Objective To observe the systemic inhalation anesthetic effects of preterm children with different gestational ages under ocular fundus examination, and to assess its safety. Methods Fifty-one preterm children with retinopathy of prematurity (ROP) were included in the study. These kids were divided into 2 groups, group Ⅰ included 24 kids with a corrected gestational age of 33 to ＜44 weeks, and group Ⅱ included 27 kids with a corrected gestational age of 44 to 64 weeks. The preterm months were same (t=-1.3.P＞0.05), but the body weights were different (t=-10.5.P＜0.05) between these two groups. Anesthesia was induced by inhalation of 6% sevoflurane, and the period from the beginning of inhalation to disappearance of body movement was the induction time. 6% sevoflurane was inhaled continuously for another period of the induction time, and then the concentration of sevoflurane was adjusted to a maintenance concentration. The initial maintenance concentration was 3%, and was adjusted by 0.5% each time. Sequential method was used to determine the subsequent maintenance concentration. If the preceding patient had not moved during the maintenance period, the sevoflurane concentration was decreased by 0.5% for the next patient. If the preceding patient had moved during the maintenance period, the sevoflurane concentration was increased by 0.5% for the next patient. Respiratory depression and cough during the induction and maintenance period, duration of anesthesia and recovery time were recorded. Choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination were also recorded. Results The effective inhale concentration in 50% patient of sevoflurane was 2.5% in group Ⅰ, 2.9% in group Ⅱ. The average maintenance concentration was (2.5plusmn;0.5)% in group Ⅰ, (3.0plusmn;0.5)% in group Ⅱ. The difference was statistically significant (t=-3.3.P＜0.05). The average duration of anesthesia and the average awake time were the same (t=0.04 and -1.0 respectively.P＞0.05) between these two groups. The average induction time was significantly shorter in group Ⅰ than in group Ⅱ, the difference was statistically significant (t=-4.9.P＜0.05). All patients were successfully completed the ocular examination. No respiratory depression or cough occurred during and after the examination. No choking and vomiting during drinking or milkfeeding in one hour after the ocular fundus examination. Conclusion Anesthesia with inhaled sevoflurane by a face mask is safe for preterm outpatients undergoing fundus examination.
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 characteristics of images of ocular fundus obtained by computer-assisted imaging system of binocular indirect ophthalmosco p y (CABIO) in the healthy premature infants and the ones with retinopathy of prem aturity(ROP), and evaluate the value of the clinical practice of CABIO in ROP s creening. Methods From January, 2006 to December, 2006, we exa mined 150 prematur e infants in ROP screening procedure by using the computerassisted imaging sys t em of binocular indirect ophthalmoscope, beginning at the infantsprime;age of postn a tal 4-6 weeks or the corrected age above 32 weeks. The follow-up duration was co nfirmed according to the first examination results. The procedure of the operati on was recorded and the typical pictures were shot to obtain the images of the o cular fundus of the healthy premature infants and the ones with ROP. The charact eristics of the images were retrospectively analyzed and compared. Resu lts The typical images of normal ocular fundus and that with ROP in the 150 premature i nfants were successfully obtained by indirect ophthalmoscope. In normal fundus o f infants, the color of optic disc was pale, peripheral retina was not completel y vascularized and presented gray-tone in color;while all stages of ROP present ed dif ferent appearances under the indirect ophthalmoscope. Conclusions Computer-ass isted imaging system of the binocular indirect ophthalmoscopy can clearly observ e the characteristics of normal ocular fundus of premature infants and the ocula r fundus with ROP, and can save the objective examination results, which may pro vide significant references in screening and treating ROP.
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.
Objective To learn the screening results of retinopathy o f prematur ity (ROP) of the preterm infants in three hospitals in Shenzhen. Metho ds From Jan. 2004 to Jan. 2007, 1372 preterm infants (2744 eyes) with birth weight lt;200 0 g or but the ones having severe systemic disease in Shenzhen People's Hospita l, Shenzhen Maternity and Child Healthcare Hospital and Shenzhen Eye Hospital we re screened for ROP with binocular indirect ophthalmoscope and (or) widefield digital pediatric retinal imaging system (RetCamII). Cryotherapy or laser photoco agulation was performed if threshold or pre-threshold type I ROP was found. All preterm infants were followed up until retina is completely vascularized or the disease regressed. Results In all the infants, 218 cases (436 eyes) (15.9％) developed ROP, including 190 eyes (6.9％) suffering from threshold or pre-threshold type 1 ROP, 16 eyes (0.6％) from stage 4 or stage 5, and 230 eyes (8.4％) from stages below threshold or pre-threshold type 1 ROP. There were 435 infants ( 870 eyes) (31.7%) with BW of 1500g or less, in which 236 eyes (27.1％) developed ROP, including 126 eyes (14.5％) suffering from threshold or pre-threshold type 1 ROP, 10 eyes (1.1％) from stage 4 or stage 5, and 100 eyes (11.5％) from stages below threshold or pre-threshold type 1 ROP. There were 137 infants 274 eyes (10%) with BW of 1250g or less, in which 108 eyes (39.4％) developed ROP, including 60 eyes (21.9％) suffering from th reshold or pre-threshold type 1 ROP, 4 eyes (1.4％) from stage 4 or stage 5, and 44 eyes (16％) from stages below threshold or pre-threshold type 1 ROP. Th eincidence of ROP（chi;2=60.43，Plt;0.001）, the incidence of threshold or pre-threshold type 1 ROP（chi;2=46.82，Plt;0.001）and the incidence of below threshold or pre-threshold type 1 ROP （chi;2=10.71，P=0.005）among the total group, BWle;1500g group and BWle;1250g group had statistical differences. Conclusions The incidence of ROP in the three hospitals in Shenzhen was lower. However, the incidence of severe ROP (threshold or pre-threshold type 1 ROP) was higher. Birth weight is an important factor to affect ROP incidence.
Objective To investigate the degree of retinal development in preterm infants.MethodsFlash electroretinography (ERG) was performed on 25 healthy preterm infants and 25 full-term ones, and the response of rod cells and cone cells and maximal mixed responses were recorded. The delitescence and amplitudes of a-and b-waves and the ratio of amplitudes of b-/a-wave of maximal responses were analyzed. ResultsCompared with the full-term infants, The delitescence of responses of rod cells in preterm infants was statistically longer（t=11.007，P=0.000）but without any significant changes of amplitudes （t=1.836，P=0.069）; statistically longer delitescence (t=2.44, P=0.010; t=10.800, P=0.000) and lower amplitude (t=5804，P=0.000; t=5.809,P=0.000) of a-and b-wave of maximal response were found in preterm infants group. In the response of cone cells, there were significant differences of the delitescence （t=4.444，P=0.000）and amplitude （t=3.819，P=0.000）of a-wave and delitescence of b-wave（t=2.850，P=0.005） between the two groups, and no statistical difference of amplitude of b-wave （t=0.486，P=0.628） between the two groups. The ratio of amplitudes of b-/a-wave of the maximal mixed response was not significantly different between the two groups （t=1.142，P=0.256）.ConclusionsThe development of retinal function is slower in preterm infants than that in full-term ones.(Chin J Ocul Fundus Dis, 2005,21:285-287)
ObjectiveTo analysis the fundus characteristics of fundus fluorescein angiography (FFA) of retinopathy of prematurity (ROP). MethodsEighty-four cases (168 eyes) who were diagnosed with ROP by a binocular indirect ophthalmoscope were included in the study. Among the 84 cases, there were 2 cases (4 eyes) of stage 1 ROP, 26 cases (52 eyes) of stage 2 ROP, 40 cases (80 eyes) of stage 3 ROP, 4 cases (8 eyes) of stage 4 ROP, and 4 cases (8 eyes) of stage 5 ROP, 9 cases (18 eyes) of plus disease, 8 cases (16 eyes) of aggressive posterior ROP (APROP). All infants received FFA with RetCam Ⅱ under general anesthesia and mydriasis. The retinal vein morphology, capillary filling state, neovascularization morphology and fluorescein leakage were observed. ResultsFFA revealed increased branching, expansion and tortuous peripheral retinal capillaries, increased capillary permeability with a small amount of fluorescein leakage in stage 1 ROP. There was a clear dividing line between the vascular area and the remote avascular area. In stage 2, the peripheral branches of temporal retinal blood vessels increased, and parallel distributed like a broom. The capillary end anastomosed with each other to form a loop. The fibrous tissues at the lesion edge proliferated as a ridge, with popcorn phenomenon. In stage 3, the ridge continued broadening, and the neovascular fibrous membrane formed breakthrough internal limiting membrane, stretched into the vitreous with a lot of fluorescein leakage. The ridge and remote avascular zone demarcated clearly. In stage 4 and 5, the vessel changes had similar phenomenon with the stage 2 and 3 in undetached retina, but the vessels in the detached retina expanded with fluorescein leakage. As for plus disease, the retinal arterioles in the posterior pole were tortuous, there were a large number of non-perfusion area in the peripheral retina with hemorrhage and obscured fluorescence. The retinal vessels in posterior pole in AP-ROP were also tortuous, and the capillaries were extreme expanded, while there were very few tortuous vessels and no capillary formation in the other part of retina.At the avascular zone boundaries, there were a large group of neovascularization with fluorescein leakage. ConclusionsThe demarcation line separating the avascular from the vascularized retinal regions is formed in stage 1, 2 and 3, and the amount of fluorescein leakage gradually increase from stage 1 to stage 3 ROP. The detached retina of stage 4 and stage 5 has an unclear focal length in the FFA. The plus disease mainly has arteriolar tortuosity in the posterior pole retina. In the AP-ROP cases, both of the arterioles and venules in posterior pole of retina are tortuous and expanding with neovascularization leakage of fluorescein.
ObjectiveTo retrospectively analyze incidence and trends of retinopathy of prematurity (ROP) from 2004 to 2013 in Shenzhen. MethodsA total of 9100 preterm children (5401 males, 3699 females) were screened for ROP in Shenzhen from January 2004 to June 2013 using binocular ophthalmoscope or RetCam Ⅱ. First examination was performed from 4-6 weeks after birth. The birth weight was 520-2990 g with an average of (1710±410) g.The gestational age were 24-36 weeks with an average of (31.57±1.99) weeks. The gestational age of 208 children were <28 weeks, 3608 children were 28-32 weeks, 3553 children was 33-34 weeks, 1731 children was >34 weeks. The ocular findings were recorded according to the International Classification of ROP and The Early Treatment for ROP. Only the more aggressive eye of bilateral asymmetrical cases was counted for statistical purpose, and the cases required surgeries were defined as severe cases. The 10 years period was divided into first phase (2004-2008) and second phase (2009-2013). The incidence of ROP and severe ROP of these two phases was compared and statistics was analyzed. ResultsIn the past 10 years, the overall incidence of ROP and sever ROP in Shenzhen was 12.49% and 4.99% in this screen. The children were divided into 4 groups according to the birth weight, the ROP incidences of birth weight <1000 g, 1000-1499 g, 1500-1999 g and ≥2000 g were 62.62%, 28.40%, 11.34% and 3.63% respectively. The severe ROP incidences were 34.95%, 12.21%, 3.73% and 0.49% respectively in these birth weight groups. The children were divided into 4 groups according to gestational weeks, the ROP incidences of gestational age <28 weeks, 28-32 weeks, 33-34 weeks and >34 weeks were 67.31%, 25.27%, 7.22% and 3.87% respectively. Severe ROP incidences were 37.02%, 10.71%, 1.79% and 0.68% in these gestational age groups respectively. ROP and severe ROP incidences were decreased from 14.64% at first phase to 11.47% at second phase, and from 6.52% at first phase to 4.26% second phase respectively, the differences were statistical significant (χ2=26.96, 26.61; P<0.05). ROP and severe ROP incidence in <1000 g birth weight group at second phase were much less than the first phase (χ2=13.676, 5.271; P<0.05). In <28 weeks gestational age group, the ROP incidence was the same in first phase and second phase (χ2=0.843, P>0.05), but the severe ROP incidence at second phase was much less the first phase (χ2=4.757,P<0.05). ConclusionFrom 2004 to 2013, the incidences of ROP and severe ROP have decreased significantly in Shenzhen.