• Clinical and Experimental Pediatrics
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• v.65 no.3
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• pp.115-126
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• 2022

Retinopathy of prematurity (ROP) is among the most common causes of childhood blindness. Three phases of ROP epidemics have been observed worldwide since ROP was first described in the 1940s. Despite advances in neonatal care, the occurrence of ROP and associated visual impairment has been increasing somewhere on Earth and remains difficult to control. Conventional treatment options for preventing ROP progression include retinal ablation using cryotherapy or laser therapy. With the emergence of anti-vascular endothelial growth factor (anti-VEGF) treatment for ocular diseases, the efficacy and safety of anti-VEGF therapy for ROP have recently been actively discussed. In the advanced stage of ROP with retinal detachment, surgical treatment including scleral buckling or vitrectomy is needed to maintain or induce retinal attachment. At this stage, the visual outcome is usually poor despite successful anatomical retinal attachment. Therefore, preventing ROP progression by timely screening examinations and treatment remains the most important part of ROP management.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.22-27
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• 2009

Retinopathy of prematurity (ROP) is a major cause of blindness that affects premature infants. With advances in neonatology, ROP is likely to emerge as the most serious problem of vision loss in children even in developed countries; such a situation could be called the third epidemic of ROP. However, controversy and uncertainty still surround favorable outcomes of ROP. For successfully controlling ROP, timely and accurate screening is crucial because early treatment leads to favorable outcomes. Standard guidelines, including ROP classification, have provided satisfactory instructions for the screening and treatment of ROP. To improve the structural and functional outcomes of ROP, optimizing the timing of surgical interventions including cryotherapy, laser-photocoagulation, encircling, and vitrectomy is essential; these interventions can prevent the sequelae of ROP. It is essential for the neonatologist and the ophthalmologist to cooperate extensively for the successful treatment of ROP.

• Neonatal Medicine
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• v.28 no.1
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• pp.7-13
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• 2021

Purpose: To evaluate the risk factors and effects of fluctuations in oxygen saturation on the occurrence and severity of retinopathy of prematurity (ROP). Methods: From January 1, 2013 to January 31, 2020, 260 patients hospitalized in the neonatal intensive care unit of Ajou University Hospital were retrospectively analyzed. Results: Sixty-six patients (25%) were diagnosed with ROP; of them 39 required treatment. In the multivariate regression analysis of ROP severity, the odds ratio (OR) of gestational age was 0.32 (95% confidence interval [CI], 0.22 to 0.47; P<0.0001). The OR of saturation of peripheral oxygen (SpO₂) fluctuations at the 4th week after birth was 1.02 (95% CI, 1.02 to 1.12; P=0.041). Conclusion: SpO₂ fluctuations in premature infants younger than 30 weeks' gestational age affects ROP severity, especially at the 4th week of life.

• Clinical and Experimental Pediatrics
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• v.58 no.2
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• pp.52-59
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• 2015

Purpose: This study aimed to investigate the relative weight gain at 2-week intervals up to 6 weeks after birth to predict retinopathy of prematurity (ROP) requiring treatment among very low birth weight infants. Methods: A total of 211 preterm infants with birth weights <1,500 g and gestational age <32 weeks were retrospectively reviewed. The main outcome was the development of ROP requiring treatment. Body weight measurements were recorded daily. Relative weight gains (g/kg/day) were calculated at the second, fourth, and sixth week after birth. Results: Of the 211 infants, 89 developed ROP, of which 41 spontaneously regressed and 48 with early treatment of ROP type I required laser treatment. The relative weight gain at 2, 4, and 6 weeks postnatal age was significantly lower in infants with ROP requiring treatment than in infants without ROP or those with spontaneous regression (P<0.001, P=0.005, and P=0.004, respectively). On logistic regression, poor relative weight gain in the first 2 weeks was found to be related to ROP requiring treatment (adjusted odds ratio, 0.809; 95% confidence interval, 0.695-0.941; P=0.006). Relative weight gain at 2 weeks postnatal age was significantly lower in infants with ROP requiring treatment compared to that in ROP requiring no treatment (P=0.012). Conclusion: Poor postnatal weight gain in the first 2 weeks of life is an important and independent risk factor for ROP requiring treatment. Postnatal weight gain can predict the development of severe ROP requiring treatment.

• Child Health Nursing Research
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• v.25 no.3
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• pp.255-261
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• 2019

Purpose: This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods: Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n=15), or distilled water (n=16), 2 minutes before an eye examination. Their pain score, pulse rate, and oxygen saturation were measured at three time points: 5 minutes before the examination, 30 seconds after speculum introduction, and 2 minutes after the examination. Results: The infants' mean gestational age and weight at birth were $33.1{\pm}2.1$ weeks and $1,842{\pm}470g$, respectively. There were no between-group differences in pain relief during the eye examination. The pain score significantly increased both during (p<.001) and after the examinations (p=.003). Oxygen saturation decreased during the examinations (p<.001); however, the infants in the 24% sucrose group showed higher oxygen saturation (p=.047) during the examinations than the infants in the other groups. Conclusion: Sucking on a pacifier dipped in human milk or 24% sucrose did not reduce the pain associated with eye examinations in preterm infants. Pacifiers dipped in sucrose can be used to maintain better oxygen saturation during these examinations.

• 제어로봇시스템학회:학술대회논문집
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• 2004.08a
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• pp.312-316
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• 2004

The paper presents a technique to identify the boundary of the optic disc in infant retinal digital images using an approach based on active contours (snakes). The technique can be used to be develop a automate system in order to help the ophthalmologist's diagnosis the retinopathy of prematurity (ROP) disease which may occurred on preterm infant,. The optic disc detection is one of the fundamental step which could help to create an automate diagnose system for the doctors we use a new kind of active contour (snake) method has been developed by Chenyang et. al. [1], based on a new type of external force field, called gradient vector flow, or GVF. GVF is computed as a diffusion of the gradient vectors of a gray-level or binary edge map derived from the image. The testing results on a set of infant retinal ROP images verify the effectiveness of the proposed methods. We show that GVF has a large capture range and it's able to move snakes into boundary concavities of optic disc and finally the optic disk boundary was determined.

• 제어로봇시스템학회:학술대회논문집
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• 2004.08a
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• pp.321-325
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• 2004

Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. It can be characterized by inappropriate and disorganized vessel. This paper present a method for blood vessel detection on infant retinal images. The algorithm is designed to detect the retinal vessels. The proposed method applies a Lapalacian of Gaussian as a step-edge detector based on the second-order directional derivative to identify locations of the edge of vessels with zero crossings. The procedure allows parameters computation in a fixed number of operations independent of kernel size. This method is composed of four steps : grayscale conversion, edge detection based on LOG, noise removal by adaptive Wiener filter & median filter, and Otsu's global thresholding. The algorithm has been tested on twenty infant retinal images. In cooperation with the Digital Imaging Research Centre, Kingston University, London and Department of Opthalmology, Imperial College London who supplied all the images used in this project. The algorithm has done well to detect small thin vessels, which are of interest in clinical practice.

• Molecules and Cells
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• v.41 no.8
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• pp.771-780
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• 2018

Angiogenesis must be precisely controlled because uncontrolled angiogenesis is involved in aggravation of disease symptoms. Vascular endothelial growth factor (VEGF)/VEGF receptor 2 (VEGFR-2) signaling is a key pathway leading to angiogenic responses in vascular endothelial cells (ECs). Therefore, targeting VEGF/VEGFR-2 signaling may be effective at modulating angiogenesis to alleviate various disease symptoms. Oleanolic acid was verified as a VEGFR-2 binding chemical from anticancer herbs with similar binding affinity as a reference drug in the Protein Data Bank (PDB) entry 3CJG of model A coordination. Oleanolic acid effectively inhibited VEGF-induced VEGFR-2 activation and angiogenesis in HUVECs without cytotoxicity. We also verified that oleanolic acid inhibits in vivo angiogenesis during the development and the course of the retinopathy of prematurity (ROP) model in the mouse retina. Taken together, our results suggest a potential therapeutic benefit of oleanolic acid for inhibiting angiogenesis in proangiogenic diseases, including retinopathy.

• Korean Journal of Ophthalmology
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• v.32 no.6
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• pp.451-458
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• 2018

Purpose: To investigate the efficacy, safety, and anatomical outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) treatment of retinopathy of prematurity (ROP). Methods: We performed a retrospective review of intravitreal anti-VEGF (bevacizumab or ranibizumab) treatment of 153 eyes (83 infants) diagnosed with ROP at two tertiary hospitals from June 2011 to January 2017. The primary outcome was the rate of recurrence requiring additional treatment; secondary outcomes included incidence of major complications and final refractive error. Results: A total of 101 eyes were treated with bevacizumab, and 52 with ranibizumab. The bevacizumab and ranibizumab groups were characterized by mean birthweights of $941.8{\pm}296.1$ and $1,257.7{\pm}514.5g$, gestational ages at birth of $26.9{\pm}1.9$ and $28.1{\pm}3.2$ weeks, and postmenstrual ages at treatment of $40.4{\pm}2.4$ and $39.2{\pm}2.3$ weeks, respectively. The two groups differed significantly in birthweights and gestational ages at birth, but not in postmenstrual ages at treatment. The mean follow-up duration was $30.9{\pm}18.4$ months for the bevacizumab group, and $13.9{\pm}12.5$ months for ranibizumab. More cases were classified as zone 1 ROP in the ranibizumab group (44.2% vs. 11.9%, p < 0.001). Major surgical interventions included scleral encircling and vitrectomy (one and two eyes, respectively, both in the bevacizumab group). Retinal detachment was noted in one eye treated with bevacizumab. There was no significant difference in the most recent spherical equivalence for the two groups ($+0.10{\pm}3.66$ and $+0.22{\pm}3.00$ diopters for bevacizumab and ranibizumab, respectively). Univariable analysis revealed that only ROP stage influenced the occurrence of major complications (odds ratio, 9.046; p = 0.012). Conclusions: Intravitreal anti-VEGF treatment of ROP with both bevacizumab and ranibizumab achieved stable retinal vascularization with a low rate of complications and recurrence. Ranibizumab achieved similar anatomical outcomes as bevacizumab, without additional risk for major complications.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.50-55
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• 2009

Purpose : This study aimed to determine the influence of low-dose oxygen ($FiO_2$ <25%) therapy through nasal cannulae on the progress and prognosis of retinopathy of prematurity (ROP) as well as methods of preventing ROP. Methods : Our subjects comprised premature infants (gestation period <37 weeks; birth weight <1,750 g) born in Daegu Fatima Hospital between February 1, 2001 and January 31, 2006. We retrospectively reviewed and analyzed the medical records of 273 patients who were available for eye examination and follow up over 6 months. Results : The factors maximally influencing the occurrence of ROP were low gestation age and low birth weight. We observed that the incidence of ROP increased with the increasing duration of low-dose oxygen therapy. ROP onset was delayed during ongoing oxygen therapy; however, rapid progression of ROP occurred after the discontinuation of oxygen therapy among premature infants up to the prethreshold stage. Conclusion : To prevent of occurrence of severe ROP and its rapid progression, the period of low-dose oxygen therapy needs to be shortened. Moreover, frequent eye examinations should be performed after the discontinuation of oxygen therapy.