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Author(s): Feiler, Daniel L; Browne, Andrew W; Rachitskaya, Aleksandra V; Taban, Mehran; Sonnie, Christine; Hayden-Loreck, Brandy C; Sharma, Sumit; Sears, Jonathan E

Importance The Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) demonstrated that static low oxygen saturation decreased retinopathy of prematurity (ROP) but increased mortality compared with static high oxygen saturation cohorts. Objective To compare outcomes of a biphasic oxygen protocol with static targets recommended by SUPPORT. Design, Setting, and Participants Retrospective cohort study comparing biphasic vs static standards 41 months prior to and 42 months after a change from biphasic to static SUPPORT standards at a level III neonatal intensive care unit (Fairview Hospital, Cleveland, Ohio). The study included infants born at a corrected gestational age (CGA) of 31 weeks or younger or birth weight 1500 g or less. Data were analyzed between August 2010 and July 2017. Interventions The pre-SUPPORT group underwent biphasic protocol target saturations of 85% to 92% at younger than 34 weeks’ CGA and greater than 95% at 34 weeks’ CGA or older. The post-SUPPORT group underwent a constant 91% to 95% target. Main Outcomes and Measures Primary outcome was incidence of type 1 ROP. Secondary outcomes were incidence of any ROP, time to full vascularization, and mortality. Results Of 596 eligible infants, 562 were included in ophthalmic analysis. Three hundred three patients were boys (54%); 399 were white (71%), 87 were black (15%), and 76 were of other or unknown race/ethnicity (14%). Mean (SD) CGA and birth weight were 29 (2) weeks and 1151 (346) g, respectively. Any ROP overall increased (53 [20%] pre-SUPPORT vs n = 86 [28%] post-SUPPORT; absolute difference, 8%; 95% CI, 1%-15%; odds ratio, 1.6; 95% CI, 1.05-2.3;P = .03). Type 1 ROP increased in the post-SUPPORT era (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; odds ratio, 2.7; 95% CI, 1.05-6.9;P = .03). There was a delay in vascularization in the post-SUPPORT group (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%;P = .03). Conclusions and Relevance Compared with static oxygen standards, biphasic oxygen targets are associated with decreased incidence and severity of ROP without increasing mortality.

Familial exudative vitreoretinopathy (FEVR) can often present with retinal falciform folds, and rarely with retrolenticular adhesive radial retinal folds. Management of advanced FEVR-associated tractional falciform folds with retrolenticular adhesion to the peripheral retina in the literature has been limited to vitrectomy with or without lensectomy. The authors describe a unique surgical management of a case of bilateral FEVR-associated tractional radial folds with nonaxial retrolenticular adhesion treated with scleral buckling with deferred laser, avoiding the complications associated with vitrectomy and lensectomy on ocular development. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:594–596.]

Purpose To determine the incidence of retinopathy of prematurity (ROP) over a 2-year period before and after a change in the practice of oxygen supplementation. Design Nonrandomized, retrospective study. Participants All infants in a single Level III neonatal intensive care unit between the years of 2005 and 2007. Methods A prospective database recorded the gestational age, birth weight, stage and zone of ROP, threshold disease, treatment, final outcome and date of examination, maternal and infant demographics, and neonatal intensive care unit course. Year 1 (August 1, 2005 to July 31, 2006) includes a patient cohort who received the standard oxygen supplementation protocol, which has oxygen targets of 95% to 100% saturation. Year 2 (August 1, 2006 to July 31, 2007) includes a patient cohort who has strictly monitored oxygen targets of 34 weeks corrected gestational age limits of 85% to 100% and target 92% to 97% saturation. Main Outcome Measure Incidence of ROP in year 1 before a change in oxygen protocol compared with the incidence of ROP in year 2 after a change in the oxygen protocol. Results A total of 114 children in year 1 and 108 children in year 2 were identified as having been born or transferred to the Fairview Nursery. Ninety-eight infants were examined before and 92 infants were examined after the change in oxygen standards, comprising 190 consecutive patients examined between September 2005 and October 2007. ROP was present in 35% of infants in group 1 before the change in oxygen protocol compared with 13% after the change in oxygen standards ( P = 0.001); stage 3 decreased from 11% to 2% ( P = 0.021); threshold disease decreased from 7% to 1% ( P = 0.066). Stage 0 (immature vessels, no ROP) incidence increased (pre/post-oxygen change 30%/51% stage 0, P = 0.001). There were statistically significant differences in mode of delivery ( P = 0.007), sepsis P = 0.01), and oxygen at discharge ( P = 0.003). Conclusions Lower oxygen targets at early gestational age and higher oxygen targets at older gestational age decrease the severity and incidence of ROP while inducing normal retinal development. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To compare the anatomic outcomes of lens-sparing vitrectomy (LSV) with those of combined LSV and scleral buckle (SB) in surgical repair of retinopathy of prematurity (ROP) stage 4 retinal detachment. Design Retrospective, interventional, consecutive case series. Methods Twenty-one eyes of 15 patients with stage 4 ROP detachment were enrolled. All patients were selected from consecutive patients with stage 4 ROP detachment treated with LSV alone or combined LSV and SB. Patient characteristics, including gestational age, birth weight, gender, corrected gestational age at time of surgery, surgical procedure, anatomic outcome, ability to fix and follow, and progression of cataract or glaucoma were recorded. Results Twelve of 21 eyes underwent the combined procedure (LSV with SB), and the remaining nine eyes underwent LSV alone. Eighteen (86%) of 21 eyes achieved retinal reattachment overall, with seven (87%) of eight stage 4B detachments repaired in one surgery. Eleven (85%) of 13 stage 4A detachments were repaired in one surgery. Of the patients in whom treatment failed, two were in the LSV with SB group (2/12; 16%) and one was in the LSV alone group (1/9; 11%). Conclusions The data suggest that SB adds little to the success or failure of LSV and therefore is an unnecessary adjunct to LSV for stage 4 ROP.

Purpose To determine the diagnostic yield of tests commonly used for vitreous fluid analysis in eyes with suspected intraocular infection or malignancy. Design Noncomparative interventional case series. Participants Forty-four consecutive patients (45 eyes) treated from 1998 through 2006 with posterior segment inflammation who underwent pars plana vitrectomy for diagnostic purposes. Intervention Vitreous specimens obtained via pars plana vitrectomy were analyzed by microbiologic culture, cytologic analysis, and flow cytometry. Main Outcome Measures Diagnostic yield and sensitivity of each test performed on vitreous specimens and visual outcomes of eyes that underwent diagnostic vitrectomy (DVx). Results Preoperative diagnoses were infection in 15 eyes and malignancy in 30 eyes. Overall, vitreous analysis identified a specific cause in 9 (20%) of 45 eyes. The overall sensitivity of DVx was 63.6%. The sensitivities of individual tests were: culture, 50%; cytologic analysis, 66.7%; and flow cytometry, 83.3%. The yields of diagnostic tests were: culture, 5.7%; cytologic analysis, 14.3%; and flow cytometry, 20.6%. Final diagnoses were infection in 6 eyes, malignancy in 9 eyes, and idiopathic in 30 eyes. Mean visual acuity improved significantly in the first 6 months after DVx. Visual acuity improved in 60% of eyes, with 37.8% of eyes improving by 3 lines or more. Conclusions Analysis of vitreous fluid by widely available tests is useful in identifying intraocular infection or malignancy. Most patients experienced a substantial improvement in vision.