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Comparison of fluorescein angiographic findings in type 1 and type 2 retinopathy of prematurity with intravitreal bevacizumab monotherapy and spontaneous regression
摘要： Purpose To investigate the extent of vascularization of the peripheral retina and vascular development patterns in patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of bevacizumab (IVB) and compare fluorescein angiography (FA) findings of them to those seen in patients with type 2 ROP who have recovered spontaneously. Methods Between May 2014 and September 2016, patients with type 1 ROP who had a single 0.025 ml (0.625 mg) IVB were evaluated as study group. On the other hand, type 2 ROP patients with stage 2 or stage 3 ROP in zone II without plus disease on indirect ophthalmoscopy were not treated and included as a control group. The progression of ROP and vascularization of retina were evaluated by FA under sedation analgesia in all patients. Results Sixty-two eyes of 31 premature infants were included in the study: 36 eyes/18 patients were treated for type 1 ROP and 26 eyes/13 patients were followed conservatively with the diagnoses of type 2 ROP. In the last FA examination among the study group, vascular terminal was in zone II in 8 eyes/4 patients (22.22%) and in zone III in 28 eyes/14 patients (77.78%). Vascular terminal was in zone III in all eyes of the control group (100%). We noted circumferential vessels in 12 eyes/8 patients (33.3%) and 7 eyes/5 patients (26.92%) in the study and control groups, respectively. Abnormal branching was noticed in 13 eyes/7 patients (46.42%) in the control group, whereas it was not detected in the study group. Arteriovenous shunts were noted in 1 eye of a patient in the study group and in 5 eyes/4 patients in the control group. In 6 eyes/3 patients among the study group, we performed laser photocoagulation to the avascular retina because of profound vascular leakage. Conclusion Peripheral vascular abnormalities probably occur as a result of ROP itself because similar FA findings were detected both in type 1 and type 2 ROP patients with or without treatment, although significantly less in IVB-treated group. Retinal vascularization usually reaches the farthermost limits with time even though it slows down in eyes treated with IVB, indicating the importance of a longer follow-up.
关键词： Fluorescein angiography,Bevacizumab,Peripheral vascular abnormalities,Retinopathy of prematurity
更新于2025-09-23 15:23:52
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Expression and significance of the Hedgehog signal transduction pathway in oxygen-induced retinal neovascularization in mice
摘要： Aim: The aim of the study was to investigate the signal transduction mechanism of Hedgehog–vascular endothelial growth factor in oxygen-induced retinopathy (OIR) and the effects of cyclopamine on OIR. Methods: An OIR model was established in C57BL/6J mice exposed to hyperoxia. Two hundred mice were randomly divided into a control group, an OIR group, an OIR-control group (treated with isometric phosphate-buffered saline by intravitreal injection), and a cyclopamine group (treated with cyclopamine by intravitreal injection), with 50 mice in each group. The retinal vascular morphology was observed using adenosine diphosphatase and number counting using hematoxylin and eosin-stained image. Quantitative real-time quantitative polymerase chain reaction was used to detect mRNA expression. Protein location and expression were evaluated using immunohistochemistry and Western blot. Results: The OIR group and OIR-control group demonstrated large-area pathological neovascularization and nonperfused area when compared with the control group (both P<0.05). The area of nonperfusion and neovascularization in the cyclopamine group was significantly reduced compared with the OIR and OIR-control groups (both P<0.05). Compared with the control group, the OIR and OIR-control groups had more vascular endothelial cells breaking through the inner limiting membrane. The number of new blood vessel endothelial cell nuclei in the cyclopamine group was significantly reduced (both P<0.05) when compared with the OIR and OIR-control groups. The mRNA and protein expressions of Smoothened, Gli1, and vascular endothelial growth factor in the signal pathway of the OIR and OIR-control groups were significantly higher than those of the control group; however, in the cyclopamine group, these factors were reduced when compared with the OIR and OIR-control groups (all P<0.05). Conclusion: Our data suggest that abnormal expression of the Hedgehog signaling pathway may be closely associated with the formation of OIR. Inhibiting the Smoothened receptor using cyclopamine could control retinal neovascularization, providing new ideas and measures for the prevention of oxygen-induced retinal neovascularization.
关键词： neovascularization,retinopathy of prematurity,oxygen-induced retinopathy,Hedgehog signaling pathway,cyclopamine
更新于2025-09-23 15:22:29
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Quantification of the Changes in the Openness of the Major Temporal Arcade in Retinal Fundus Images of Preterm Infants With Plus Disease
摘要： PURPOSE. We tested the hypothesis that the openness of the major temporal arcade (MTA) changes in the presence of plus disease, by quanti?cation via parabolic modeling of the MTA, as well as measurement of an arcade angle for comparative analysis. Such analysis could assist in the detection and treatment of progressive retinopathy of prematurity. METHODS. Digital image processing techniques were applied for the detection and modeling of the MTA via a graphical user interface (GUI) to quantify the openness of the MTA. An arcade angle measure, based on a previously proposed method, also was obtained via the GUI for comparative analysis. The statistical signi?cance of the differences between the plus and no-plus cases for each parameter was analyzed using the P value. The area (Az) under the receiver operating characteristic curve was used to assess the diagnostic performance of each feature. RESULTS. The temporal arcade angle measure and the openness parameter of the parabolic model were used to perform discrimination of plus versus no-plus cases. Using a set of 19 cases with plus and 91 with no plus disease, Az ? 0.70 was obtained using the results of dual-parabolic modeling in screening for plus disease. The arcade angle measure provided comparable results with Az ? 0.73. CONCLUSIONS. Using our proposed image analysis techniques and software, this study demonstrates, for the ?rst time to our knowledge, that the openness of the MTA decreases in the presence of plus disease.
关键词： plus disease,computer-aided diagnosis,retinopathy of prematurity,major temporal arcade,digital image analysis
更新于2025-09-23 15:22:29
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Comparison of OCT angiography in children with a history of intravitreal injection of ranibizumab versus laser photocoagulation for retinopathy of prematurity
摘要： Purpose To compare the foveal microvascular structure characteristics in children with a history of intravitreal injection of ranibizumab (IVR) versus laser photocoagulation (LP) for retinopathy of prematurity by optical coherence tomography angiography (OCTA). Methods In this cross- sectional study, a total of 17 children (28 eyes) underwent IVR and 20 children (37 eyes) underwent LP were recruited. The age of doing OCTA examination of the two groups are 5.4±1.1 years and 6.3±1.8 years, respectively (p=0.07). Spectral- domain OCTA was performed for all the eyes with a scan size of 3×3 mm. The data of the superficial retinal layer were analysed. The foveal avascular zone (FAZ) and vessel density (including vessel length density (VLD) and perfusion density (PD)) were measured using the software of OCTA (Cirrus AngioPlex 5000, Carl Zeiss, Meditec, Dubin, California, USA). The central foveal thicknesses (CFT) were measured by cross- sectional OCT. results In the central fovea, the retinal VLD and PD of patients with IVR were 13.82±2.99 mm/ mm2 and 0.25±0.05 mm2/mm2, respectively, which were significantly lower than those of the LP group (15.64±2.71 mm/mm2 and 0.28±0.05 mm2/mm2, p=0.01 and p=0.006). The FAZ area of patients with IVR and LP were 0.13±0.09 mm2 and 0.09±0.07 mm2, respectively (p=0.048). The CFT of patients with IVR and LP were 200.7±16.7 μm and 220.9±22.7 μm, respectively (p<0.01). The logarithm of the minimal angle of resolution best- corrected visual acuity of patients with IVR and LP were 0.2±0.1 and 0.1±0.1, respectively (p=0.01). There was no significant difference in the parafoveal and foveal VLD and PD, FAZ morphological index and spherical equivalent refraction (SER) between the two groups. Conclusion The IVR might contribute to microvascular changes in the macular zone, such as reducing the central foveal VLD and PD, while the LP might contribute to microstructural changes, such as smaller FAZ and thicker CFT.
关键词： intravitreal injection of ranibizumab,foveal microvascular structure,OCT angiography,laser photocoagulation,retinopathy of prematurity
更新于2025-09-23 15:21:01
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Myopia and anterior segment optical coherence tomography findings in laser-treated retinopathy of prematurity eyes
摘要： To evaluate structural features and visual outcomes in eyes with a prior history of laser treatment for retinopathy of prematurity (ROP). Laser-treated eyes for type 1 ROP, preterm monitored eyes, and full-term control eyes were included. LogMAR conversion of Snellen best-corrected visual acuity and spherical equivalent based on cycloplegic refraction were measured in children 5-15 years of age. Anterior segment optical coherence tomography (OCT) was used to study structural features, including anterior chamber angle (ACA) in a subset of eyes. A total of 50 eyes of 50 patients were included (19 full-term eyes, 19 laser-treated type 1 ROP eyes, 12 preterm monitored eyes). Of these, 44 eyes had visual outcomes data, and 15 eyes had anterior segment data. There was no significant difference in sex or age at final examination between the three groups. There was no significant difference in gestational age between the laser-treated and preterm monitored groups. Compared with the full-term control group and the preterm monitored group, the laser-treated ROP group had narrower ACA and more myopic refractive error. There was a significant correlation between ACA and spherical equivalent. Laser treatment may affect angle configuration in ROP eyes. Anterior segment OCT is an easy and useful modality that could aid in screening for visually impairing conditions such as myopia and glaucoma in children with ROP.
关键词： anterior segment OCT,retinopathy of prematurity,myopia
更新于2025-09-23 15:21:01
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Asymmetry of Retinopathy of Prematurity Border in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study
摘要： Purpose: To measure the location of the retinopathy of prematurity (ROP) border in a sample of premature infants who developed ROP and determine location for predicting subsequent development of referral-warranted ROP (RW-ROP, defined as Stage 3 ROP, zone I ROP, or plus disease) or treated ROP. Design: Secondary analysis of data from an observational cohort study, The Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study. Subjects: Infants with birth weight (BW) less than 1251g with at least one exam and image session at ≤34 weeks postmenstrual age (PMA) with ROP not meeting RW-ROP, and at least one subsequent exam at ≥36 weeks PMA. Methods: The 5-image set from the first imaging session for each eligible eye was mosaicked, and measurements of the ROP border in each mosaicked image were made using Image J. Measurements were compared among 3 groups of eyes with ROP: (1) never developed RW-ROP or received treatment, (2) developed RW-ROP but did not receive treatment, and (3) received treatment; using analysis of variance and linear trend tests that accounted for the inter-eye correlation. Main outcome measures: RW-ROP, treated ROP Results: 317 eyes from 217 infants with mean BW 755g, mean GA 25 weeks, and mean PMA 33 weeks at first exam met study criteria. Of 211 (66.6%) eyes with sufficient quality images for grading, 147 (69.7%) did not develop RW-ROP or receive treatment, 36 (17.1%) developed RW-ROP not requiring treatment, and 28 (13.3%) received treatment for ROP. Among all eyes, the disc-to-ROP border distance followed a consistent pattern, with nasal < inferior < superior < temporal. Eyes that developed RW-ROP or underwent treatment had significantly shorter nasal and temporal disc-to-ROP border distances and smaller areas of retina within the ROP border. In multivariate analysis adjusted by BW and GA, nasal ROP border distance was a significant predictor of developing treated ROP (OR=0.86 for every 10 pixel increase in distance, p=0.002). Conclusions: ROP is located asymmetrically around the optic disc and is closest to the optic disc nasally. Location of ROP nasally at first imaging is a significant predictor of developing treated ROP.
关键词： retinopathy of prematurity,ROP,asymmetry,telemedicine,optic disc
更新于2025-09-23 15:21:01
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Foveal microvasculature, refractive errors, optical biometry and their correlations in school-aged children with retinopathy of prematurity after intravitreal antivascular endothelial growth factors or laser photocoagulation
摘要： Aims To compare the differences and to assess the correlations regarding to foveal microvasculature, refractive errors and optical biometry in children with history of type 1 retinopathy of prematurity (ROP) treated with either laser photocoagulation or intravitreal injection of antivascular endothelial growth factors (anti-VEGF). Methods This is a retrospective and comparative case series. Measurements of fovea microvasculature included the retinal thickness and subfoveal choroid thickness, the size of fovea avascular zone (FAZ), the fovea, parafovea and perifoveal vessel density (VD). Measurements of refractive errors and optical biometry included spherical equivalent, astigmatism, cornea curvature, anterior chamber depth (ACD), lens thickness and axial length (AXL). Results A total 47 eyes in 25 children were studied (22 laser-treated eyes from 12 children and 25 anti-VEGF treated eyes from 13 children). Laser-treated eyes had significantly smaller FAZ (p=0.004), higher fovea VD, lower parafoveal VD (p=0.02 and 0.01 in superficial capillary plexus; p=0.05 and 0.01 in deep capillary plexus), thicker inner retinal thickness (p=0.002). Laser-treated eyes had significantly higher degree of myopia (p=0.01). Regarding to optical biometry, laser-treated eyes had significant steeper cornea curvature, shallower ACD and thicker lens (p=0.01, 0.01 and 0.02, respectively) but no differences in AXL was noted (p=0.58). Significant correlations presented between inner retina thickness and FAZ to anterior segment variables. Conclusion In school-aged children with history of type 1 ROP, despite similar visual acuity outcome, those who underwent anti-VEGF injection had favourable developmental outcomes compared with laser photocoagulation. Significant correlations exist between fovea microvasculature and optical biometric components.
关键词： laser photocoagulation,anti-VEGF,foveal microvasculature,retinopathy of prematurity,optical biometry,refractive errors
更新于2025-09-23 15:19:57
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Serum VEGF and Ang-2 Levels in Infants Before and After Laser Treatment for Retinopathy of Prematurity
摘要： Objectives: To investigate VEGF and Ang-2 level changes in the systemic circulation after laser photocoagulation in premature infants with ROP. Methods: Eleven infants (4 girls and 7 boys) had serum levels determined for VEGF and Ang-2, collected 1 day prior to and 7 days after ROP laser therapy. Serum levels of VEGF and Ang-2 were quantified by enzyme-linked immunosorbent assay (ELISA). Results: Serum VEGF levels were significantly lower at 7 days after laser therapy compared to that at 1 day prior to laser therapy (p ? 0.045). Serum Ang-2 levels increased significantly at 7 days after laser therapy compared with that at 1 day prior to laser therapy (p ? 0.046). Conclusions: Serum VEGF levels in patients with ROP were suppressed and Ang-2 levels elevated significantly after laser therapy. The results suggest that changes in VEGF and Ang-2 serum levels may reflect regression and treatment of ROP.
关键词： angiopoietin 2,premature infants,serum levels,Retinopathy of prematurity,vascular endothelial growth factor
更新于2025-09-23 15:19:57
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Inadequate laser coagulation is an important cause of treatment failure in Type 1 retinopathy of prematurity
摘要： Purpose of the study: To examine the cause of treatment failures in Type 1 retinopathy of prematurity (ROP). Patients and Methods: The medical charts of all infants with disease persistence after laser treatment at Uppsala University Hospital, Sweden, during a 10-year period (2009–2019) were reviewed. RetCam photography and angiography were used to document the retinal appearance before and after retreatment. Results: Ten infants (18 eyes), of whom nine were referred from other hospitals, had persistence of Type 1 ROP in zone I or zone II despite previous laser treatment. Their mean gestational age was 24 weeks and their mean birth weight was 618 g. Seven eyes were diagnosed as stage 3 plus, eight eyes as stage 4A and three eyes as stage 4B. In eight infants (14 eyes), inadequate laser coagulation was suspected to be the cause for persistence of type 1 disease. Two infants (four eyes) were appreciated to have persistence of plus disease because of presence of zone I disease. For persistence of Type 1 ROP, ?ve infants (seven eyes) were treated with vitrectomy, two infants (three eyes) with laser photocoagulation and anti-vascular endothelial growth factor (VEGF), two infants (four eyes) with anti-VEGF alone and ?nally two infants (four eyes) with laser photocoagulation alone. The anatomical outcome was good in 14 eyes and poor in four eyes (three infants). Conclusions: Inadequate laser coagulation is an important cause of treatment failure of ROP Type 1. Another cause is laser coagulation in zone I. To minimize remaining visual disability, some kind of centralization of the ROP treatment is suggested.
关键词： treatment failure,retinopathy of prematurity,laser coagulation,anti-VEGF
更新于2025-09-19 17:13:59
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RATES AND RISK FACTORS FOR RECURRENCE OF RETINOPATHY OF PREMATURITY AFTER LASER OR INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY
摘要： To determine the rates and risk factors of recurrent retinopathy of prematurity (ROP) treated by laser photocoagulation, intravitreal bevacizumab (IVB) monotherapy, or intravitreal ranibizumab (IVR) monotherapy. In this retrospective cohort study, consecutive infants with Type 1 ROP who received laser, IVB, or IVR treatments were followed for at least 75 weeks of postmenstrual age. Data analysis was performed between March 2010 and February 2017 in Chang Gung Memorial Hospital, Linkou, Taiwan. A total of 176 infants (340 eyes) were included in this study. The mean follow-up was 197.3 ± 110 weeks. All of the baseline demographic and ROP characteristics among the laser, IVB, and IVR groups were similar. The overall recurrence rate after treatment was 44 of 340 eyes (12.9%). The IVB group had a recurrence rate of 10.0%, followed by the laser group (18.0%) and the IVR group (20.8%); however, these rates were not signi?cantly different (P = 0.0528). Compared with the laser group, the IVB and IVR groups exhibited recurrence at later ages (43.4 ± 3.5 weeks for the IVB group, 42.3 ± 2.0 weeks for the IVR group, and 39.5 ± 2.8 weeks for the laser group; P = 0.0058). The mean interval of recurrence from initial treatment in the laser group was 3.6 ± 1.4 weeks compared with 8.8 ± 3.9 weeks and 8.3 ± 1.6 weeks in the IVB and IVR groups, respectively (P = 0.0001). Overall, the independent risk factors of recurrence included an early postmenstrual age at initial treatment (P = 0.0160), Zone I (P = 0.0007), low Apgar score (P = 0.0297), and multiple births (P = 0.0285). There was no signi?cant difference in progression to retinal detachment among the three groups (laser: 3/61, 4.9%; IVB: 2/231, 0.9%;and IVR: 1/48, 2.1%; P = 0.2701). Laser, IVR, and IVB are effective for Type 1 ROP. Retinopathy of prematurity recurrence requiring re-treatment was encountered as late as 50 weeks of postmenstrual age after IVB or IVR but earlier after laser. Longer follow-up for infants treated with anti–vascular endothelial growth factor is needed, especially in patients with signi?cant risk factors such as an early postmenstrual age at initial treatment, Zone I ROP, low Apgar score, and multiple births.
关键词： ranibizumab,risk factors,bevacizumab,rates,laser,anti-VEGF,recurrent retinopathy of prematurity
更新于2025-09-12 10:27:22