Natural History of Retinopathy of Prematurity

Chen, Yi-Hsing; Lien, Reyin; Tsai, Shih‐Wei; Chang, Chee Jen; Lai, Chi-Chun; Chao, An-Ning; Chen, Kuan‐Jen; Hwang, Yih-Shiou; Wang, Nan-Kai; Chen, Yen‐Po; Chen, Tun-Lu; Wu, Wei‐Chi

doi:10.1097/iae.0000000000000270

Cited by 25 publications

(12 citation statements)

References 32 publications

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“…This trial, using the Simon two-stage optimal design, showed that propranolol 0.2% eye micro-drops are safe and probably effective in reducing the expected progression of ROP from stage 1 to stage 2 plus or 3 plus. In our historical group, this progression occurred in 23.7% of the infants, a value in line with incidence reported in the ETROP Cooperative Group study (25) and additional studies (26), corresponding to the 2.9% of all VLBW admitted, and in line with incidence recently reported in UK (27), while topic ocular propranolol reduced this progression rate to 12.4% (corresponding to the 1.1% of all VLBW admitted). The mean plasma propranolol levels were consistently below the cut-off value of 20 ng/mL, and the biochemical, hematologic, hemodynamic, and respiratory parameters in the treated newborns were reassuring.…”

Section: Discussionsupporting

confidence: 91%

Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study

et al. 2019

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Background: Oral propranolol reduces retinopathy of prematurity (ROP) progression, although not safely. Propranolol 0.1% eye micro-drops administered to newborns with stage 2 ROP are well-tolerated, but not sufficiently effective. Methods: A multi-center open-label trial was conducted to assess the safety and efficacy of propranolol 0.2% eye micro-drops in newborns with stage 1 ROP. The progression of the disease was evaluated with serial ophthalmologic examinations. Hemodynamic, respiratory, biochemical parameters, and propranolol plasma levels were monitored. Demographic and perinatal characteristics, co-morbidities and co-intervention incidences, together with ROP progression, were compared with a historical control group in the same centers participating in the trial. Results: Ninety-eight newborns were enrolled and compared with the historical control group. Populations were not perfectly homogeneous (as demonstrated by the differences in the Apgar score and the different incidence rate in surfactant administration and oxygen exposure). The progression to ROP stage 2 or 3 plus was significantly lower than the incidence expected on the basis of historical data (Risk Ratio 0.521, 95% CI 0.297– 0.916). No adverse effects related to propranolol were observed and the mean propranolol plasma level was significantly lower than the safety cut-off of 20 ng/mL. Unexpectedly, three newborns treated with oral propranolol before the appearance of ROP, showed a ROP that was unresponsive to propranolol eye micro-drops and required laser photocoagulation treatment. Conclusion: Propranolol 0.2% eye micro-drops were well-tolerated and appeared to reduce the ROP progression expected on the basis of a comparison with a historical control group. Propranolol administered too early appears to favor a more aggressive ROP, suggesting that a β-adrenoreceptor blockade is only useful during the proliferative phase. Further randomized placebo-controlled trials are required to confirm the current results. Clinical Trial Registration The trial was registered at ClinicalTrials.gov with Identifier NCT02504944 and with EudraCT Number 2014-005472-29.

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Section: Discussionsupporting

confidence: 91%

Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study

et al. 2019

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“…We believe that the timing for the development of prethreshold ROP in our study was later than that observed in the ETROP and CRYO-ROP studies due to the relative maturity of infants included in our study. However, there are contradictory data from other developing countries demonstrating a similar mean postmenstrual age at treatment for threshold ROP (20) or an earlier mean postmenstrual age for onset of type 1 ROP (21) as that found in developed countries.…”

Section: Dıscussıonmentioning

confidence: 77%

The Demographic and Clinical Characteristics of The Patients Treated For Type 1 Retinopathy of Prematurity in a Referral center in Turkey

Erşan¹,

Pirhan²,

Kavuncuoğlu³

et al. 2018

IKSST

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Objective: To present the demographic and clinical characteristics of patients who were treated for type 1 retinopathy of prematurity (ROP). Material and Method: The medical records of 89 premature infants who were treated in the ophthalmology department of Kanuni Sultan Suleyman Education and Research Hospital between June 2012 and March 2014 and completed a 6-month-follow-up period were evaluated retrospectively. The patients were divided into two groups as inpatients and referrals. Results: Seventeen infants were inpatients, and 72 infants were referrals. The mean gestational age (GA) and birth weight (BW) of the inpatients were significantly lower than those of referred infants (p=0.09 and p=0.024, respectively). The mean GA and BW of the inpatients with zone 1 ROPwere significantly lower than those of the referred infants (p=0.014 and p=0.048, respectively). There was no significant difference in postmenstrual age or chronological age at treatment between the inpatients and referred infants (p>0.05). No retinal detachment was observed. Conclusion: The timely application of current treatment methods is successful in resolving severe ROP. The significantly higher mean BW and GA of the referred patients compared with the inpatient infants imply that patient outcomes at level 3 referral centers may not be representative of other neonatal intensive care units.

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“…The use of supplemental oxygen in closed incubators for the preterm infants is one major cause of ROP [3]. ROP starts from an arrest of retinal vascularisation (phase 1), which is followed by later hypoxia-induced pathologic vasoproliferation (phase 2) [1–4]. It will eventually lead to a complete retinal detachment behind the lens [3].…”

Section: Introductionmentioning

confidence: 99%

Gremlin promotes retinal pigmentation epithelial (RPE) cell proliferation, migration and VEGF production via activating VEGFR2-Akt-mTORC2 signaling

et al. 2016

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Retinopathy of prematurity (ROP) is characterized by late-phase pathologic retinal vasoproliferation. Gremlin is a novel vascular endothelial growth factors (VEGF) receptor 2 (VEGFR2) agonist and promotes angiogenic response. We demonstrated that gremlin expression was significantly increased in retinas of ROP model mice, which was correlated with VEGF upregulation. In retinal pigmentation epithelial (RPE) cells, gremlin activated VEGFR2-Akt-mTORC2 (mammalian target of rapamycin complex 2) signaling, and promoted cell proliferation, migration and VEGF production. VEGFR inhibition (by SU5416) or shRNA knockdown almost abolished gremlin-mediated pleiotropic functions in RPE cells. Further, pharmacological inhibition of Akt-mTOR, or shRNA knockdown of key mTORC2 component (Rictor or Sin1) also attenuated gremlin-exerted activities in RPE cells. We conclude that gremlin promotes RPE cell proliferation, migration and VEGF production possibly via activating VEGFR2-Akt-mTORC2 signaling. Gremlin could be a novel therapeutic target of ROP or other retinal vasoproliferation diseases.

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Natural History of Retinopathy of Prematurity

Cited by 25 publications

References 32 publications

Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study

Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study

The Demographic and Clinical Characteristics of The Patients Treated For Type 1 Retinopathy of Prematurity in a Referral center in Turkey

Gremlin promotes retinal pigmentation epithelial (RPE) cell proliferation, migration and VEGF production via activating VEGFR2-Akt-mTORC2 signaling

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