Linda A. Cernichiaro-Espinosa

Comparison of iridocorneal angle in infants with retinopathy of prematurity and healthy infants using spectral domain optical coherence tomography.

PURPOSEnTo compare measurements and morphologic characteristics of the iridocorneal angle in preterm infants with retinopathy of prematurity (ROP) and healthy infants using spectral domain optical coherence tomography (SD-OCT).nnnMETHODSnIn this observational, case-control study, the eyes of children with ROP and healthy controls under 1 year old were imaged using SD-OCT without sedation to capture the iridocorneal angle. The ROP staging was made by a pediatric retinal specialist. The following measurements were analyzed with custom software: angle opening distance (AOD500) at 500 μm; angle opening in degrees (AOG); and angle recess area (ARA750).nnnRESULTSnA total of 27 eyes of 14 children with ROP and 21 of 13 children without ROP were included. The mean gestational age of children in the ROP group was 30 weeks; of the controls, 35 weeks. The mean birth weight in the ROP group was 1,545 g; in the non-ROP group 2,100 g. Mean age at the time of the study was 18.1 (ROP group) vs 25.7 weeks (non-ROP). In the ROP group AOD500 was 477 μm (95% CI, 358-597 μm), AOG was 37.3° (95% CI, 30.4°-44.3°), and ARA750 was 231 mm(2) (CI 95%, 171-291 mm(2)). The same parameters on the non-ROP group were 400 μm (CI 95% 333-468 μm), 34.7° (CI 95% 30.4°-39°), and 203 mm(2) (95% CI, 171-236 mm(2)). The iris showed a more convex pattern on eyes with ROP (56% vs 23%).nnnCONCLUSIONSnIn this study cohort, children with ROP showed higher AOD500, AOG, and ARA750, perhaps because of different patterns of physiological development in children with ROP.

New insights in diagnosis and treatment for Retinopathy of Prematurity

AbstractnThe purpose of this study was to review current perspectives on diagnosis and treatment of Retinopathy of Prematurity (ROP). We performed a systematic review of how much has been produced in research published online and on print regarding ROP in different settings around the world. Early Treatment for ROP (ETROP) classification is the currently accepted classification of ROP. Fluorescein angiography and spectral domain optical coherence tomography (SD-OCT) may eventually lead to changes in the definition of ROP, and as a consequence, they will serve as a guide for treatment. Intravitreal anti-VEGF therapy has proven to be more effective in terms of lowering recurrence, allowing growth of the peripheral retina, and diminishing the incidence of retinal detachment when proliferative ROP is diagnosed. Whether anti-VEGF plus laser are better than any of these therapies separately remains a subject of discussion. Telemedicine is evolving everyday to allow access to remote areas that do not count with a retina specialist for treatment. A management algorithm is proposed according to our reference center experience. ROP is an evolving subject, with a vulnerable population of study that, once treated with good results, leads to a reduction in visual disability and in consequence, in a lifetime improvement.

Management of Retinopathy of Prematurity--Use of Anti-VEGF Therapy

Abstract: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Although laser photocoagulation remains the gold standard for treating threshold and prethreshold disease (type 1 ROP), the off‐label use of anti‐vascular endothelial growth factor (anti‐VEGF) therapy to treat ROP is increasing. Benefits include acute regression of ROP, growth of retinal vasculature beyond the demarcation line, lesser degree of myopia and peripheral visual field loss, and avoidance of sedation and intubation required for laser. However, controversies regarding anti‐VEGF in this vulnerable population persist including choice of anti‐VEGF agent, dosing, systemic absorption, safety, and late recurrence. This review updates recent evidence regarding the use of anti‐VEGF therapy in the management of ROP.

Vascular changes on fluorescein angiography of premature infants with low risk of retinopathy of prematurity after high oxygen exposure.

PurposeTo describe a wide array of peripheral vascular changes using fluorescein angiography in preterm neonates, without high risk characteristics for developing retinopathy of prematurity, that were exposed to high oxygen concentration.MethodsRetrospective, two center, case series. Newborns at two different hospitals with ≥1500xa0g or gestational age of ≥32xa0weeks, fluorescein angiography performed, and with high oxygen exposure without adequate control were included.Results294 infants diagnosed with ROP were analyzed. Only 28 eyes from 14 patients with peripheral vascular abnormalities in older and heavier babies were included. Two distinct type of peripheral vascular changes were observed: group 1 or non-proliferative: areas of capillary non-perfusion along with widespread arteriovenous shunting between adjacent primary vessels, tortuosity of primary vessels, abnormal budding of tertiary vessels and capillaries, abnormal capillary tufts and absence of foveal avascular zone; group 2 or proliferative: all of the characteristics of group 1 plus leakage of dye from the boundary between perfused and non-perfused retina and/or optic disc.ConclusionPeripheral vascular abnormalities different from retinopathy of prematurity are observed in older than 32xa0weeks of gestational age, and heavier than 1500xa0g babies. This makes the authors classify these patients as having a disease caused solely by oxygen dysregulation at the neonatal intensive care unit similarly to the oxygen induced retinopathy in experimental studies.

Peripheral Vascular Abnormalities Seen by Ultra-Widefield Fluorescein Angiography in Adults With History of Prematurity: Report of Three Cases

Retinopathy of prematurity (ROP) may lead to late-developing complications due to the abnormal vitreoretinal interface. In this case report, three adult patients (ages 39 years, 62 years, and 64 years) with a history of prematurity underwent imaging with ultra-widefield fluorescein angiography (UWFFA). The UWFFA demonstrated late peripheral vascular hyperfluorescence in all three patients, perivascular leakage in two of the patients, hyperfluorescent foveal avascular zone in two of the patients, peripheral avascular retina in two of the patients, vasoproliferative tumor in one of the patients, peripheral neovascularization in one of the patients, and vascular anastomosis in one of the patients. Descriptive analysis of the images is reported. The authors concluded UWFFA reveals details in adults with history of ROP that may gain importance during the follow-up or in the surgical management of these patients; however, prospective studies are needed. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:278-283.].

Subretinal Cysticercosis Extraction With Bimanual, 3-D, Heads–Up-Assisted Pars Plana Vitrectomy: Clinicopathological Correlation and Surgical Technique

A 16-year-old male presented with blurred vision in the right eye after recent travel to Nicaragua. Funduscopic examination revealed subretinal cysticercosis superior to the optic nerve. The cyst was drained and excised using a bimanual, three-dimensional, heads-up-assisted pars plana vitrectomy without complications. Technical maneuvers for cyst extraction along with clinicopathological correlation are described. Postoperatively, the patient exhibits no signs of recurrence and has excellent vision. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:708-711.].

Imaging Modalities in Pediatric Vitreoretinal Disorders

Purpose of ReviewThis review updates current applications of novel imaging technologies to pediatric vitreoretinal disorders.Recent FindingsUltra-widefield technology has revolutionized retinal imaging in pediatric patients. Color imaging, fluorescein angiography, autofluorescence, and optical coherence tomograpy (OCT) have all been adapted to capture the anterior segment and the posterior pole in children, and serve as valuable tools in diagnosis, management, and documentation of disease processes over time. The role of intraoperative OCT and 3D heads-up visualization technologies continues to evolve with improvement in intraoperative visualization and surgical outcomes.SummaryNew imaging technologies have the ability to improve our understanding and management of pediatric vitreoretinal disorders.