Association of platelet deficiency with severe retinopathy of prematurity: a review

Abstract

Aim The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data. Methods A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually. Results There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen‐induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity. Conclusion Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.

Preterm Assessment at Birth and Its Association With the Development of Retinopathy of Prematurity (ROP): A Tertiary Care Center Experience

“…Our study showed no significance between platelet count and the development of ROP in either eye. This goes against a review by Seliniotaki et al, which concluded that platelet deficiency was associated with severe forms of ROP [26]. This conflict in results between our study and others in the literature might be due to the fact that the majority of thrombocytopenic neonates who were included in our study had mild platelet deficiency.…”

Retinopathy of prematurity: Metabolic risk factors

“…In the same study, retinal VEGF-A expression was found to be induced with platelet depletion and decreased with platelet transfusion and that clinically, platelet deficiency is associated with severe ROP ( Cakir et al, 2018 ). Other studies have also shown this association ( Jensen et al, 2018 ; Parrozzani et al, 2021 ; Şahinoğlu Keşkek et al, 2020 ; Seliniotaki et al, 2022 ). A hospital based prospective study found that platelet transfusion protects against ROP development ( Faheem et al, 2021 ).…”

Is thrombocytopenia and postnatal weight gain associated with treatment‐requiring retinopathy of prematurity? A matched case–control study

“…In a retrospective case–control study, (Korkmaz et al, 2018) no differences in median PLT during ROP phase 1 (first 10 days of life) or ROP phase 2 (PMA ≥ 32 weeks for infants with GA < 27 weeks, PMA ≥ 33 weeks for infants with GA 27–29 weeks, PMA ≥ 34 weeks for infants with GA > 30 weeks) were found between cases and controls, while higher median PMI was ascertained in cases compared with controls during ROP phase 2, as opposed to our study. However, the above definitions of ROP phases are not widely accepted, and it is not clarified whether single PLT/PMI measurements or averaged values of multiple measurements were analysed (Hellström et al, 2013; Seliniotaki et al, 2022).…”

“…These parameters could be included into a prognostic model for increasing the specificity of the applied ROP screening criteria. However, existing studies assessing platelet parameters present significant clinical heterogeneity and methodological limitations (Seliniotaki et al, 2022). Furthermore, prediction models incorporating postnatal weight gain, as a surrogate measure of IGF‐1, have been developed in high‐income countries and cannot be extrapolated to other populations without further validation (Athikarisamy et al, 2021).…”