Purpose: To analyze the weekly rate of retinal vascular growth in treatment-naïve babies with various stages of retinopathy of prematurity (ROP) and validate if this could be a predictor of treatment need. Methods: Retrospective review of medical charts and retinal images of babies with various stages of ROP. The images were enhanced using red-green image enhancement software. Using the length of the horizontal disc diameter (DD) of each eye, the vessel growth was measured from the disc margin up to the vessel tip in fixed quadrants. The rate of vessel growth was the ratio of vessel length to the number of weeks it took to reach this length. The babies were divided into treatment warranting ROP (group 1), low-risk pre-threshold (type II) ROP (group 2,), and no-ROP (group 3) for analysis. The “no-ROP” group acted as normal control. Group 1 was further subdivided into 1A (threshold ROP), IB (aggressive posterior ROP), 1C (hybrid ROP), and ID (high-risk pre-threshold ROP). Results: Out of 436 eyes, groups 1, 2, and 3 had 238, 108, and 90 eyes, respectively. The mean rate of vascular outgrowth along with 95% confidence interval (CI) was 0.490 [0.487,0.520], 0.612 [0.599, 0.638], and 0.719 [0.703, 0.740] DD/week, respectively, for babies with “treatment warranting,” “low risk pre-threshold” and “no ROP” groups, respectively. In our estimate, more than 80% of eyes with a vessel growth rate of 0.54 DD/week or less required treatment Conclusion: A rate of retinal vascular growth less than 0.54 DD/week can be used to determine treatment requirements in babies with ROP.
Purpose: To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India. Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible. Results: In the given period, 222 babies were examined versus 624 in the preceding year ( P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti-VEGF) injection was more often used than in the previous year ( n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care. Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.
Objective To report the demographic profile,clinical characteristics, and outcomes of retinopathy of prematurity (ROP) in Zone I posterior. Methods In a partly retrospective (ten years) and partly prospective (one year) study, we analyzed the demographic profile, clinical characteristics, treatment type, recurrences, and outcomes of babies with ROP in Zone I posterior. Results The study included 130 eyes of 67 infants with a mean gestational age and birth weight of 29.3 (± 2.2) weeks and 1217.3 (± 381.9) grams, respectively. All babies had received unblended oxygen with a poor weight gain in the majority.The ROP subtypes included aggressive,threshold, hybrid, stage 4, and atypical type in 78, 20, 11, 15, and 6 eyes, respectively. Fibrovascular proliferation when present,was prominent nasally, occasionally overriding the disc margin. Extensive arteriovenous tortuosity was more prominent than vascular dilatation. Atypical observations included bleb-like detachment(n = 6 eyes), candle wax-like preretinal deposits (n = 23 eyes), and large arteriovenous shunts (n = 9eyes). Primary treatment included intravitreal anti-VEGF in 119 eyes and laser in 11 eyes. Among those with follow-upfor more than 6 months, the recurrence was seen in 48.3% (n = 29) of eyes with anti-VEGF; with additional laser treatment, the outcome was favorable in 90.5% (n = 116) of eyes. Conclusions Zone I posterior ROP has a distinct profile with several atypical characteristics; it differsfrom ROP in other zones. Primary anti-VEGF treatment is beneficial but inadequate; most babies need additional laser or surgery.Improved neonatal care, earlier screening, and a combination of intravitreal anti-VEGF and laser are recommended.
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