Objective To investigate the incidence of retinopathy of prematuri ty (ROP) in the area of Shanghai, and to provide the preliminary data for the ev aluation of present criteria for ROP screening. Methods Record s of 289 prematur e infants who had undergone ROP screening from the four NICU in Shanghai between February 2004 and January 2005 were analyzed. Screening criteria included prete rm infants or low birth weight (LBW) infants with BW of 2000g or less. The first examination starts at 4 to 6 weeks chronologic age or 32 weeks post conceptual age. Results In the 289 screened infants, 19 had developed acu te ROP. There we re 3 threshold ROP, 7 prethreshold ROP and 9 developed ROP less than prethreshol d. The incidence of ROP was 6.6%. According to the British recommended guideline s（BWle;1500 g or GAle;31 weeks）, only 119 out of 289 needed screening and one ca se of stage 1 ROP was missed; the incidence of ROP was 15.1% (18/119). When lowered sc reening criteria to the American guidelines（BWle;1500g or GAle;28 weeks）, t here were only 83 infants needed screening, and we missed 2 stage 1 and 1 prethreshold ROP and the incidence of ROP was 19.3% (16/83). Conclusions The i ncidence of ROP i s 6.6% according to our study. It is lower than other reports and it has somethi ng to do with our present screening guideline. Further epidemiological data are needed to modify the guideline accordingly.
ObjectiveTo analyze the regulative rule of mRNA of vascular endothelial growth factor (VEGF) in mice with oxygen-induced retinopathy, and to elucidate the possible mechanism of occurrence of neovascularization in retinopathy of prematurity (ROP).MethodsSixty 7-day-old C57BL/6J mice were divided into oxygen-induced retinopathy group and control group. In oxygen-induced retinopathy group, 36 mice were exposed to 75% oxygen for 5 days and then to room air for 5 days; in control group, 24 mice were raised in room air. Vascular perfusion of fluorescein and retinal stretched preparation were used to observe the morphologic changes of retinal vessels. Reversal transcriptionpolymerase chain reaction (RT-PCR) was used to observe changes of VEGF mRNA in each group. ResultsIn oxygen-induced retinopathy group, the morphologic characteristics of retinal vessels were the unperfused area at the center of superficial and deepseated vessels, and the neovascularization appeared at mid-peripheral retina after 2 days in relative hypoxia condition. The results of RT-PCR showed space-time corresponding relation between expression of VEGF and neovascularization, which meant that the transcription of VEGF mRNA decreased in hyperxia conditionand increased in relative hypoxia condition. ConclusionHypoxia is the main reason of occurrence of retinal neovascularization; increased expression of VEGF caused by relative hypoxia after hyperxia might be effective in reducing the occurrence of neovascularization in ROP.(Chin J Ocul Fundus Dis, 2005,21:292-295)
ObjectiveTo screen compounds or drugs can affect the hypoxia induced-gene expression of retinal vascular endothelial cell based on gene expression microarrays and connectivity map (CMAP) technology. MethodsTotally 326 up-regulated and down-regulated genes of hypoxic human embryonic retinal microvascular endothelial cells minduced by cobalt chloride in the previous study were converted into query signature format documents. Gene profile of the disease characteristics was then compared with that of control in CMAP website database, positive and negative compounds related to retinopathy of prematurity (ROP) were finally screened out. Results44 and 18 compounds or drugs have positive and negative relationship with ROP respectively by searching CMAP database with differentially expressed genes. Ciclopirox, cobalt chloride, gossypol and withaferin A have positive relationship with ROP. Cyclic adenosine monophosphate, harmalol, naringin and probenecid have a negative effect on ROP. ConclusionsCiclopirox, cobalt chloride, gossypol and withaferin A have a positive effect on ROP. However, cyclic adenosine monophosphate, harmalol, naringin and probenecid have a negative effect.
Objective To investigate the effect of inducible nitric oxide synth ase (iNOS) or cyclooxygenase－2 (COX－2) on retinal neovascularization and its possible mechanism in oxygen－induced retinopathy （OIR） mouse model. Methods Retinal neovascularization was induced by oxygen with different concentration. The expression of iNOS, COX－2, matrix metalloproteinases 2 (MMP－2) and vascular end othelial growth factor (VEGF) in the retinae of experimental animals were analyzed by immunohistochemistry, realtime polymerase chain reaction and western blotting technologies. Results The inhibition of COX－2 or iNOS obviously attenuated retinal neovascularization and decreased the expression of VEGF and MMP－2. The iNOS inhibition decreased COX－2 expression, and vice versa. Conclusions COX－2 and iNOS may play a role in retinal neovascularization in OIR mouse model, which may act by regulating the expression of VEGF and MMP－2.
ObjectiveTo observe clinical outcomes of laser photocoagulation on retinopathy of prematurity (ROP). MethodsClinical data of 64 cases of ROP infants (127 eyes) were studied retrospectively. Fifteen infants (30 eyes) were diagnosed of pre-threshold ROP (type Ⅰ, 23.6%) and 49 cases (97 eyes) of threshold ROP (76.4%). All the eyes underwent photocoagulation through binocular indirect ophthalmoscope (532 nm or 810 nm) within 72 hours after the confirmation ROP. In all the 15 cases (30 eyes) of pre-threshold ROP (type Ⅰ), 6 of them (12 eyes) were photocoagulated by laser of 532 nm, and the other 9 ones (18 eyes) were treated with 810 nm. In 49 threshold ROP infants (97 eyes), 37 cases (73 eyes) and 12 ones (24 eyes) were treated with laser of 532 nm or 810 nm respectively. All the infants were followed up 12-36 months (18.4 months) since photocoagulation to investigate regression of ROP. All the data of ROP infants photocoagulated, such as recovery rate of one-time photocoagulation, repeat rate, unfavorable outcomes, and complications, were analyzed statistically according to the severity of ROP and wave length of laser employed. ResultsIn all the 127 photocoagulation treated eyes, ROP regressed completely in 125 eyes (98.4%), temporal retinal traction remained in 2 eyes (1.6%), and no retinal detachment was found. ROP regressed completely in 118 eyes (92.9%) after one-time photocoagulation, recovered totally in 6 eyes (4.7%) after repeating photocoagulation 2-3 times, and resorted to cryotherapy in 3 eyes (2.4%). Subconjunctiva hemorrhage, found in 12 eyes (9.4%), was the most common complication. During photocoagulation, anesthetic accident occurred in 1 infant (1.6%), and 1 eye developed cataract (0.8%). It was suggested from statistical analysis that there was no significant difference on efficiency or safety between pre-threshold (type Ⅰ) and threshold ROP photocoagulated by laser of 532 nm or 810 nm. However, almost all of the ROP infants need repeat photocoagulation or additional cryotherapy, and patients with unfavorable outcomes or severe complications, occurred in threshold ROP treated with 532 nm laser. ConclusionPhotocoagulation with 532 nm or 810 nm laser is effective for type Ⅰ pre-threshold or threshold ROP.
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.