Characteristic clinical features associated with aggressive posterior retinopathy of prematurity

Ahn, Ye Jin; Hong, Kyung Euy; Yum, Hae Ri; Lee, J H; Kim, K S; Youn, You-Sook; Park, S H

doi:10.1038/eye.2017.18

Cited by 40 publications

(36 citation statements)

References 35 publications

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“…That the fetal inflammatory response induced by CA might specifically influence the development of the fetal retina is a biologically plausible hypothesis. It has been suggested that multiple hits of antenatal and postnatal infection/inflammation are involved in ROP etiology and progression [ 16 , 28 , 93 , 94 ]. Proinflammatory cytokines may exert a direct effect on retinal angiogenesis or sensitize the developing retina to the effects of postnatal oxygen, or other stressors.…”

Section: Discussionmentioning

confidence: 99%

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Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis

et al. 2018

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The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CA-exposed group was significantly associated with a higher risk of ROP. Meta-analyses of studies with data adjusted for confounders could not find a significant association between CA and ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.

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Section: Discussionmentioning

confidence: 99%

“…Of note, our meta-analysis could not demonstrate that CA was a significant risk factor for ROP stage 1–2 ( Fig 4 ). Recent clinical data suggest that infection/inflammation mechanisms are mainly related to the more advanced stages of ROP, particularly the so-termed aggressive posterior ROP (APROP) [ 28 , 93 ].…”

Section: Discussionmentioning

confidence: 99%

Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis

et al. 2018

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“…That the fetal inflammatory response induced by CA might specifically influence the development of the fetal retina is a biologically plausible hypothesis. It has been suggested that multiple hits of antenatal and postnatal infection/inflammation are involved in ROP etiology and progression [15,27,90,91]. Retinal vascular development occurs while the fetus is in the uterus in a relatively hypoxic environment.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, our meta-analysis could not demonstrate that CA was a significant risk factor for ROP stage 1-2 (Fig 4). Recent clinical data suggest that infection/inflammation mechanisms are mainly related to the more advanced stages of ROP, particularly the so-termed aggressive posterior ROP (APROP) [27,90].…”

Section: Discussionmentioning

confidence: 99%

Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Villamor-Martínez

Cavallaro

Raffaeli

et al. 2018

Preprint

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The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) is difficult to establish, because CA-exposed and CA-unexposed infants frequently present different baseline characteristics. We performed an updated systematic review and meta-analysis of studies reporting on the association between CA and ROP. We searched PubMed and EMBASE for relevant articles. Studies were included if they examined preterm or very low birth weight (VLBW, <1500g) infants and reported primary data that could be used to measure the association between exposure to CA and the presence of ROP. Of 748 potentially relevant studies, 50 studies met the inclusion criteria (38,986 infants, 9,258 CA cases). Meta-analysis showed a significant positive association between CA and any stage ROP (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.74). CA was also associated with severe (stage ≥3) ROP (OR 1.63, 95% CI 1.41 to 1.89). Exposure to funisitis was associated with a higher risk of ROP than exposure to CA in the absence of funisitis. Additional meta-analyses showed that infants exposed to CA had lower gestational age (GA) and lower birth weight (BW). Meta-regression showed that lower GA and BW in the CAexposed group was significantly associated with a higher risk of ROP. In conclusion, our study confirms that CA is a risk factor for developing ROP. However, part of the effects of CA on the pathogenesis of ROP may be mediated by the role of CA as an etiological factor for very preterm birth.

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“…The gestational age (GA), BW, hyperoxia and systemic inflammation are important factors that may increase the risk of APROP. The mean GA and BW of infants with APROP were significantly lower than those of infants with non-APROP in a previous study [ 13 ]. Moreover, compared with infants with non-APROP, infants with APROP required heavier laser treatment and exhibited a higher retreatment rate.…”

Section: Introductionmentioning

confidence: 61%

Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab

et al. 2018

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BackgroundThis study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment.MethodsThis was a retrospective study. A total of 83 preterm infants (160 eyes) diagnosed with APROP who were primarily treated with IVR were included. The 160 eyes were divided into two groups based on the anatomic outcomes. Group A included 35 eyes that developed retinal detachment, and Group B included 125 eyes without retinal detachment. The following patient factors were retrospectively reviewed: gender, gestational age (GA), birth weight (BW), postmenstrual age (PMA) at first treatment, iris neovascularizations, retinal hemorrhage, neutrophil and lymphocyte counts before the first intravitreal injection, neutrophil-to-lymphocyte ratio (NLR), anatomical outcomes, additional treatment and follow-up time. Three dummy variables were created as dependent variables based on the methods of retreatment. The possible risk factors for APROP were evaluated, and statistical analyses included univariate and multivariate logistic regression.ResultsA total of 160 eyes from 83 preterm infants (56 males and 27 females) underwent initial IVR treatment with a follow-up time of 17.17 ± 10.54 months. Thirty-five of the 160 (21.9%) eyes progressed to retinal detachment, and 82 of the 125 (65.6%) non-retinal detachment eyes needed retreatment, with favorable anatomical outcomes. The disease improved approximately 1.5 ± 1.2 weeks after the first IVR treatment. The mean recurrence period of APROP was approximately 7.5 ± 6.9 weeks after the first IVR treatment. Multiple logistic regression analysis revealed postmenstrual age (P < 0.001) and neutrophil count (P = 0.009) as the most significant factors for retinal detachment in APROP. Retinal hemorrhage (P = 0.007) and BW (P = 0.04) were most significantly associated with APROP recurrence and retreatment.ConclusionsIVR injection is an effective treatment for APROP. In this study, older postmenstrual age and low neutrophil count were identified as risk factors for retinal detachment in APROP. In addition, retinal hemorrhage and low BW were significantly associated with recurrence and retreatment in non-retinal detachment APROP. Thus, patients with a lower BW, older postmenstrual age, low neutrophil count and retinal hemorrhage should be reexamined in a timely and more frequent manner.

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Characteristic clinical features associated with aggressive posterior retinopathy of prematurity

Cited by 40 publications

References 35 publications

Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis

Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis

Chorioamnionitis as a risk factor for retinopathy of prematurity: an updated systematic review and meta-analysis

Outcomes and prognostic factors for aggressive posterior retinopathy of prematurity following initial treatment with intravitreal ranibizumab

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