ObjectiveTo detect the development of retinal neovascularization (NV) induced by metabolic acidosis in neonatal rats and investigate the relationship between the occurrence of NV and vascular endothelial growth factor (VEGF). MethodsA total of 425 newborn Sprague-Dawley rats in experimental group underwent tubal feeding of NH4Cl (535 mg/kg) with the concentration of (50 mg/ml) (twice per day) from the 2nd day after the birth for 6 days and followed by a period of recovery. Additional 150 neonatal rats were in the control group without the tubal feeding. The rats were executed at the 3rd, 5th, 8th, 10th, 13th, 20th day after birth respectively. The retinal vessels were evaluated through retinal stretched preparation andadenosine diphosphatase (ADPase) staining; VEGF in retina was detected by enzymelinked immunosorbent assay(ELISA).ResultsIn the experimental group, the incidence of retinal NV at the 3rd, 5th, 8th, 10th, 13th, 20th day after birth was 0%，9%，26%，55%，19%, and 0% respectively. At the 3rd day, the expression of VEGF protein was lower in experimental group ［（101.1±14.2 ）pg/mg］ than that in the control group ［（133.2±15.9） pg/mg］（P＝0.004）, while at the 8th day it was higher in experimental group［(98.4±19.2) pg/mg］than that in the control group［（78.1±8.7） pg/mg］（P=0.028). There was no significant difference between the two groups at the 5th, 10th, 13th, and 20th day (Pgt;0.05). ConclusionsMetabolic acidosis may induce NV by injuring the developing retinal vessels. Retinal NV induced by acidosis relates to VEGF. (Chin J Ocul Fundus Dis, 2005,21:296-299)
ObjectiveTo observe and analyze the correlation between erythrocyte count and hemoglobin level in early life and retinopathy of prematurity (ROP). MethodsA clinical retrospective study. From January 2020 to December 2022, a total of 303 premature infants, who underwent fundus screening in Children's Hospital of Henan Province were included. There were 219 males and 84 females, with the average gestational age of (30.36±1.52) weeks and the average birth weight of (1 368.43±171.37) g. Early life was defined as 14 days after birth. According to the screening results, patients were divided into ROP group and no ROP group (control group). The results of red blood cell count, hematocrit and hemoglobin concentration of the two groups were compared and observed on the 3rd, 7th and 14th day after birth. The measurement data were compared by t-test, and the count data were compared by χ2 test. The risk factors of ROP were analyzed by logistic regression. The correlation between red blood cell count as well as hemoglobin concentration in early life and ROP was analyzed by receiver operating characteristics (ROC) curve. ResultsAmong the 303 premature infants screened, a total of 101 preterm infants were included in the ROP group, with the average gestational age of (30.39±1.48) weeks. And a total of 202 preterm infants were included in the control group, with the average gestational age of (30.35±1.55) weeks. There was no significant difference between the two groups in sex composition ratio (χ2=0.296) and gestational age (t=0.251) (P＞0.05). There were significant differences in birth weight (t=－2.024), blood transfusion times (U=－4.957), invasive mechanical ventilation duration (U=－2.215) and continuous positive airway pressure ventilation time (U=－5.224) between the two groups (P＜0.05). The incidence of periventricular leukomalacia (χ2=5.069), bronchopulmonary dysplasia (χ2=9.794) and sepsis (χ2=8.041) were significantly different (P＜0.05). The average hemoglobin level of patients in the ROP group on the 3rd, 7th and 14th day after birth were lower than those in the control group (t=－3.813, －2.753, －2.847; P＜0.05). Logistic regression analysis showed that low frequency of blood transfusion [odds ratio (OR)=1.241, 95% confidence interval (CI) 1.016-1.517] and short duration of continuous positive airway pressure (OR=1.128, 95%CI 1.031-1.234) were protective factors for ROP. The ROC curve analysis indicated that the abnormal threshold values of hematocrit and hemoglobin were the highest on the 14th day after birth, which were 115.5 g/L and 36.25% respectively. The sensitivities were 88.1% and 83.2%, respectively. ConclusionRed blood cell count and hemoglobin level in early life of preterm infants may have a certain correlation with the occurrence and development of ROP.
Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation. Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group. There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group, with an average age of (7.0±1.28) years. The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks, the birth weight (BW) of (1402.33±369.61) g and the number of laser burns was (517.86±277.40). The control group included 7 females (13 eyes) and 6 males (12 eyes), with an average age of (7.17±0.96) years. The age (t=0.691) and gender (χ2=1.425) were comparable between the two groups (P=0.491, 0.233). The data of patients and controls were retrospectively analyzed including best corrected visual acuity, refractive examination, automated perimetry test. The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed. ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB), mild VF loss group (MD≤6 dB) and moderate VF loss group (MD＞6 dB) according to the results of automated perimetry test, the differences of gestational age (GA), PA, BW, number of laser burns and SE between these groups were comparatively observed. Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27±3.34 dB, respectively; the difference between the two groups was statistically significant (t=–4.01,P＜0.001). The subgroup analysis showed that BW, number of laser burns, and SE were significantly different between no VF loss group and VF loss group (t=2.074, –1.996, –2.162;P=0.042, 0.026, 0.034); while the GA was not significantly different between these two groups (t=1.973,P=0.052). The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002). For refractive outcomes, the BW and ROP stage correlated with SE significantly (r=–0.304, –0.387;P=0.015, 0.002). The mean BCVA in ROP group was 0.84±0.23, and 59 eyes (91.2%) with BCVA better than 0.5. Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss, with good visual outcome.
In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti-VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti-VEGF therapy for zoneⅡ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc.
Objective To determine the incidence of and risk fact ors for retino pathy of prematurity (ROP) among preterm infants in Beijing after implementation of the ROP guidelines. Methods The preterm infants with birth weight le; 2000 g or gestational age le; 3 4 weeks who were admitted to the neonatal intensive care units in 6 hospitals in Beijing from Jan. 1, 2005 to Dec. 31, 2005 were screened. Ophthalmologic examin ations started 3-4 weeks after birth and ROP was classified by the revised Inte r national Classification. Maternal and perinatal risk factors of occurrence of R OP were analyzed. Results In the 639 infants who had been scre ened in the 6 ho spitals, ROP was detected in 69 (10.8%), in whom 23 infants (39 eyes) (3.6%) had type 1 ROP and underwent photocoagulation. The lower the birth weight and small er the gestational age was, the higher the incidence of ROP was. Logistic regres sion analysis indicated that low birth weight, apnea gt;20 seconds, anemia, hypoxic-ischemic encephalopathy and placenta abruption were the high risk factor of R O P.Conclusion In Beijing the incidence of ROP is 10.8% after i mplementation of the ROP guidelines. Low birth weight, apnea gt;20 seconds, anemia, hypoxicischem ic encephalopathy and placenta abruption were the high risk factor of ROP.
Objective To observe the therapeutic efficacy and postoperative complications of combined surgery and sequential surgery in treating proliferative diabetic retinopathy (PDR) and cataract. Methods The cilinical data of 59 patients (66 eyes) with PDR were retrospectively analyzed. The patients were divided into combinedsurgery group and sequential surgery group. Combined surgery was performed on patients with obvious lens opacity which was an obstacle to the ocular fundus surgery, while sequential surgery was performed on the patients with transparent lens or lens with light opacity on which ocular fundus surgery could be performed. Lens excision in cataractopoiesis could only be performed when the state of ocular fundus was stable and cataractopoiesis was the main cause of vision damage. A total of 28 patients (32 eyes) in combinedsurgery group underwent vitrectomy combined with phacoemulsification and IOL implantation; 31 patients (34 eyes ) in sequentialsurgery group underwent vitrectomy, lens excision and IOL implantation. Corrected visual acuity (BCVA) and complications were observed. The mean followup period was (25plusmn;8.5) months. The measurement data were analyzed with t test and enumeration data with 2 test. Results In combinedsurgery group, visual acuity improvement was achieved in 27 eyes （84.4%）, remained unchanged in 2 eyes （6.3%）and decreased in 3 eyes （9.4%）. In sequentialsurgery group, visual acuity improved in 26 eyes （76.5%）, remained unchanged in 2 eyes（5.8%）and decreased in 6 eyes（17.7%.）. However, anterior chamber fibrin exudation occurred in 4 eyes in the combinedsurgery group and no eyes in the sequentialsurgery group; compared with each other, the difference is statistically significant (chi;2=4.524，P=0.033). Conclusion Combined surgery and sequential surgery are all safe and effective on treating PDR and postoperative complications have no obvious correlation with the surgery procedure.
ObjectiveTo evaluate the characteristics of electroretinagram (EGR) in children with history of pre-threshold or threshold retinopathy of prematurity (ROP). MethodsA total of 24 children (48 eyes) with history of pre-threshold ROP or threshold ROP received F-ERG examination.Ten age and body weight-matched children with a history of premature birth (20 eyes) but without ROP were recruited as control group. The rod response, maximal rod-cone response and cone response of F-ERG were recorded respectively following the International Standard Protocal of ISCEV (2000 version).The latency and amplitude of a-wave and b-wave of various responses were analyzed. The trial was approved by the Ethic Committee of Hunan Children's Hospital and informed consent was obtained from the parents of patients prior to any medical procedure. ResultsThere was significant difference between ROP and control group in rod response,the latency was longer (t=5.643,P<0.05) and the amplitude was lower in ROP group(t=7.068,P<0.05).In maximal rod-cone response both in a and b wave, the latency wave was longer(t=3.099, 2.886;P<0.05) and the amplitude was lower(t=5.614, 2.850;P<0.05) in ROP group. But there is no difference between ROP and control group in cone response latency(t=0.819, 0.948)and amplitude(t=0.904, 0.850). ConclusionERG in ROP children with history of pre-threshold or threshold ROP is abnormal, which mainly in rod response,but the cone response remains normal.
ObjectiveTo observe the morphologic characteristics of color Doppler flow imaging (CDFI) and blood stream in patients with retinopathy of prematurity, and provide the new clinical diagnostic gist.MethodsCDFI was performed on 78 patients (156 eyes) with ROP at Ⅳ and Ⅴ stage, who had the diseases history such as prematurity and low birthweight which had been diagnosed by indirect ophthalmoscope, underwent the examination of CDFI. Morphologic characteristics of the results of CDFI and features of blood flow of the pathological changes were observed. ResultsIn the patients with ROP at the Ⅳ stage, a weak zonal echo originated from one side of peripheral wall of eye ball in the vitreous body, and extended to the echo of post pole and wall of eye ball and joined the echo of optic disc. In the patients with ROP at the V stage, lumplike echo connected closely with echo of lens and the circumambience was surrounded; the focus looked like lotus when combined with retinal detachment: the swelled “corona” wrapped and tightly connected with the lens, and the thin “caulis” showed weak zonal echo which attached to the optic disc. The features of blood flow showed the signal of blood stream connected with central retinal artery at the “caulis”, which was analyzed by Doppler spectrum as the bloodflow spectrum of artery and vein in the same direction which was the same as the central retinal artery and vein.ConclusionsIn patients with ROP at the IV and V stage, the results of CDFI mainly shows zonal or lumplike echo, in which the bloodflow signal extended with central retinal artery could be seen. The morphological changes of CDFI and the features of blood flow are useful in diagnosis of ROP. (Chin J Ocul Fundus Dis, 2005,21:282-284)
Objective To observe the clinical therapeutic effect of v itrectomy with closed triple incisions on stage 4 or 5 retinopathy of prematurity (ROP). Methods The clinical data of 32 eyes of 26 infants with stage 4 or 5 ROP who un derwent vitrectomy with closed triple incisions from Jan. 2003 to Jan. 2007 were retrospectively analyzed. The 26 infants included 18 males and 8 females, with the gestational age of 27－35 weeks (average 29.4 weeks) and the birth weight of 960－2200 g (average 1434.6 g). The age at the operation was 50-705 days with t he average of 158.3 days. In these 32 eyes, stage 5 ROP was in 13, stage 4 ROP was in 19 (stage 4A in 10 and 4B in 9) in which 11 eyes underwent indirectophthal m oscope photocoagulation because of threshold and type 1 prethreshold ROP and 1 eye underwent cryotherapy again with the disease developing into stage 4 or 5. T he entrance of vitrectomy was closed triple incisions. The lens were saved in 11 eyes and removed in 21 eyes. The followup duration was 2-24 months and the c ondition of retinal reattachment was observed. Results The procedures of operative therapies on 26 affected infants ran smooth. In the 19 eyes at stage 4 ROP, the retina reattached completely in 10 at stage 4A (100%), in which macular traction at optic disc was in 3, remained proliferative membran e in front of the optic disc, in front of the nasal retina and at the peripheral area of the temporal side was found in 4, few vitreous hemorrhage after the ope ration was in 1 which was absorbed 2 weeks later, and cataract after the operati on was in 1; in 9 eyes at stage 4B, retina reattached completely in 6 (66.7%), m acular traction at optic disc was in 1, and retina remained detached in 3 with v itreous hemorrhage after the operation including 2 eyes with anterior chamber he morrhage. In 13 eyes at stage 5, retinal reattached completely in 3 (23.1%) in w hich scars in the peripheral retina, thin retinal vessels and pale optic disc wa s found in 2 and retinal rumple at the temporal side was found in 1; retina reat tached mostly in 1 eye (7.7%) with retinal proliferative membrane and slight re t inal detachment at the nasal side; retina remained detached in 7 eyes. Conclusion Vitrectomy with closed triple incisions for stage 4 ROP may lead the retina l reattachment effectively, but the therapeutic effect is not good on the infant s with stage 5 ROP.
Objective To explore the effect of oxygen inhalation on the retinae of newborn rats and its mechanism.Methods We mimicked the retinopathy of prematurity(ROP) by putting the newborn rats in high concentrated oxygen. One-day old rats were put into the oxygen box with the oxygen concentration of 80% for continuous 7 days; then in air condition for 7 days. The arterial blood oxygen pressure, retinal superoxide dismutase (SOD), and malondialdehyde (MDA) of the rats (1,2,4,7,8,9,11,14 days old) were examined. The diameter of retinal vessels′main branch and the coverage rate of peripheral vessels were measured in 7- and 14-day-old rats by ink perfusion. The retinal neovascularization of rats (8,9,11, 14 days old) were observed by HE staining. The rats of the same age fed in air condition were in the control group.Results The differential pressures of blood oxygen of rats (1,2,4,7 days old) in study group were significantly higher than those in the control group (P＜0.01), while the differential pressures of blood oxygen of rats (8,9,11,14 days old) in study group were lower than those in the control group (P＞0.05). The contents of SOD of the retinae in the rats ( 1,2,4,7,8 days old) were significantly lower than those in the control group(P＜0.01, P＜0.05 ), while the contents of MDA were significantly higher than those in the control group (P＜0.01,P＜0.05). The diameter of retinal vessels′main branch in 7-day rats was 75% of the control group, and the coverage rate of peripheral vessels was 22% of the control group; and was 61% and 73% respectively in 14-day-old rats. The neovascularization could be seen in 16.7% of the rats in the study group and nought in the control group.Conclusion The damage of free radical of the retina in high concentrated oxygen and hypoxia situation after oxygen supply may be one of the most important mechanism of ROP. (Chin J Ocul Fundus Dis，2003，19：269-332)