Publications by authors named "Anand Vinekar"

85 Publications

Improving Retinopathy of Prematurity Care: A Medico-Legal Perspective.

Asia Pac J Ophthalmol (Phila) 2021 Aug 27. Epub 2021 Aug 27.

Narayana Nethralaya Eye Institute, Bangalore, India GM Eye Institute, Raipur, India Dr. Subhodh Agarwal Memorial Eye Hospital, Lucknow, India H V Desai Memorial Hospital, Pune, India Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, India.

Abstract: Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world. India leads all nations with the highest number of premature infants born each year. Asia has the highest estimated incidence, where visual loss from ROP is over twice as high per million live births compared to established market economies. The problems of ROP management in these countries are compounded by a large cohort of babies who require screening, relatively few ROP specialists, and more recently medico-legal challenges. The authors share the Indian jurisprudence literature from the past decade relating to ROP, summarizing key clinical lessons learned from these legal judgments. The authors endeavor to enlist good clinical practices for various key steps involved in ROP care to help mitigate future litigations as well as protect the clinical interest of the infants who require ROP screening and treatment.
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http://dx.doi.org/10.1097/APO.0000000000000388DOI Listing
August 2021

Anti-vascular endothelial growth factor in the management of retinopathy of prematurity: A survey among the members of Indian Retinopathy of Prematurity Society.

Indian J Ophthalmol 2021 08;69(8):2158-2163

Director, MGM Eye Institute, Raipur, Chhattisgarh, India.

Purpose: To report the results of the survey for the role of anti-VEGF in the management of retinopathy of prematurity (ROP) among the members of Indian ROP (iROP) society.

Methods: A questionnaire was designed in English using Google forms and its link was circulated to the members of the iROP society on their mobile numbers. The survey included questions pertaining to demographics, anti-VEGF agents, injection technique, post-injection follow-up, and documentation pertaining to their ROP practice. Anonymous responses were obtained and analyzed for individual questions.

Results: 226 members of the society were contacted and 157 responded (69.4%) to the survey. 137 (87.2%) respondents used anti-VEGF in the management of ROP. Aggressive posterior ROP (APROP) was the most common indication (78, 52.7%). The procedure was carried out in the main operation room (102, 70.3%) simultaneously for both the eyes (97; 68%) under topical anesthesia (134; 86.4%) by most of the respondents. One-hundred thirteen (77.9%) respondents used half of the adult dose, irrespective of the agent used; however, more than half of them preferred bevacizumab (85, 54%). 53 (36.3%) respondents followed up infants as per disease severity rather than a fixed schedule while only 33 (23%) performed photo documentation. 151 (96.2%) respondents felt the need for guidelines regarding the usage of anti-VEGF in ROP.

Conclusion: There is an increase in the trend towards the use of anti-VEGF in the management of severe ROP, particularly APROP. However, there are considerable variations among the ROP practitioners regarding the agent, dosage, follow-up schedule, and documentation, suggesting the need for uniform guidelines.
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http://dx.doi.org/10.4103/ijo.IJO_200_21DOI Listing
August 2021

Commentary: Wide-field imaging vs binocular indirect ophthalmoscopy in retinopathy of prematurity screening: Real-world advantages.

Authors:
Anand Vinekar

Indian J Ophthalmol 2021 08;69(8):2146

Department of Pediatric Retina, Program Director, KIDROP, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/ijo.IJO_1416_21DOI Listing
August 2021

Timing of laser following intravitreal anti-vascular endothelial growth factor injections for aggressive posterior zone 1 retinopathy of prematurity.

Authors:
Anand Vinekar

Indian J Ophthalmol 2021 08;69(8):1988-1989

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/ijo.IJO_373_21DOI Listing
August 2021

International Classification of Retinopathy of Prematurity, Third Edition.

Ophthalmology 2021 Oct 8;128(10):e51-e68. Epub 2021 Jul 8.

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

Purpose: The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system.

Design: Review of evidence-based literature, along with expert consensus opinion.

Participants: International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men.

Methods: The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification.

Main Outcome Measures: Consensus statement.

Results: The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae.

Conclusions: These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.
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http://dx.doi.org/10.1016/j.ophtha.2021.05.031DOI Listing
October 2021

Evaluating Contrast Sensitivity in Asian Indian Pre-Term Infants With and Without Retinopathy of Prematurity.

Transl Vis Sci Technol 2021 04;10(4):12

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, India.

Purpose: The purpose of this study was to evaluate the contrast threshold in Asian Indian preterm infants with and without retinopathy of prematurity (ROP) using Newborn Contrast Cards measured during the first ROP screening and to correlate with final outcome and visual acuity at 3 months of corrected age.

Methods: Preterm infants born ≤ 2000 grams birth weight (BW) and/or ≤ 34 weeks gestational age (GA) undergoing ROP screening were enrolled prospectively. Visual acuity was recorded using Teller Acuity Cards. Contrast threshold was measured with Newborn Contrast Cards at first screening visit and at the end of ROP screening at 40 weeks of postmenstrual age or older.

Results: Of the 173 study infants, 134 (77.5%) did not have any stage of ROP. Of the remaining 39 (22.5%), 34 (87%) had type 2 ROP and 5 (13%) had type 1 ROP requiring treatment. The mean contrast threshold at the first visit of the no ROP type 1 and type 2 groups was 0.36 ± 0.07, 0.65 ± 0.19, and 0.46 ± 0.09, respectively (P < 0.001). Contrast threshold had a significant correlation with BW (R = -0.291, P = < 0.001) and gestational age (R = -0.47, P = < 0.001). The contrast threshold at the first visit correlated with visual acuity measured at 3 months of corrected age in logMAR (R = 0.36, P = 0.01). Other than BW and GA, no other systemic risk factors correlated with contrast threshold measured at the first screening visit.

Conclusions: Newborn Contrast Cards are a viable tool to test contrast threshold in preterm infants. The association between contrast threshold and ROP, and its correlation with visual acuity, suggest that contrast threshold measurement may help predict the clinical vision outcome among prematurely born infants.

Translational Relevance: Contrast threshold measurement may prove to be a useful tool in the estimation of visual potential in preterm infants.
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http://dx.doi.org/10.1167/tvst.10.4.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054629PMC
April 2021

Imaging the pediatric retina: An overview.

Indian J Ophthalmol 2021 04;69(4):812-823

Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.
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http://dx.doi.org/10.4103/ijo.IJO_1917_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012979PMC
April 2021

Monitoring healing of accidental laser burns of the macula using optical coherence tomography.

Clin Exp Optom 2021 Mar 1:1-4. Epub 2021 Mar 1.

Department of Vitreoretina, Narayana Nethralaya Eye Institute, Bangalore, India.

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http://dx.doi.org/10.1080/08164622.2021.1878860DOI Listing
March 2021

Tear Fluid Angiogenic Factors: Potential Noninvasive Biomarkers for Retinopathy of Prematurity Screening in Preterm Infants.

Invest Ophthalmol Vis Sci 2021 03;62(3)

GROW Research Lab, Narayana Nethralaya Foundation, Bangalore, India.

Purpose: To determine the status of proangiogenic factors in the tear fluid of preterm infants with and without retinopathy of prematurity (ROP).

Methods: Preterm infants (n = 36) undergoing routine ROP screening included in the prospective study were categorized as No-ROP (n = 13, no ROP at any visits), ROP (if ROP was present at first visit; n = 18), or No-ROP to ROP (no disease at first visit, but developed ROP subsequently; n = 5). Infants with ROP were also grouped as progressing (n = 7) and regressing (n = 16) based on ROP evolution between the first and subsequent visits. Schirmer's strips were used to collect tear fluid and proangiogenic factors (VEGF, angiogenin, soluble vascular cell adhesion molecule, and fractalkine) levels (in picograms per milliliter) in tear fluid were measured by multiplex ELISA.

Results: Lower levels of VEGF (135 ± 69; mean ± standard deviation) and higher levels of angiogenin (6568 ± 4975) were observed in infants with ROP compared with infants without ROP (172.5 ± 54.0; 4139 ± 3909) at the first visit. Significantly lower levels of VEGF were observed in the No-ROP to ROP group compared with the No-ROP and ROP groups. The VEGF and angiogenin levels at the first visit were significantly lower in infants with ROP with progressing disease. Angiogenin levels negatively correlated with birth weight and gestational age in ROP. The area under the curve (AUC) and odds ratio (OR) analysis demonstrated that angiogenin/birth weight (AUC = 0.776; OR, 8.6); angiogenin/gestational age (AUC = 0.706; OR, 7.3) and Angiogenin/VEGF (AUC = 0.806; OR, 14.3) ratios were able to differentiated preterm infants with and without ROP.

Conclusions: The association between angiogenin and ROP suggests its possible role in ROP. The ratio of angiogenin level with birth weight, gestational age, and/or VEGF could serve as a potential noninvasive screening biomarker for ROP.
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http://dx.doi.org/10.1167/iovs.62.3.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938022PMC
March 2021

Artificial Intelligence for ROP Screening and to Assess Quality of Care: Progress and Challenges.

Pediatrics 2021 03;147(3)

Narayana Nethralaya Eye Hospital, Bangalore, India.

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http://dx.doi.org/10.1542/peds.2020-034314DOI Listing
March 2021

Optical coherence tomography angiography in preterm-born children with retinopathy of prematurity.

Graefes Arch Clin Exp Ophthalmol 2021 Aug 6;259(8):2131-2137. Epub 2021 Feb 6.

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

Purpose: To describe the foveal avascular zone (FAZ) and vessel density (VD) in the superficial and deep capillary plexus in children with a history of prematurity on optical coherence tomography angiography (OCTA) and their correlation with gestational age (GA) and birth weight (BW).

Methods: We enrolled 81 preterm- and eight term-born children in this prospective observational study. The Optovue RTVue AVANTI (Optovue Inc., Fremont, CA) was used to procure the OCTA images. The 3 × 3 mm scan protocol centered on the fovea and the central 1 mm of the grid along with the FAZ of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was acquired.

Results: The mean SCP-VD was comparable between the preterms and term controls (p = 0.315) in the central fovea (1-mm grid). However, the SCP-VD of the 3-mm grid was lower in the preterms born without ROP, with type 1 ROP, and with type 2 ROP (47.61, 47.90, and 48.82 respectively) compared to that in the term group (51.38; p = 0.031). The FAZ in the SCP (p = 0.003) and DCP (p = 0.003) was significantly smaller in the preterms compared to that in the controls. Based on the GA sub-analysis, the FAZ was significantly smaller in the SCP and DCP of preterms born < 31 weeks and > 31 weeks GA (p < 0.000, p < 0.035, respectively). Based on the BW, the difference between the FAZ in the SCP (p = 0.002) and DCP (p = 0.003) was significant. There was no association between the visual acuity and FAZ.

Conclusion: Optical coherence tomography angiography findings in this study show an altered foveal morphology and vascularity in preterms with and without ROP.
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http://dx.doi.org/10.1007/s00417-021-05090-7DOI Listing
August 2021

Commentary: Impact of the COVID-19 pandemic on digital eye strain in children.

Indian J Ophthalmol 2020 11;68(11):2383-2384

Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/ijo.IJO_3028_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774209PMC
November 2020

Solved mystery of the stellate lesion!

Eur J Ophthalmol 2020 Oct 2:1120672120962021. Epub 2020 Oct 2.

Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

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http://dx.doi.org/10.1177/1120672120962021DOI Listing
October 2020

Retinopathy of Prematurity: How to Prevent the Third Epidemics in Developing Countries.

Asia Pac J Ophthalmol (Phila) 2020 Sep-Oct;9(5):440-448

Narayana Nethralaya Eye Institute, Bangalore, India.

Retinopathy of prematurity (ROP) is vasoproliferative disease affecting preterm infants and is a leading cause of avoidable childhood blindness worldwide. The world is currently experiencing the third epidemic of ROP, where majority of the cases are from middle-income countries. Over 40% of the world's premature infants were born in India, China, Bangladesh, Pakistan, and Indonesia. Together with other neighboring nations, this region has unique challenges in ROP management. Key aspects of the challenges including heavier and more mature infants developing severe ROP. Current strategies include adoption of national screening guidelines, telemedicine, integrating vision rehabilitation and software innovations in the form of artificial intelligence. This review overviews some of these aspects.
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http://dx.doi.org/10.1097/APO.0000000000000313DOI Listing
July 2021

Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology.

Indian J Ophthalmol 2020 Jul;68(7):1316-1327

Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India.

While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.
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http://dx.doi.org/10.4103/ijo.IJO_1509_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574118PMC
July 2020

Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era.

Indian J Ophthalmol 2020 06;68(6):962-973

Centre for Sight, Hyderabad, India.

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.
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http://dx.doi.org/10.4103/ijo.IJO_1404_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508071PMC
June 2020

Foveal cyst: Unknown etiology and unexplained response to treatment.

Eur J Ophthalmol 2021 May 13;31(3):NP19-NP24. Epub 2020 Feb 13.

Department of Vitreoretina, Narayana Nethralaya Eye Institute, Bangalore, India.

Background: Foveal cysts have been associated with vitreous traction due to a taut posterior hyaloid. These eyes may progress to become a full-thickness macular hole, remain stable, or resolve after a posterior vitreous detachment. A foveal cyst in an eye with a complete posterior vitreous detachment and no other obvious pathology is unusual.

Case Presentation: A 21-year-old male presented with blurred vision in the left eye of 1-month duration. On examination his left-eye vision was 20/60, and anterior segment examination was normal. Fundus examination showed internal limiting membrane folds with a suspected lamellar macular hole. A spectral domain optical coherence scan showed a thin dome-like cyst in the sub foveal region involving the outer retinal layer with a detached posterior hyaloid face. A trial of intravitreal dexamethasone implant was given, following which there was improvement in vision and resolution of the foveal cyst. At the third-month follow-up, the patient presented with a stellate pattern of hyporeflectivity in the macular area both on spectral domain optical coherence scan and multicolor imaging with no change in visual acuity.

Conclusion: The presence of a foveal cyst in a young male without any risk factors is peculiar, and the rapid response to intravitreal dexamethasone implant raises questions about the pathogenesis. The stellate pattern of hyporeflectivity on spectral domain optical coherence scan imaging with an intraretinal "filling defect"-like picture on fluorescein angiography suggests a possible ongoing ischemic pathology.
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http://dx.doi.org/10.1177/1120672120904665DOI Listing
May 2021

Vitamin-D3 (α-1, 25(OH) 2D3) Protects Retinal Pigment Epithelium From Hyperoxic Insults.

Invest Ophthalmol Vis Sci 2020 02;61(2)

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Purpose: Oxidative stress affects the retinal pigment epithelium (RPE) leading to development of vascular eye diseases. Cholecalciferol (VIT-D) is a known modulator of oxidative stress and angiogenesis. This in vitro study was carried out to evaluate the protective role of VIT-D on RPE cells incubated under hyperoxic conditions.

Methods: Cadaver primary RPE (PRPE) cells were cultured in hyperoxia (40% O2) with or without VIT-D (α-1, 25(OH) 2D3). The functional and physiological effects of PRPE cells with VIT-D treatment were analyzed using molecular and biochemical tools.

Results: Vascular signaling modulators, such as vascular endothelial growth factor (VEGF) and Notch, were reduced in hyperoxic conditions but significantly upregulated in the presence of VIT-D. Additionally, PRPE conditioned medium with VIT-D induced the tubulogenesis in primary human umbilical vein endothelial cells (HUVEC) cells. VIT-D supplementation restored phagocytosis and transmembrane potential in PRPE cells cultured under hyperoxia.

Conclusions: VIT-D protects RPE cells and promotes angiogenesis under hyperoxic insult. These findings may give impetus to the potential of VIT-D as a therapeutic agent in hyperoxia induced retinal vascular diseases.
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http://dx.doi.org/10.1167/iovs.61.2.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325624PMC
February 2020

Taking subspecialty pediatric eye care to the community - The Narayana Nethralaya model.

Indian J Ophthalmol 2020 02;68(2):301-302

Consultant, Pediatric Vitreoretina Service, Narayana Nethralaya Eye Institute, 121/C, West of Chord Road, Rajaji Nagar, 1st R Block, Bengaluru - 560 010, Karnataka, India.

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http://dx.doi.org/10.4103/ijo.IJO_19_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003588PMC
February 2020

Imaging the ora serrata with the 3Nethra Neo camera - Importance in screening and treatment in retinopathy of prematurity.

Indian J Ophthalmol 2020 01;68(1):270-271

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Rajajinagar, Bengaluru, Karnataka, India.

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http://dx.doi.org/10.4103/ijo.IJO_1232_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951155PMC
January 2020

Retinopathy of prematurity treatment: Asian perspectives.

Eye (Lond) 2020 04 29;34(4):632-642. Epub 2019 Oct 29.

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.

Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.
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http://dx.doi.org/10.1038/s41433-019-0643-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093470PMC
April 2020

Bilateral acute necrotizing retinitis due to cytomegalovirus infection in an infant: Challenging case report.

Am J Ophthalmol Case Rep 2019 Dec 10;16:100553. Epub 2019 Sep 10.

Department of Cataract, Narayana Nethralaya, Bangalore, India.

Purpose: To report a case of bilateral acute necrotising retinitis due to cytomegalovirus infection (CMV) in an Asian Indian infant.

Observations: An Asian Indian infant born with a birth weight of 1000 g at 26 week of gestation acquired cytomegalovirus infection from repeated blood transfusion for anemia. During the routine course of ROP screening, both eyes were detected with Type 1 ROP (stage 3 in zone 1 with plus disease) and treated with laser photoablation at 39 + 2 weeks post menstrual age. The disease responded to the laser and showed signs of regression. Four weeks after laser therapy (PMA 43 + 3 weeks), both eyes presented with vitritis, inferior vitreous condensation and white lesions in the lower nasal retina and temporal retina overlying the lasered retinal bed associated with white fluffy hemorrhagic lesions resembling necrotising retinitis. As the infant was seropositive for CMV earlier, Necrotising retinitis due to CMV was suspected. The CMV DNA was repeated and was detected in serum. Infant was treated with anti-CMV medication (oral valgancyclovir) for six weeks. The retinal lesions resolved completely.

Conclusion And Importance: Bilateral acute necrotising retinitis may present in an infant on post lasered retina as early as 16 weeks after birth. CMV may also present as acute necrotising retinitis in unusual cases therefore high index of suspicion and early management can result in a successful outcome.
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http://dx.doi.org/10.1016/j.ajoc.2019.100553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804511PMC
December 2019

The role of retinal photography and telemedicine in ROP screening.

Semin Perinatol 2019 10 13;43(6):367-374. Epub 2019 May 13.

Department of Pediatric Retina, KIDROP, Narayana Nethralaya Eye Institute, Bangalore, India.

Until advances in retinal imaging over recent decades, detection of retinopathy of prematurity requiring treatment depended largely on indirect ophthalmoscopy by ophthalmologists with experience in examination of low birth weight, often fragile infants. Recent studies have added to our understanding of the pros and cons of using this technology to provide timely care for the increasing number of infants at risk for ROP blindness worldwide.
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http://dx.doi.org/10.1053/j.semperi.2019.05.010DOI Listing
October 2019

Retinal immaturity at first screening and retinopathy of prematurity: Image-based validation of 1202 eyes of premature infants to predict disease progression.

Indian J Ophthalmol 2019 06;67(6):846-853

Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India.

Purpose: To use the extent of retinal immaturity at the first visit to predict progression to any stage and treatment-requiring retinopathy of prematurity (ROP).

Methods: Retrospective, multicenter, nonrandomized, observational, clinical, validation study. In all, 601 Asian Indian preterm infants born < 2000 g and/or < 34 weeks of gestation completing ROP screening with RetCam images taken during each visit were included. A total of 1202 eyes of these infants were classified into three groups based on the retinal immaturity at the first screening visit into "mild" (Group 1), vessels reaching the posterior boundary of zone 3; "moderate" (Group 2), vessels entering zone 2 anterior; and "severe" (Group 3), vessels in zone 1 or zone 2 posterior. RetCam images at each subsequent visit were evaluated and the proportion of eyes that progressed to Type 1 or Type 2 ROP was correlated with the degree of retinal immaturity.

Results: Of the 958 eyes in Group 1, 200 eyes in Group 2, and 44 eyes in Group 3, any stage ROP developed in 15% of eyes in Group 1, 46.5% of eyes in Group 2, and 100% of eyes in Group 3 (P < 0.001). Sixteen of 128 eyes (12.5%), 12 of 72 (16.6%), and 28 of 44 of eyes (63.6%) in Groups 1, 2, and 3, respectively, required treatment (P < 0.001).

Conclusion: Retinal immaturity at first screening visit predicts Type 1 and Type 2 ROP. "Severe" immaturity is more likely to progress to "treatment-requiring" disease. This could be a useful tool for prognostication, counseling, and scheduling follow-up.
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http://dx.doi.org/10.4103/ijo.IJO_469_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552627PMC
June 2019

The Indian Retinopathy of Prematurity (iROP) society: Challenges ahead.

Indian J Ophthalmol 2019 06;67(6):722

Bharati Eye Hospital, New Delhi; Raj Retina Eye Center, Patna, Bihar, India.

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http://dx.doi.org/10.4103/ijo.IJO_852_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552570PMC
June 2019

Automated Detection and Classification of Telemedical Retinopathy of Prematurity Images.

Telemed J E Health 2020 03 14;26(3):354-358. Epub 2019 May 14.

Karnataka Internet-Assisted Diagnosis of Retinopathy of Prematurity, Department of Pediatric Retina, Narayana Nethralaya, Bangalore, Karnataka, India.

Retinopathy of prematurity (ROP) is a retinal disorder of low birth weight infants and it is the leading cause of childhood blindness. The capability of wide field digital imaging systems to capture the clinical features of ROP has greatly helped the physicians to assess the severity of ROP and prevent childhood blindness due to ROP. Currently there is a lack of automated systems to assess the severity of ROP to assist the ROP specialist to make treatment decision. To present an automated detection and classification approach to assess the severity of ROP using wide field telemedical images. A total of 160 telemedical ROP (tele-ROP) images were collected out, of which 36 images were Normal, 79 images were Stage 2, and 45 images were Stage 3. Hessian analysis and support vector machine (SVM) classifier have been used to detect and classify the severity of ROP from tele-ROP images. Classified the Normal, Stage 2, and Stage 3 images using SVM. Achieved accuracy of 91.8%, sensitivity of 90.37%, specificity of 94.65%, false positive rate of 5.35%, and false negative rate of 9.63%. The automated approach of detecting and classifying ROP would support pediatric ophthalmologists for early treatment decisions with optimal care.
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http://dx.doi.org/10.1089/tmj.2019.0004DOI Listing
March 2020

A Prospective OCT Study of Rubella Retinopathy.

Ophthalmol Retina 2018 12 17;2(12):1235-1240. Epub 2018 Jul 17.

Imaging, Biomechanics and Mathematical Modelling Solutions, Narayana Nethralaya Foundation, Bangalore, India.

Purpose: To analyze rubella retinopathy qualitatively and quantitatively in children diagnosed with congenital rubella syndrome (CRS) using a handheld spectral-domain (SD) OCT device.

Design: Prospective, cross-sectional, nonrandomized, comparative observational study in a tertiary eye care center in south India.

Participants: Cases comprised 24 eyes of 13 children diagnosed with CRS based on seropositivity with rubella retinopathy. Controls comprised 26 eyes of 13 age-matched healthy children with normal retina.

Methods: All participants underwent retinal imaging with RetCam fundus photography (Natus Medical Inc, Pleasanton, CA) and handheld SD OCT (Bioptigen, Inc., Durham, NC). The SD OCT images of both cases and controls were segmented. Retinal and choroid thickness parameters were computed.

Main Outcome Measures: Qualitative and quantitative changes were observed in SD OCT images of rubella retinopathy compared with those from controls.

Results: Characteristic salt-and-pepper appearance was observed on fundus photography in children with rubella compared with the healthy children. The appearance of fovea and retinal features such as foveal dip, external limiting membrane, inner segment-outer segment boundary, outer segment-retinal pigment epithelium boundary, and retinal pigment epithelium were significantly different (P < 0.05) in eyes with rubella retinopathy compared with healthy eyes Furthermore, eyes with rubella retinopathy exhibited significantly reduced central foveal thickness (P = 0.025), subfoveal outer retinal thickness (P = 0.01), and subfoveal choroid thickness (P = 0.007) compared with healthy eyes.

Conclusions: Distinct qualitative and quantitative differences were observed in the SD OCT images of eyes with rubella retinopathy compared with those from healthy eyes.
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http://dx.doi.org/10.1016/j.oret.2018.06.003DOI Listing
December 2018

A computer-aided diagnosis system for plus disease in retinopathy of prematurity with structure adaptive segmentation and vessel based features.

Comput Med Imaging Graph 2019 06 18;74:72-94. Epub 2019 Apr 18.

Narayana Nethralaya PG Institute of Ophthalmology, Bangalore, India. Electronic address:

Retinopathy of Prematurity (ROP) is a blinding disease affecting the retina of low birth-weight preterm infants. Accurate diagnosis of ROP is essential to identify treatment-requiring ROP, which would help to prevent childhood blindness. Plus disease, which characterizes abnormal twisting, widening and branching of the blood vessels, is a significant symptom of treatment requiring ROP. In this paper, we have developed and evaluated a computer-based analysis system for objective assessment of plus disease in ROP, which best mimics the clinical method of disease diagnosis by identifying unique vessel based features. The proposed system consists of an initial segmentation stage, which will efficiently extract blood vessels of varying width and length by utilizing structure adaptive filtering, connectivity analysis and image fusion. The paper proposes the usage of additional retinal features namely leaf node count and vessel density, to portray the abnormal growth and branching of the blood vessels and to complement the commonly used features namely tortuosity and width. The test results show a better classification of plus disease in terms of sensitivity (95%) and specificity (93%), emphasizing the superiority of the proposed segmentation algorithm and vessel-based features. An additional advantage of the proposed system is that the process of selection of relevant vessels for feature extraction is fully automated, which makes the system highly useful to the non-physician graders, owing to the unavailability of a sufficient number of ROP specialists.
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http://dx.doi.org/10.1016/j.compmedimag.2019.04.003DOI Listing
June 2019
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