares, María Graciela Hernández-Peláez, Leonor Hernández Salazar, Luis Porfirio Orozco Gómez, Luz Consuelo Zepeda-Romero

 

 

Abstract

The increase in survival rates among preterm infants, characteristics of neonatal care for such infants and a lack of suitable programs for preventing, detecting and treating retinopathy of prematurity (ROP) are factors that have made this disease the main cause of preventable blindness among children in Mexico.


The advent of antiangiogenic agents in cancer treatment and their off-label use with favorable results in the treatment of proliferative vessel disease of the retina among adult patients, as well as anecdotal reports in the literature and a series of cases showing serious methodological flaws, have prompted their use in the treatment of retinopathy of prematurity. Unfortunately, these agents used indiscriminately in our country have a systemic absorption and secondary effects on the preterm patient’s body. There are no long-term monitoring studies that guarantee their safe use in this segment of the population.

This article describes the situation in our country and warns of the risks posed by the use of this type of drug on the preterm infant population.

 

2013

Factores de riesgo y comportamiento de la retinopatía de la prematuridad

 

Publicado en la Revista de Ciencias Médicas de Pinar del Río (Cuba) en 2013

 

Autores: Blanca Emilia Eliot Fuentes, Marucha Chávez Morales, Yunaisy Barrera
Villar, Carmen Luisa García Muñóz, Martha María de la Portilla Castro

 

RESUMEN

 

Introducción: la retinopatía de la prematuridad constituye una causa importante de morbilidad a nivel mundial, evolucionando a la ceguera si no se diagnostica y trata adecuadamente.

 

Objetivo: evaluar el comportamiento de la retinopatía de la prematuridad en recién nacidos pretérmino del servicio de Neonatología del Hospital General Docente "Abel Santamaría" de Pinar del Río, de enero de 2007 a diciembre del 2011.

 

Método: se realizó un estudio observacional, transversal y retrospectivo en 402 pacientes menores de 35 semanas y/o menores de 1700 gramos, así como aquellos que sobrepasaron esta edad gestacional y peso, pero que presentaron factores de riesgo para desarrollar la enfermedad. Se utilizaron como variables la edad gestacional, peso al nacer, grados de retinopatía y factores de riesgo asociados. La recopilación de datos se obtuvo de la historia clínica individual y se procesaron utilizando el sistema Microstad y Epi-info.

 

Resultados: la frecuencia de retinopatía fue de 7.5%, el grado I en zona 1,2 ó 3 se presentó en 6.7%, el 6.8% de los pacientes nacieron con menos de 34 semanas, y el 7.8% con peso menor a 1700 gramos; el 100% de los casos recibió oxígeno suplementario, el 50% presentó distress respiratorio y un 23.3% sepsis.

 

Conclusiones: la incidencia de retinopatía del prematuro en la provincia ha disminuido, el grado I fue el más frecuente, se afectaron más los nacidos con menos de 34 semanas y menos de 1700 gramos, y los factores de riesgo asociados fueron el tratamiento con oxígeno, distress respiratorio y la sepsis neonatal.

 

2013

Incidence and Main Risk Factors for Retinopathy of Prematurity in Infants Weighing Less Than 1000 grams in Brazil


Publicado en 2013 en el Journal of Tropical Pediatrics

Autores: João Borges Fortes Filho, Bárbara Gastal Borges Fortes, Marcia Beatriz Tartarella, Renato Soibelmann Procianoy

SUMMARY


Objectives: This study evaluated the incidence and risk factors for severe retinopathy of prematurity (ROP) in babies <1,000g at Porto Alegre, Brazil.

Methods: Prospective cohort study including premature children with birth weight ≤1,000g. Main outcome was the occurrence of severe ROP needing treatment.

Results: A total of 157 infants were included. Severe ROP occurred in 20 infants (12.7%). Nineteen patients were treated by laser photocoagulation. Main risk factors for severe ROP were gestational age at birth (P=0.029), infant’s weight measured at 6th week of life (P<0.001) and number of days of oxygen-therapy under mechanical ventilation (P<0.001). After logistic regression infant’s weight at 6th week of life and number of days in mechanical ventilation were associated to severe ROP.

Conclusions: We reported the incidence of 12.7% of severe ROP among babies born ≤1,000 g in our institution. Laser photocoagulation was effective to stabilize the disease among 19 treated patients.


 

2013

Persistent Fetal Vasculature: Ocular Features, Management of Cataract and Outcomes


Publicado en 2013 en los Arquivos Brasileiros de Oftalmologia

Autores: Marcia Beatriz Tartarella, Rodrigo Ueno Takahagi, Ana Paula Braga, João Borges Fortes Filho
 

ABSTRACT

Purposes: To describe ocular features, management of cataract and functional outcomes in patients with persistent fetal vasculature (PFV).

Methods: Retrospective, descriptive case series of patients with PFV. Data were recorded from the Congenital Cataract Section of Federal University of São Paulo, Brazil from 2001 to 2012. All patients were evaluated for sex, age at diagnosis, systemic findings, laterality, age at surgery, and initial and final follow-up visual acuities. Follow-up and complications after cataract surgery were recorded. Ultrasound was performed in all cases and ocular eco-doppler was performed in most.

Results: The study comprised 53 eyes from 46 patients. Age at diagnosis ranged from 5 days of life to 10 years-old (mean 22.7 months). Twenty-seven patients were male (58.7%). Persistent fetal vasculature was bilateral in 7 patients (15.2%). Forty-two eyes (79.2%) had combined (anterior and posterior forms) PFV presentation, 5 eyes (9.4%) had only anterior PFV presentation and 6 eyes (11.3%) had posterior PFV presentation. Thirty-eight eyes (71.7%) were submitted to cataract surgery. Lensectomy combined with anterior vitrectomy was performed in 18 eyes (47.4%). Phacoaspiration with intraocular lens implantation was performed in 15 eyes (39.5%), and without lens implantation in 5 eyes (13.2%). Mean follow-up after surgery was 44 months. Postoperative complications were posterior synechiae (3 cases), retinal detachment (2 cases), phthisis (3 cases), posterior capsular opacification (8 cases), inflammatory pupillary membrane (5 cases), glaucoma (4 cases), IOL displacement (1 case) and vitreous hemorrhage (2 cases). Complications were identified in 19 (50%) of the 38 operated eyes. Visual acuity improved after cataract surgery in 83% of the eyes.

Conclusions: Patients with PFV have variable clinical presentation. There is an association of PFV with congenital cataract. Severe complications are related to cataract surgery in patients with PFV, but 83% of the operated eyes improved visual acuity.

 

 

2013

Tratamiento de la retinopatía del prematuro con bevacizumab intravítreo

 

Publicado en la Revista Chilena de Pediatría en 2013

 

Autores:  Aldo Bancalari M, Ricardo Schade Y, Rubén Peña Z, Nicolás Pavez P 

 

ABSTRACT

 

Introduction: Standard treatment of threshold Retinopathy of Prematurity (ROP) is laser photocoagulation (LPC). Recently, bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor has been used with positive results.

 

Objective: To communicate the response to treatment with bevacizumab in premature newborns with threshold retinopathy.

 

Patients and Method: Very low birth weight (VLBW) infants that received bevacizumab, in monotherapy or associated with LPC, as treatment for threshold ROP, were analyzed. Response to treatment, reinterventions and complications were evaluated.

 

Results: 17 VLBW infants were analyzed with mean gestational age 26.4 ± 1.7 weeks and mean birth weight 850 ± 141 g. All 6 patients treated with bevacizumab in association with LPC did not require reintervention. Of the 11 neonates that only received bevacizumab, 36.3% needed further treatment.

 

Conclusions: Bevacizumab could be an effective therapy for treatment of threshold ROP. In our experience it presented advantages compared with LPC, since therapy can be carried out without transferring the patient and with no use of general anesthetics. No short term complications were observed with the use of bevacizumab in treated patients.

 

2013

Comportamiento de la retinopatía de la prematuridad en la provincia La Habana

 

Publicado en la Revista Cubana de Oftalmología en 2013

 

Autores: Olga Lidia Baños Carmona, Yusimik Toledo González, Mavys Soto García, Mayra Mier Armas, Raúl Rúa Martínez, Suzel Lapido Polanco


RESUMEN

 

Objetivo: evaluar el comportamiento de la retinopatía de la prematuridad en los nacidos con menos de 1750 g o menos de 35 semanas de gestación.

 

Métodos: se realizó un estudio retrospectivo, observacional, descriptivo en el período comprendido de enero de 2005 a septiembre de 2010, en los servicios de neonatología de la provincia La Habana. Se estudió el total de recién nacidos vivos (207) con menos de 35 semanas de edad gestacional y un peso inferior a 1 750 g al nacer ingresados en las unidades de cuidados intensivos neonatales de este territorio.

 

Resultados: el 42,8 % correspondió con los nacidos entre las semanas 33 y 34,6, y un 42,8 % con un peso entre 1250 y 1499 g.  El 89,8 % de los recién nacidos presentaron una retina inmadura y un 10,1 % desarrolló retinopatía de la prematuridad. El 88,8 % de los tratados con láser evolucionaron favorablemente.

 

Conclusiones: la retinopatía de la prematuridad ha disminuido en los últimos años a pesar de que existe un incremento en el bajo peso al nacer y prematurez. La edad gestacional menor de 34,6 semanas, el peso al nacer menor de 1500 g y el síndrome de dificultad respiratoria fueron los factores más importante en la aparición de la retinopatía. Con el diagnóstico precoz de la enfermedad se trató oportunamente, logrando disminuir las secuelas y mejoría de la calidad de vida.

 

2013

Long-term effect of antiangiogenic therapy for retinopathy of prematurity up to 5 years of follow-up

 

Publicado en Retina en 2013

 

Long-term effect of antiangiogenic therapy for retinopathy of prematurity up to 5 years of follow-up

 

Authors: Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, Kon-Jara VA, Garcia-Aguirre G, Guerrero-Naranjo JL, Chan RV, Quiroz-Mercado H.

 

ABSTRACT

 

PURPOSE: To evaluate ocular function and systemic development in premature infants treated with intravitreal bevacizumab injections for retinopathy of prematurity over a period of 5 years.

 

METHODS: A prospective, interventional, noncomparative case study. The primary outcome measure was visual acuity. The secondary outcomes were structural assessment, other ocular functional measurements, and developmental state.

 

RESULTS: Eighteen eyes of 13 consecutive patients were divided into 3 groups: Group 1, Stage 4 unresponsive to previous conventional treatment (n = 4); Group 2, in which conventional treatment was difficult or impossible because of inadequate visualization of the retina (n = 5); and Group 3, newly diagnosed high-risk prethreshold or threshold retinopathy of prematurity (n = 9). All patients showed initial regression of neovascularization. One patient was diagnosed with recurrence of neovascularization and was treated with intravitreal bevacizumab. Visual acuity was preserved, and median vision was 20/25 (excluding 2 operated eyes). Twelve eyes developed mainly low myopia over the years, with an overall mean value of 3.2 diopters. Electroretinograph was normal in 4 eyes that had no previous detachment. One patient showed delay in growth and neurodevelopment, whereas all the others were within the normal range.

 

CONCLUSION: Five years of follow-up in a small series suggest that intravitreal bevacizumab for retinopathy of prematurity results in apparently preserved ocular function and systemic development.

 

2013

Pain assessment in premature infants treated with intravitreal antiangiogenic therapy for retinopathy of prematurity under topical anesthesia

 

Publicado en Graefes Archives for Clinical and Experimental Ophthalmology en 2013

 

Autores: Maria Ana Martínez Castellanos, Shulamit Schwartz, Ricardo Leal, Robison Vernon Paul Chan, Hugo Quiroz-Mercado

 

ABSTRACT

 

PURPOSE: To evaluate the physiological and behavioral pain response in premature infants receiving intravitreal bevacizumab injection (IVB) for retinopathy of prematurity (ROP) under topical anesthesia.

 

METHODS: A prospective interventional non-comparative case series. Premature infants with high-risk prethreshold or threshold ROP received IVB using topical anesthesia with tetracaine eye drops. A Premature Infant Pain Profile was used to assess the pain response during the procedure.

 

RESULTS: Nine premature infants requiring bilateral IVB therapy were included in the study. Mean gestational age was 28.7 ± 1.3 weeks, and birth weight was 1,200 ± 194 grams. The mean total pain score was found to be 8.7 ± 2.4 (range 5-14), indicating generally mild pain during the procedure. Eye squeeze was the most prominent indicator of pain. Most changes occurred at the beginning, with the insertion of the lid speculum and were hardly noted during the rest of the procedure including the injection itself.

 

CONCLUSION: Topical anesthesia with tetracaine is an effective method for the relief of pain associated with intravitreal injections in premature infants with ROP.

 

2013

Oral Glucose for Pain Relief During Examination for Retinopathy of Prematurity: A Masked Randomized Clinical Trial


Publicado en 2013 en Clinics

Autores: Marlene Coelho da Costa, Gabriela Unchalo Eckert, Bárbara Gastal Borges Fortes, João Borges Fortes Filho, Rita C. Silveira, Renato S. Procianoy

ABSTRACT


Background: Ophthalmologic examination for retinopathy of prematurity (ROP) is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed in order to reduce pain during eye examination.

Purpose: To evaluate the use of oral 25% glucose solution to relief pain during ophthalmologic examinations for ROP.

Methods: A masked randomized clinical trial with the use of 1 ml of oral 25% glucose solution once 2 minutes before the first ophthalmologic examination for ROP was carried out between March 2008 and April 2010 comparing with a control group that did not receive oral glucose solution. Pain was evaluated by Neonatal Infant Pain Scale (NIPS) immediately before and immediately after the ophthalmologic examination in both groups.

Results: One hundred and twenty four patients who were examined for the first time for ROP were included. Seventy were included in intervention group and 54 in control group. The number of patients with pain immediately before the procedure was similar in both groups, and after ophthalmologic examination was: intervention group 15.7% and control group 68.5% (P<0.001).

Conclusions: One ml of oral 25% glucose solution given 2 minutes before the ophthalmologic examination for ROP was an effective measure for pain relief.


 

2013

Características clínicas epidemiológicas de la retinopatía de la prematuridad en recién nacidos de embarazos múltiples

 

Publicado en la Revista Cubana de Oftalmología en 2013

 

Autores: Marilay Soto Fors, Mayra Mier Armas, Raúl Rúa Martínez, Melbis López Hernández,Yusimik Toledo González

 

Hospital "Leopoldito Martínez". Mayabeque, Cuba.

Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La Habana, Cuba.

Hospital Materno "Piti Fajardo". Mayabeque, Cuba.

Centro de atención y educación al diabético. Artemisa, Cuba.

 

 

RESUMEN

 

 

Introducción: las principales líneas del programa de Retinopatía de la Prematuridad en Cuba es la prevención de la ceguera por esta enfermedad y el tratamiento oportuno en los casos que lo requieran.

 

Objetivo: determinar las características clínicas y epidemiológicas de la retinopatía de la prematuridad en el recién nacido de embarazos múltiples, sobre la base del programa nacional.

 

Métodos: se realizó un estudio observacional descriptivo retrospectivo, entre enero de 1999 y diciembre de 2010, en el Hospital Universitario Materno Infantil "Eusebio Hernández". Se incluyeron 52 recién nacidos de embarazos múltiples de menos de 35 semanas de edad gestacional, y bajo peso al nacer (< 1700 g). Las variables analizadas fueron: sexo, edad gestacional, peso, factores perinatales asociados con el desarrollo de la retinopatía y los estadios más frecuentes.

 

Resultados: presentaron algún estadio de la retinopatía 9 recién nacidos para el 17,3 %. Dentro de los bebés con retinopatía de la prematuridad, fueron más frecuentes el sexo masculino y el estadio I. El peso sobrepasó los 1500 g y la edad gestacional estuvo entre 34 y 36 semanas. Los antecedentes que más incidieron en los recién nacidos con retinopatía fueron el uso de oxigeno y los esteroides.

 

Conclusiones: la aplicación del programa permite detectar la aparición de la retinopatía del prematuro y tomar conductas adecuadas en la población en riesgo. Es necesario Continuar la identificación de factores de riesgo potenciales de producir o empeorar la enfermedad.

 

2012

Phacoemulsification and Foldable Acrylic IOL Implantation in Children with Treated Retinoblastoma


Publicado en 2012 en los Arquivos Brasileiros de Oftalmologia

Autores: Marcia Beatriz Tartarella, Glória Fátima Britez-Colombi, Marcia Motono, Martha Motono Chojniak, João Borges Fortes Filho 
 

ABSTRACT

Purpose:  To study the results of cataract surgery in children with radiation-induced cataract after treatment for retinoblastoma.

Methods:  Retrospective interventional case series. Six consecutive patients diagnosed with secondary cataracts due to radiation therapy for retinoblastoma. Intervention: Phacoemulsification and foldable acrylic intraocular lens implantation. Outcomes measured: Visual acuity, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy. Aspirated lens material and aqueous humor samples were collected during surgery.

Results: Six uniocular children between 3 to 5 years of age at time of surgery were studied. The mean time interval between radiotherapy and cataract diagnosis was 22.3 months. The mean follow-up after surgery was 17.2 months (range: 12 to 23 months). All eyes achieved a clear visual axis after surgery allowing monitoring the tumor status. None developed recurrence or retinoblastoma dissemination. Histopathological analysis of the aspired material showed no tumoral cells in all samples. All patients improved vision after cataract surgery.

Conclusions: Phacoemulsification with acrylic intraocular lens implantation seems to be a safe, feasible, and effective method for the removal of radiation-induced cataracts in patients with treated retinoblastoma.




 

 

2012

Intraocular Pressure in Very Low Birth Weight Preterm Infants and its Association with Postconceptional Age

Publicado em 2012 no Clinics


Publicado en 2012 en Clinics

Autores: Rodrigo Leivas Lindenmeyer, Lucas Farias, Taís Mendonça, João Borges Fortes Filho, Renato Soibelmann Procianoy, Rita C. Silveira

ABSTRACT


Objective:  To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with the postconceptional age.

Methods:  A longitudinal and prospective cohort study evaluated weekly measurements of intraocular pressure in very low birth weight premature infants (defined as birth weight ≤1,500 g and/or gestational age ≤32 weeks) admitted to Hospital de Clínicas de Porto Alegre, Brazil.  The evaluated outcome was the variation of intraocular pressure according to the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination) in the weeks following preterm birth. Statistics: Mixed-effects models were used for the statistical analysis to determine intraocular pressure variation according to postconceptional age. Means, 10th and 90th percentiles were calculated for intraocular pressure values.

Results: Fifty preterm infants, with a mean gestational age of 29.7 ± 1.6 weeks and mean birth weight of 1,127.7 ± 222.7 g, were evaluated. Mean intraocular pressure in the whole cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all measurement values were greater than 20 mmHg. The analysis revealed a mean intraocular reduction of 0.29 mmHg for each increase of postconceptional (P=0.047; 95% CI: -0.58 to -0.0035). Mean intraocular pressure (P10-P90) decreased from 16.3 mmHg (10.52-22.16) at 26.3 weeks to 13.1 mmHg (7.28-18.92) at 37.6 weeks of postconceptional age. 

Conclusions: Mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreases by 0.29 mmHg per week as the postconceptional age increases.

 

 

2012

Proposal of a Novel Classification of Leukocorias


Publicado en 2012 en el Clinical Ophthalmology

Autores: Marcia Beatriz Tartarella, Glória Fátima Britez-Colombi, João Borges Fortes Filho

ABSTRACT


Background: To present a clinical report of 10 patients presenting leukocoria without lens opacification or retrolental abnormalities and to propose a classification for the leukocorias.

Methods: An institutional and retrospective study including a case series of patients assisted in the Congenital Cataract Section of Federal University of São Paulo, Brazil, during the period between 2005 and 2010 with pre-lenticular leukocoria and clear lens.

Results: Ten patients younger than 4 years of age presented the diagnosis of unilateral pre-lenticular opacities without cataract. Echography in all patients revealed no posterior segment or lens abnormalities in the affected eye. Among the patients, 2 presented juvenile xanthogranuloma with secondary pupillary membrane, 1 had persistent fetal pupillary membrane, 1 had pre-lenticular membrane due to congenital toxoplasmosis, 2 had idiopathic pre-lenticular membrane formation, 1 had anterior chamber inflammatory membrane due to hyphema caused by intraocular (iris) hemangioma, 1 had limbal dermoid cyst associated to pupillary membrane, 1 had central corneal scar (leukoma) and 1 had anterior segment persistent fetal vasculature.

Conclusions: This group of children presented unilateral pre-lenticular leukocoria without lens opacification or posterior segment abnormalities. Different etiologies were associated with this condition. The exact diagnosis is important in order to avoid clear lens extraction. A classification of leukocorias is proposed herein including: pre-lenticular leukocorias, lenticular leukocorias, retrolenticular leukocorias, mixed presentation leukocorias, and pseudophakic or aphakic leukocorias.


 

2012

Prediction of retinopathy of prematurity using the screening algorithm WINROP in a Mexican population of preterm infants.


Publicado en los Archives of Ophthalmology en 2012


 

Authors: Luz Consuelo Zepeda-Romero, Anna-Lena Ha rd, Larissa Maria Gomez-Ruiz, Jose Alfonso Gutierrez-Padilla, Eusebio Angulo-Castellanos, Juan Carlos Barrera-de-Leon, Juan Manuel Ramirez-Valdivia, Cesareo Gonzalez-Bernal, Claudia Ivette Valtierra-Santiago, Esperanza Garnica-Garcia, Chatarina Lofqvist, Ann Hellstrom

 

 

Abstract



OBJECTIVE: To retrospectively validate the WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm in identification of type 1 ROP in a Mexican population of preterm infants.


METHODS: In infants admitted to the neonatal intensive care unit at Hospital Civil de Guadalajara from 2005 to 2010, weight measurements had been recorded once weekly for 192 very preterm infants (gestational age [GA] <32 weeks) and for 160 moderately preterm infants (GA ≥32 weeks). Repeated eye examinations had been performed and maximal ROP stage had been recorded. Data are part of a case-control database for severe ROP risk factors.


RESULTS: Type 1 ROP was found in 51.0% of very preterm and 35.6% of moderately preterm infants. The WINROP algorithm correctly identified type 1 ROP in 84.7% of very preterm infants but in only 5.3% of moderately preterm infants. For infants with GA less than 32 weeks, the specificity was 26.6%, and for those with GA 32 weeks or more, it was 88.3%.


CONCLUSIONS: In this Mexican population of preterm infants, WINROP detected type 1 ROP early in 84.7% of very preterm infants and correctly identified 26.6% of infants who did not develop type 1 ROP. Uncertainties in dating of pregnancies and differences in postnatal conditions may be factors explaining the different outcomes of WINROP in this population.

 

2012

Prevalencia de patología oftalmológica en prematuros menores de un año de edad

 

Publicado en los Archivos Chilenos de Oftalmología en 2012

 

Autores: Juan Pablo López G, Diego Ossandón V, Oliver Denk V, Ricardo Stevenson A, Ricardo Agurto R, Andrés Uauy N, Ricardo Salinas G Marcela Pérez R, Horacio Cox M, Andrés Maturana P, Soledad Elías A

 

 

ABSTRACT

 

Objective: To report ocular abnormalities in premature infants examined before one year of Corrected Gestational Age (CGA).

 

Patients and Methods: Retrospective review of medical records of a number of premature infants ([birth weight (BW) ≤ 1500 g and/or ≤ 32 week gestational age (GA)] born between 2006 and 2009 and examined before one year of CGA. GA, BW, retinopathy of prematurity (ROP), CGA examination, refraction, anisometropia and strabismus information were recorded.

 

Results: Out of the 149 premature infants born during the period, 100 had eye exam before one year of age (67.14%), the mean GA and BW was 29.3 (range 23-36) weeks and 1217 (343-2190) g, respectively. 29% had ROP, 4% required treatment. The mean CGA at the time of ophthalmologic examination was 6.4 (3 to 11.5) months. The spherical equivalent was +1.34 D (-1.75 to +5.75), 2.2% presented anisometropia > 1D (95% CI, -0.82 to 5.26). 3.3% (95% CI, -0.38 to 7.04) were in need of glasses according to international recommendations and 4% (95% CI, 0.16 to 7.84) had strabismus.

 

Conclusions: The low prevalence of risk factors for amblyopia detected in this population compared with that reported for premature infants with severe ROP could be explained by the low prevalence of the latter in this study.

 

2012

Causes of Blindness and Visual Impairment in Latin America


Publicado en el Survey of Ophthalmology en 2012

 

Authors: João M. Furtado, Van C. Lansingh, Marissa J. Carter, María F. Milanese, Brenda N. Peña, Hernán A. Ghersi, Paula L. Bote, María E. Nano, Juan C. Silva

 

Abstract


We review what is known in each country of the Latin American region with regards to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and glaucoma are starting to make serious inroads, although epidemiological data are limited, and age-related macular degeneration is now a concern in some populations. Infectious diseases such as trachoma and onchocerciasis are quickly diminishing. Although progress has been made, retinopathy of prematurity remains the major cause of childhood blindness. If VISION 2020 is to succeed, many more epidemiological studies will be needed to set priorities, although some can be of the Rapid Assessment of Avoidable Blindness design. Developing the infrastructure for screening and treatment of ophthalmic disease in Latin America continues to be a challenge.

 

Surv Ophthalmol 57:149--177,2012.


 

2012

Retinopatía del prematuro en la Unidad de Cuidados Intermedios. Servicio de Neonatologia. Hospital Central de Maracay

 

Publicado en los Archivos Venezolanos de Puericultura y Pediatría

 

Autores: Yohana Paz Diaz Cáceres, Zay Rivas, Xiomara Lanza, Anna Randazzo, Miriam Bolívar, Carla Cárdenas, Deikalejandra Romero, Andrea Verenzuela

 

 

RESUMEN

 

 

La incidencia de la Retinopatía del Prematuro (ROP) se asocia con las tasas de supervivencia y con la gravedad del proceso sistémico en el recién nacido pretérmino y está influenciada por diversos factores.

 

Objetivos: 1- Conocer la incidencia actual y la gravedad de la ROP. 2- Determinar la frecuencia según el sexo y edad gestacional.

 

Método: estudio descriptivo, de diseño longitudinal. Se analizó una población de 363 prematuros, quienes fueron explorados secuencialmente en búsqueda de ROP, de acuerdo al protocolo estandarizado de dicha condición. La severidad de ROP fue estimada según la extensión de la lesión.

 

Resultados: Del total de los 363 prematuros evaluados en la primera consulta, 214 presentaron ROP en la primera evaluación, y de estos 102 (28%) mantuvieron un diagnóstico definitivo a través del seguimiento. No hubo diferencia de incidencia entre varones y hembras. 40,65% tuvo un peso entre 1001-1499 gramos. 97 casos (45,32%) ocurrieron en niños entre 35 y 37 semanas. La ROP extendida a zona II fue la modalidad más común (88,23%).

 

Conclusiones: 28% de los prematuros estudiados desarrolló definitivamente la enfermedad. La mayoría de niños afectados tuvo ROP extendida a zona II. Hubo una alta incidencia de niños prematuros tardíos afectados por la complicación.

 

2012

A Predictive Score for Retinopathy of Prematurity in Very Low Birth Weight Preterm Infants


Publicado en 2012 en el Eye (London)

Autores: Gabriela Unchalo Eckert, João Borges Fortes Filho, Mauricio Maia, Renato Soibelmann Procianoy

ABSTRACT


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 BW ≤1,500 g and/or GA ≤32 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.

 

2011

Multiple Pregnancies and its Relationship with the Development of Retinopathy of Prematurity (ROP)


Publicado en 2011 en el Clinical Ophthalmology

Autores: Mário Martins dos Santos Motta, João Borges Fortes Filho, Jacqueline Coblentz, Claudia Amaral Fiorot

2011

Maternal Preeclampsia Protects Preterm Infants Against Severe Retinopathy of Prematurity


Publicado en 2011 en el Journal of Pediatrics

Autores: João Borges Fortes Filho, Marlene Coelho da Costa, Gabriela Unchalo Eckert, Paula Gabriela Batista de Souza, Rita C. Silveira, Renato Soibelmann Procianoy

ABSTRACT


Objective: To study the influence of the presence of maternal preeclampsia on the occurrence of any stage and severe retinopathy of prematurity.

Methods: A prospective cohort study from 2002 to 2009 included 324 preterm neonates with birth weight ≤1,500 grams and gestational age ≤32 weeks. Multiple maternal and perinatal factors were analyzed for association and confounding. Multiple logistic regression analysis was used.

Results: Mean birth weight was 1,128 240 grams, and mean gestational age 29.7 1.9 weeks. 24 newborns (7.4%) presented severe retinopathy of prematurity; 97 any stage of retinopathy and 227 no retinopathy of prematurity at all. Preeclampsia and complete antenatal steroid course had 60% and 54% reduction in risk for any stage of retinopathy of prematurity, respectively. Preeclampsia had 80% reduction in risk for severe retinopathy of prematurity.

Conclusions: Preeclampsia lowered the risk for occurrence of any stage and severe retinopathy of prematurity in very low birth weight infants.


 

2011

The utility of non-ophthalmologist examination of eyes at risk for serious retinopathy of prematurity.


Publicado en el Ophthalmic Epidemioloy en 2011


 

Authors: Luz Consuelo Zepeda-Romero, Juan Carlos Barrera-de-Leon, Cesareo Gonzáles-Bernal, Mario Marquez-Amezcua, Verónica Diaz-Artreaga, Eusebio Angulo-Castellanos, Jose Alfonso Gutiérrez-Padilla, Hector Gallardo-Rincón

 


Abstract


BACKGROUND: Retinopathy of Prematurity (ROP) is the main cause of preventable blindness in premature babies. Currently, there is a shortage of trained ophthalmologists, which has resulted in an alarming increase in cases of vision loss and related complications. This study's aim was to determine the utility of examinations conducted by non-ophthalmologist physicians to assess posterior pole vessel abnormalities in eyes at risk for ROP.


METHODS: Non-ophthalmologist physicians (pediatrician and neonatologist) were trained to use an indirect ophthalmoscope to view the posterior pole of babies at risk for ROP. Examinations were conducted on both eyes of premature infants born before 35 weeks gestational age (GA) starting at the third week after birth and weekly thereafter. The presence of Plus disease was identified by the non-ophthalmologist and results compared to the clinical examination by a pediatric ophthalmologist experienced in ROP detection and treatment. Chi-square was used for proportions and the Mann Whitney U test for medians. Fagan's nomogram was determined for diagnostic usability. The Kappa index was used to rate inter-observer agreement.


RESULTS: Results of 228 examinations performed on 150 premature infants were analyzed to determine the correlation of the non-ophthalmologist findings and the eye examination. For any vascular change in posterior pole diagnostic, findings were 87% and 87% accuracy for pediatrician and neonatologist, 82% and 83% sensitivity, 90% and 90% specificity respectively. There was no significant difference found in the detection of Plus disease for the examinations performed by the ophthalmologist compared to those performed by the non-ophthalmologist (P < 0.05).


CONCLUSIONS: After training in the use of an indirect ophthalmoscope, non-ophthalmologist physicians can reliably detect posterior pole retinal vessel changes for ROP diagnosis.

 

2011

Prevalence of Retinopathy of Prematurity in Latin America


Publicado en 2011 en el Clinical Ophthalmology

Autores: Juliana Zimmermann Carrion, João Borges Fortes Filho, Marcia Beatriz Tartarella, Andrea Araújo Zin, Ignozy Dorneles Jornada Jr

2011

Temporary morphological changes in plus disease induced during contact digital imaging

 

Publicado en el Eye en 2011


 

Authors: Luz Consuelo Zepeda-Romero, ME Martinez-Perez, S Ruiz-Velasco, MA Ramires-Ortiz, Jose Alfonso Gutiérrez-Padilla

 

Abstract
 

OBJECTIVE: To compare and quantify the retinal vascular changes induced by non-intentional pressure contact by digital handheld camera during retinopathy of prematurity (ROP) imaging by means of a computer-based image analysis system, Retinal Image multiScale Analysis.


METHODS: A set of 10 wide-angle retinal pairs of photographs per patient, who underwent routine ROP examinations, was measured. Vascular trees were matched between 'compression artifact' (absence of the vascular column at the optic nerve) and 'not compression artifact' conditions. Parameters were analyzed using a two-level linear model for each individual parameter for arterioles and venules separately: integrated curvature (IC), diameter (d), and tortuosity index (TI).


RESULTS: Images affected with compression artifact showed significant vascular d (P<0.01) changes in both arteries and veins, as well as in artery IC (P<0.05). Vascular TI remained unchanged in both groups.


CONCLUSIONS: Non-adverted corneal pressure with the RetCam lens could compress and decrease intra-arterial diameter or even collapse retinal vessels. Careful attention to technique is essential to avoid absence of the arterial blood column at the optic nerve head that is indicative of increased pressure during imaging.

 

 

2011

Epidemiología de la retinopatía del prematuro en Medellín, 2003-2008

 

Publicado en Latreia en 2011

 

Autores:  Mónica María Giraldo Restrepo, Andrea Hurtado Guzmán, Jorge Hernando Donado Gómez, Mercedes Cecilia Molina Betancur


RESUMEN


Objetivo: describir las características clínicas y demográficas y los factores de riesgo de neonatos con retinopatía de la prematuridad (ROP), detectados en el programa de tamización de la Clínica Universitaria Bolivariana, en la ciudad de Medellín, Colombia, durante los años 2003 a 2008.


Metodología: se revisaron los registros de 1.080 neonatos. Los criterios para tamización fueron: 32 o menos semanas de edad gestacional (EG) y 1.600 gramos o menos de peso al nacer (PN). Se creó una base de datos en la que se registraron las variables demográficas, algunos factores de riesgo maternos y neonatales, la clasificación de la ROP y el tratamiento requerido. Se analizaron y compararon los resultados con la epidemiología regional e internacional.


Resultados: la prevalencia global de ROP fue del 18,2% (197 neonatos), con EG media de 29,53 semanas y PN medio de 1.230 gramos. En menores de 1.250 gramos dicha prevalencia fue del 40%. Los factores de riesgo más frecuentes fueron la enfermedad de membrana hialina, la sepsis (p = 0,00) y la preeclampsia; 125 de los 197 niños (63,5%) recibieron terapia con oxígeno (p = 0,00). El 10,2 % de los neonatos con ROP requirieron tratamiento quirúrgico.


Conclusión: con el presente estudio, se aportan datos estadísticos actualizados referentes a la prevalencia de ROP y a los factores de riesgo en nuestra población.

 

2011

Cataract Surgery in Knobloch Syndrome: A Case Report


Publicado em 2011 en el Clinical Ophthalmology

Autores: Carmen Sílvia Bongiovanni, Carla Cristina Serra Ferreira, Ana Paula Silvério Rodrigues, João Borges Fortes Filho, Marcia Beatriz Tartarella

2011

Bevacizumab for Retinopathy of Prematurity

 

Publicado en el New England Journal of Medicine en 2011

 

Bevacizumab for retinopathy of prematurity.

 

Authors: Gilbert CE, Zin Andrea, Darlow B

 

To the Editor: In response to the article by Mintz-Hittner et al.: we note that bevacizumab (an anti–vascular endothelial growth factor [VEGF] agent) is already being used as first-line or rescue treatment for retinopathy of prematurity in many middle and emerging economies. In these settings, the population of babies with severe disease is very different from that in industrialized countries because more mature babies (gestational age of >31 wk) are also often affected.1 This phenomenon has been termed the “third epidemic” of retinopathy of prematurity.2 Angiogenesis is still active in many organs of these babies at the time of treatment of retinopathy of prematurity, yet the potential risks of anti-VEGF agents may not be fully explained to parents, and access to medical legal redress is limited. It is imperative that the pharmacodynamics and safety profile of bevacizumab (or alternative agents) in the premature infant with acute retinopathy of prematurity and breakdown of the blood–ocular barrier be better delineated.3 Randomized clinical trials that are adequately powered to detect adverse events and that have sufficiently long follow-up to assess neurodevelopmental outcomes are urgently needed. Until that time we would advocate that anti-VEGF medications be used only when laser photocoagulation fails and when informed consent is rigorously obtained.

 

 

2011

Phialemonium Curvatum Infection after Phacoemulsification: A Case Report


Publicado en 2011 en el European Journal of Ophhalmology

Autores: Roberto Freda, Melissa M. Dal Pizzol, João Borges Fortes Filho

ABSTRACT


Purpose: A case of Phialemonium curvatum wound corneal infection after phacoemulsification is reported.

Methods: A case report

Results: The marked aggressiveness of this fungus is demonstrated by the absence of therapeutic response to both medical and surgical treatment.

Conclusions: The poor outcome resulted in evisceration of the affected eye.

 

2011

Estudo da retinopatia da prematuridade em um hospital universitário

 

Publicado en los Arquivos Brasileiros de Oftalmologia em 2011

 

Autores: Virgínia Amélia Vaz Tomé, Janaína Fernandes Vieira, Leonardo Bruno de Oliveira, Rogério de Melo Costa Pinto, Vânia Olivetti Steffen Abdallah


Study carried out at the Serviço de Neonatologia do Hospital de Clínicas da Universidade Federal
de Uberlândia - UFU.


RESUMO


Objetivo: Avaliar a prevalência, sua classificação, descrição dos fatores de risco e tratamento da retinopatia da prematuridade (ROP) nos recém-nascidos.


Métodos: Estudo observacional transversal retrospectivo incluindo os recém-nascidos com idade gestacional ≤32 semanas e/ou peso ≤1.500 g internados na UTI neonatal do Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU) durante o período de julho de 2005 a junho de 2007.


Resultados: Foram analisados 148 pacientes. Em 66 (44,6%) detectou-se a ROP; 82 (55,4%) não apresentaram a doença. Os fatores de risco estatisticamente significantes foram: peso ao nascimento (p=0,0001), idade gestacional (p=0,0001), ventilação mecânica (p=0,0001), transfusão sanguínea (p=0,0001), persistência do canal arterial (PCA) (p=0,0001). Dos 66 prematuros com ROP, 77% foram tratados clinicamente (acompanhamento com oftalmoscopia indireta) e 23% necessitaram de tratamento cirúrgico ou fotocoagulação a laser.

Conclusão: Com base nos dados acima, a prevalência encontrada nesse estudo foi elevada. O desenvolvimento da ROP foi inversamente proporcional ao peso e à idade gestacional ao nascimento.

 

2011

Assessment of the Contribution of Cytokine Plasma Levels to Detect Retinopathy of Prematurity in Very Low Birth Weight Infants

 

Publicado en IOVS - Investigative Ophthalmology & Visual Science en 2011
 

Autores: Rita C. Silveira, João Borges Fortes Filho, Renato Soibelmann Procianoy

 

ABSTRACT

 

PURPOSE. To prospectively study the association of high cytokine plasma levels with later development of retinopathy of prematurity (ROP) in preterm infants with early-onset sepsis to assess a laboratory test to detect ROP.

 

METHODS. A prospective cohort study was conducted of preterm infants with clinical early-onset sepsis whose birth weight (BW) was 1500 g and gestational age (GA) was 32 weeks. Plasma samples were assayed for cytokines IL-6, IL-8, IL-10, IL-1, and TNF-. ROP was diagnosed in screening assessments. For the univariate analysis of the known risk factors for ROP, all infants without ROP were designated as the No ROP group, patients with any stage of ROP formed the ROP group, and all treated patients formed the Severe ROP group. The best cutoff points for all cytokine levels were determined by ROC curves.

 

RESULTS. Seventy-four patients were enrolled. Mean GA and BW were 29.6  2.1 weeks and 1110.3  232.5 g, respectively; 49 patients (66.2%) had no ROP and 25 (33.8%) had any stage of ROP (17 had stage 1 or 2 ROP and 8 had stage 3 ROP). IL-6 357 pg/mL, IL-8 216 pg/mL, and TNF- 245 pg/mL were significantly associated with treatable ROP.

 

CONCLUSIONS. There is a relationship between high plasma levels of IL-6, IL-8, and TNF- in the first days of life with the later development of ROP severe enough to treat in preterm infants with early-onset sepsis. Further epidemiologic studies are needed to explore other possible associations of high serum levels of cytokines with ROP in this population at high risk.

 

2011

Láser-ranibizumab para tratar retinopatía del prematuro en estadio umbral-preumbral. Tres años de experiencia

 

Publicado en Cirugía y Cirujanos en 2011

 

Autores: Luis Porfirio Orozco-Gómez, Leonor Hernández-Salazar, Silvia Moguel-Ancheita, María Adela Ramírez-Moreno, María Verónica Morales-Cruz

 

RESUMEN

 

Introducción: El análisis del Early Treatment for Rethinopathy of Prematurity Cooperative indicó 55.2% de resultados no favorables con el uso de láser en la zona 1 para tratar retinopatía del prematuro, lo que obliga a estudiar nuevas opciones terapéuticas. Objetivo: evaluar la eficacia de la terapia combinada láser-ranibizumab en pacientes prematuros con enfermedad umbral, preumbral y “plus”, así como alteraciones en el desarrollo infantil.

 

Material y métodos: Estudio prospectivo, experimental, longitudinal y abierto en niños prematuros menores de 32 semanas de gestación o menores de 1500 g con retinopatía en estadios umbral, preumbral o “plus”. Fueron tratados con láser de diodo y 0.3 ml de ranibizumab intravítreo. Se analizó la respuesta al tratamiento y el desarrollo infantil con la escala de Bayley.

 

Resultados: Fueron tratados 34 ojos de 17 pacientes. La edad de gestación fue de 29.9 ± 2.6 semanas y el peso al nacimiento de 1120 ± 253 g. El análisis estadístico demostró mayor relación entre severidad de retinopatía y semanas de gestación y  mayor posibilidad de desarrollar enfermedad umbral o preumbral con 29.4 semanas de gestación o peso de 1204 g. La escala de Bayley demostró desarrollo normal en 23.5%, retraso global en 23.5%, retraso psicomotriz pero mental normal en 29.4% y retraso en desarrollo mental pero psicomotriz normal en 23.5%. Hubo regresión de la retinopatía en todos los pacientes; se  observó persistencia de la tortuosidad vascular (17.6%) sin dilatación vascular y desarrollo de membranas vítreas (11.7%).

 

Conclusiones: El tratamiento láser-ranibizumab permite mayor control de la retinopatía en estadios umbral, preumbral y enfermedad “plus”.

 

 

2011

Postconceptional age at the treatment of retinopathy of prematurity in inborn and referred preterm infants from the same institution

 

Publicado en los Arquivos Braisleiros de Oftalmologia en 2011

 

Autores: João Borges Fortes Filho, Gabriela Unchalo Eckert, Fabiana Borba Valiatti, Paula Gabriela Batista dos Santos, Marlene Coelho da Costa, Renato Soibelmann Procianoy

 

ABSTRACT


Purpose: The outcomes of the treatment of retinopathy of prematurity (ROP) seem to be better in inborn patients than in those patients who were referred for ROP treatment. This study aims to investigate the timing of treatment and the outcomes in inborn patients and in patients referred for treatment to the Hospital de Clínicas de Porto Alegre, Brazil.

 

Methods: An institutional prospective cohort study was conducted from 2002 to 2010 and included in group 1 all inborn preterm neonates treated for retinopathy of prematurity and in group 2 all babies referred for treatment to the same institution. All of the included patients presented birth weight (BW) ≤1,500 g and/or gestational age (GA) ≤32 weeks. Main outcomes were postconceptional age at the treatment and one year follow-up outcomes in both groups. The considered variables were: BW, GA, stage and location of retinopathy of prematurity at treatment.

 

Results: Group 1 comprised 24 inborn patients. Mean BW and GA at birth were 918 ± 232 g and 28.2 ± 2.1 weeks, respectively, and median post-conceptional postconceptional age at treatment was 37 weeks. Group 2 comprised 14 infants transferred for treatment. Mean BW and GA at birth were 885 ± 188 g and 28.2 ± 2.4 weeks respectively, and median postconceptional age at treatment was 39 weeks. Mean BW and GA were similar in both groups (P=0.654 and P=0.949, respectively), but the difference among the postconceptional age was significant (P=0.029).


Conclusions: Inborn patients were treated for retinopathy of prematurity during the 37th week of postconceptional age while transferred patients were treated, usually, after the 39th week postconceptional age. The worst outcomes observed among referred patients could be partially explained by the delayed time for treatment.

 

2011

Factores nutricionales en la retinopatía del prematuro

 

Publicado en los Archivos Argentinos de Pediatría en 2011

 

Autores: Patricia Mena Nannig, Marcela Díaz Carnot

 

RESUMEN


La retinopatía del prematuro es una de las complicaciones de la prematurez, numerosos factores influyen en la prevalencia y la gravedad de este cuadro. Se revisan aspectos nutricionales y de crecimiento que se han asociado a mayor o menor incidencia y gravedad de la retinopatía.


Esta información puede permitir una mejor predicción del riesgo de retinopatía y un manejo clínico que contribuya a minimizar el daño visual.

 

2010

Paradoxical vascular-fibrotic reaction after intravitreal bevacizumab for retinopathy of prematurity


Publicado en el Eye en 2010


 

Authors: Luz Consuelo Zepeda-Romero, JA Liera-Garcia, Jose Alfonso Gutiérrez-Padilla, CI Valtierra-Santiago, LJ Cardenas-Lamas

 

Abstract


Retinopathy of the prematurity (ROP) is the main cause of childhood blindness in developing countries, largely because of the lack of efficient programmes for its detection and treatment. The use of antiangiogenic agents in cases of advanced ROP has been suggested even though the long-term ocular and system side effects of using these medications in premature babies are unknown.12 We report a case of advanced ROP treated with laser ablation and intravitreal injection of bevacizumab (Avastin, Genentech, San Francisco, CA USA), after which the vascular response was paradoxical with significant fibrosis and subsequent traction.

 

2010

TREATMENT OF TYPE 1 RETINOPATHY OF PREMATURITY WITH INTRAVITREAL BEVACIZUMAB (AVASTIN)

 

Publicado en Retina en 2010 

 

Treatment of type 1 retinopathy of prematurity with intravitreal bevacizumab (Avastin)

 

Autores: Paola Dorta, Andres Kychental

 

ABSTRACT

 

Purpose: To investigate the benefit of intravitreal bevacizumab as supplemental or primary treatment for retinopathy of prematurity.


Methods: The files of nine consecutive infants treated with intravitreal bevacizumab for bilateral severe posterior retinopathy of prematurity were reviewed.


Results: Gestational age was 24 weeks to 27 weeks, and birth weight was 660 g to 1,131 g. Indications for treatment were retinopathy of prematurity progression from Stage 3 to 4A or 2 to 3 with extraretinal neovascularization despite laser treatment; active neovascular Stage 4A disease after laser and cryo-treatment; anterior segment neovascularization and bleeding after laser treatment; and aggressive posterior disease with tunica vasculosa lentis and vitreous haze, which prevented laser treatment. One patient (two eyes) underwent lens-sparing vitrectomy after bevacizumab treatment; one eye acquired macular fold. One patient underwent bilateral scleral buckle. Bevacizumab treatment was associated with subsidence of the active vascular component in all eyes. Anatomical results were favorable in 17 eyes. There were no local or systemic complications.

 

Conclusion: Intravitreal bevacizumab may serve as a supplemental therapeutic agent for severe laser-refractory retinopathy of prematurity or as monotherapy when media opacities preclude diode laser photocoagulation or the patient is too sick for lengthy laser treatment.

 

2010

VITRECTOMY AFTER INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR RETINAL DETACHMENT IN RETINOPATHY OF PREMATURITY

 

Publicado en Retina en 2010

 

Autores: Andrés Kychental, Paola Dorta

 

ABSTRACT

 

Purpose: The purpose of this study was to evaluate the feasibility of performing vitrectomies after using bevacizumab (Avastin, Genentech, South San Francisco, CA) for the management of retinal detachments in retinopathy of prematurity.

 

Methods: Eleven eyes of 8 children with retinopathy of prematurity retinal detachment that developed despite peripheral ablation with indirect diode laser were injected with 0.625 mg bevacizumab. Injections were given through the pars plicata, and the status of the central retinal artery was checked with indirect ophthalmoscopy. A vitreoretinal surgery was scheduled for 1 week after the bevacizumab injection. All eyes underwent surgery using 25- or 23-gauge instrumentation. Demographic data, neovascular activity, and the anatomic status of the retina were evaluated. Systemic and local perioperative complications were recorded.

 

Results: The average gestational birth weight was 950 g, and the average gestational age at birth was 25.7 weeks. Although 9 eyes had stage 4A, 2 had stage 4B retinal detachments. Six eyes had zone II and five eyes had zone I disease. Bevacizumab was injected at an average postgestational age of 38 weeks. A notable reduction in the vascular activity could be observed 1 week later when vitrectomy was performed. With a mean follow-up of 8.5 months (range, 2–13 months), a favorable outcome could be observed in all eyes. Only one eye with persistent vitreous hemorrhage required reoperation. No complications attributable to the bevacizumab injections were noted.

 

Conclusion: These data show that vitrectomy after intravitreal bevacizumab can be effective in selected cases. The regression of the vascular activity induced by this drug might contribute to better results in some of these cases. There were no apparent short-term safety concerns for intravitreal bevacizumab injections in these babies. However, additional studies are needed to define the role of bevacizumab as a possible adjuvant in the management of retinopathy of prematurity retinal detachments.

 

2010

Tratamiento con láser por retinopatía del prematuro en 27 servicios públicos argentinos

 

Autores:  Celia C. Lomuto, Lidia Galina, Marina Brussa, Ana Quiroga, Ernesto Alda, Alicia M. Benítez, Liliana Bouzas, N. Alejandro Dinerstein, Norma Erpen, Jorgelina Falbo, Julio Manzitti, Silvia Marinaro, Ricardo Nieto, Teresa Sepúlveda, Patricia Visintín

 

Publicado en los Archivos Argentinos de Pediatría en 2010

 

RESUMEN

 

Introducción. La retinopatía del prematuro puede conducir a pérdida parcial de la visión y ceguera; la fotocoagulación con láser es el tratamiento electivo, aunque aún no está garantizado el acceso universal a él en la Argentina.

 

Objetivo. Estimar la prevalencia de niños que requirieron tratamiento con láser por retinopatía, sus características clínico-demográficas, lugar de procedencia y tratamiento.

 

Población, material y método. Estudio observacional, descriptivo, retrospectivo. Población: recién nacidos prematuros que requirieron tratamiento en servicios públicos durante 2008. Variables: peso y edad gestacional al nacer, pronóstico, casos inusuales y oportunidades perdidas. Fuente: 27 Servicios públicos de 18/24 provincias.

 

Resultados. Se registraron 235 niños tratados (Hospital Garrahan: 86; Hospital Gutiérrez: 45 y 104 en otros 25 hospitales), provenientes de 77 servicios públicos y 13 privados de 22 provincias en las que nacieron 210.720 niños. Los pacientes de la Provincia de Buenos Aires se trataron mayoritariamente en el Hospital Garrahan, todos los de la Ciudad Autónoma de Buenos Aires y 2/3 de los del resto del país lo fueron in situ. El pronóstico fue reservado en 15%, hubo 5 oportunidades perdidas y un 27% de casos inusuales.

 

Conclusión. La prevalencia de retinopatía tratada en la población estudiada fue de 1/900 nacimientos en 2008. El porcentaje de casos inusuales, pronóstico reservado y oportunidades perdidas fue alto. Es imperioso lograr un registro nacional y garantizar el acceso al tratamiento in situ.