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Purpose: The primary aim was to analyse regional incidences of retinopathy of prematurity (ROP) and frequencies of treatment and their relation to perinatal risk factors during a 3‐year period. A ...secondary aim was to study adherence to the study screening protocol in the different regions.
Methods: A population‐based study of neonatal morbidity in extremely preterm infants in Sweden (EXPRESS) was performed during 2004–2007. Screening for ROP was to start at postnatal age 5 weeks and to continue weekly until the retina was completely vascularized or until regression of ROP. Logistic regression analyses were used for evaluation of differences in incidence of Any ROP, ROP 3 or more and ROP Type 1 between the seven regions of the country.
Results: The regional incidence of ROP varied between 54% and 92% for Any ROP, between 25% and 43% for ROP stage 3 or more and between 8% and 23% of infants with ROP Type 1, all of whom were treated. There was no significant difference between the regions regarding ROP Type 1, even when adjusting for known risk factors for ROP.
Conclusion: The heterogeneity between the regions regarding the incidence of ROP was reduced with increasing severity of ROP, and there was no heterogeneity regarding frequency of treatment for ROP, which is the most important issue for the children. We cannot exclude observer bias regarding mild ROP and ROP stage 3 in this study.
OBJECTIVES To evaluate screening for retinopathy of prematurity (ROP) in Sweden and to investigate possible modifications of the present screening guidelines. METHODS Infants in Sweden with a ...gestational age (GA) of 31 weeks + 6 days or less are screened for ROP. Data from the Swedish national register for ROP (SWEDROP) during 2008 and 2009 were extracted and compared with a national perinatal quality register. RESULTS In SWEDROP, there were 1791 infants born before a GA of 32 weeks from January 1, 2008, through December 31, 2009. Another 70 infants were registered in the perinatal quality register but not in SWEDROP (dropout rate, 3.8% 70 of 1861 infants). Seven infants died before termination of screening. In the final study cohort (1784 infants), 15.6% had mild ROP and 8.5% had severe ROP. Treatment was performed in 4.4% of the infants, none of whom had a GA at birth of more than 28 weeks. Nine infants with a GA of more than 28 weeks at birth developed stage 3 ROP, which regressed spontaneously. The total number of examinations was 9286 (964 in infants with a GA of 31 weeks), and the mean (range) number of examinations of each infant was 5.2 (1-30). CONCLUSIONS The SWEDROP, a quality register for ROP, has a national coverage (ie, participation) of 96%. Data from 2008 to 2009 show that it seems possible to reduce the upper limit for screening in Sweden by 1 week, including only infants with a GA of 30 weeks + 6 days or less. However, such a change should be combined with a strong recommendation to neonatologists to refer also severely ill and more “mature” infants.
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Purpose: To investigate patients under the age of 20 with aniridia in Sweden and Norway in order to estimate the prevalence of aniridia, to describe clinical signs and identify complications in ...the young, which will help improve diagnostic tools and treatment.
Methods: A thorough search for patients with aniridia (of all ages) was performed. Sixty‐two of the 181 patients were under the age of 20. Fifty‐two of them were examined and they constituted the study population. Patient history was obtained and all participants underwent clinical ophthalmologic examination, including photography. Blood samples were taken for mutation analysis.
Results: Epidemiological data are only based on the results in Sweden. The age‐specific prevalence in Sweden was 1:47 000, male/female ratio was 0.57, mean age 12 years and median age 14 years. The proportion of sporadic cases including WAGR (Wilms tumour, Aniridia, Genitourinary abnormalities, Mental Retardation) and Gillespie syndrome (aniridia, cerebellar ataxia and mental retardation) was 48%. In the entire study population (Sweden and Norway), the mean visual acuity (VA) was 0.2 (range 0.04–0.9). We found VA < 0.3 in 80% and <0.1 in 18% of the patients. Twenty‐two patients (42%) had one or more of the sight threatening complications such as cataract/lens luxation, corneal clouding or glaucoma.
Conclusion: Descriptions of aniridia in the younger are rare. This study shows that aniridia seems to be more common than previously estimated and that some complications appear early in life. Watchfulness as regards these complications and regular examinations are essential even in the youngest.
Abstract
Aim
To study which eye‐screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study and compare results with earlier Swedish retrospective ...results.
Methods
Surveys were sent in 2006 to maternity/neonatal and women's health departments regarding screening policy. Response frequency was 96% (122/127). Data were derived from the Paediatric Cataract Register (
PECARE
), Sweden. All Swedish children diagnosed with congenital cataract and operated on before 1 year of age between January 2007 and December 2009 were included. Statistical comparison with earlier retrospective results was performed.
Results
Eye screening is a routine protocol at a rate of 90% of Swedish maternity wards. Sixty‐one children were included in the study. An increase was shown in case referrals from maternity wards compared to 10 years ago (64% vs. 50%). Detection was performed within 6 weeks of age in 75% of the cases. A significant difference between the probabilities of early referral (0.38; p < 0.001, < 6 weeks of age) and early surgery (0.36; p < 0.001) (
PECARE
) was found in comparison with the historical data of no maternity‐ward screening. Well‐baby clinics were instrumental in early detection, as well.
Conclusion
Eye screening in maternity wards is effective. Clear Swedish directives are to be preferred.
Objective Prematurity is a major risk factor for retinopathy of prematurity (ROP). We aimed to elucidate ROP prevalence, treatment and retreatment in infants born before 24 gestational age (GA) weeks ...in a Swedish cohort. Methods and analysis Infants with completed ROP screening, born at &lt;24 GA weeks, 2007-2018 in Sweden were included. Data of GA, birth weight (BW), sex, neonatal morbidities, maximal ROP stage, aggressive posterior ROP (APROP), ROP treatments, treatment modality and treatment centre were retrieved. Results In total, 399 infants, with a mean GA of 23.2 weeks (range 21.9-23.9) and a mean BW of 567 g (range 340-874), were included. ROP was detected in 365 (91.5%) infants, 173 (43.4%) were treated for ROP and 68 of 173 (39.3%) were treated more than once. As the first treatment, 142 (82.0%) received laser and 29 (16.1%) received intravitreal injection of antivascular endothelial growth factor (anti-VEGF). Retreatment was performed after first laser in 46 of 142 (32.4%) and in 20 of 29 (69.0%) after first anti-VEGF treatment. Retreatment rate was not associated with GA, BW or sex but with APROP, treatment method (anti-VEGF) and treatment centre where the laser was performed (p&lt;0.001). Twenty eyes progressed to retinal detachment, and two infants developed unilateral endophthalmitis after anti-VEGF treatment. Conclusion Infants, born at &lt;24 weeks GA, had high rates of treatment-warranting ROP and retreatments. Treatment centre highly influenced the retreatment rate after laser indicating that laser treatment could be improved in some settings.
Purpose : Description of ten years of national ROP-screening and treatment in Sweden and evaluation of the national screening program for ROP.
Methods : The study is based on a national register for ...ROP, SWEDROP, with around 96% coverage. According to Swedish guidelines, all infants born at 30 weeks gestational age (GA) or less, as well as children born later but being extremely sick, should be screened for ROP during the neonatal period. Birth data are validated in the Swedish neonatal quality register, SNQ.
Results : During the ten-year period between 2008 and 2017, 7257 infants with a GA of 30 weeks or less were registered in SWEDROP and 46.294 examinations were performed, of which 5.328 (11.5%) in infants born in gestational week 30. Mean GA was 27.6 w (range 21-30 w) and mean BW was 1116 g (range 390-2405 g). Overall, during the ten years, ROP was found in 31.8% (range 26.8-36.8%) and treatment for ROP was performed in 6% (range 4.1-7.7%) of the screened infants. Only nine infants with GA 28 w and four with GA 29 w were treated for ROP. No infant with GA 30 w was treated. Eighty-two per cent (361/441) of the treated infants had laser only and 17.7% (78/441) were treated with Anti-VEGF, alone (17 infants) or in combination with laser and/or other treatment.
Conclusions : SWEDROP is a national register for ROP with a high national coverage. The incidence of ROP and frequency of treatment remained similar over the ten-year period. Only 13 infants born at 28 – 29 weeks GA and no child born at 30 w GA were treated for ROP. Modification of guidelines is considered, with lowering the upper limit of screening with one week, i.e. to less than 30 weeks GA. During the ten-year study period, this would have resulted in a reduction of 1680 infants (23.2%) screened for ROP and of 5.328 (11.5%) examinations.
In the November 2008 issue (AOS 86:7), the article by Ulla Edén et al. was not published correctly in the printed issue. Unfortunately, part of the section ‘Visual acuity’ in the Results was repeated ...on page 732, and the start of the Discussion was omitted on page 732.
The full and correct version of this article is printed hereunder.
The Publisher apologises for this error.
Reference
Edén U,
Beijar C,
Riise R &
Tornqvist K (2008): Aniridia among children and teenagers in Sweden and Norway.
Acta Ophthalmol
86: 730–734.
.
Purpose: To investigate patients under the age of 20 with aniridia in Sweden and Norway in order to estimate the prevalence of aniridia, to describe clinical signs and identify complications in the young, which will help improve diagnostic tools and treatment.
Methods: A thorough search for patients with aniridia (of all ages) was performed. Sixty‐two of the 181 patients were under the age of 20. Fifty‐two of them were examined and they constituted the study population. Patient history was obtained and all participants underwent clinical ophthalmologic examination, including photography. Blood samples were taken for mutation analysis.
Results: Epidemiological data are only based on the results in Sweden. The age‐specific prevalence in Sweden was 1:47 000, male/female ratio was 0.57, mean age 12 years and median age 14 years. The proportion of sporadic cases including WAGR (Wilms tumour, Aniridia, Genitourinary abnormalities, Mental Retardation) and Gillespie syndrome (aniridia, cerebellar ataxia and mental retardation) was 48%. In the entire study population (Sweden and Norway), the mean visual acuity (VA) was 0.2 (range 0.04–0.9). We found VA < 0.3 in 80% and <0.1 in 18% of the patients. Twenty‐two patients (42%) had one or more of the sight threatening complications such as cataract/lens luxation, corneal clouding or glaucoma.
Conclusion: Descriptions of aniridia in the younger are rare. This study shows that aniridia seems to be more common than previously estimated and that some complications appear early in life. Watchfulness as regards these complications and regular examinations are essential even in the youngest.
Purpose To follow up children born after in vitro fertilization (IVF) with respect to eye malformations and poor visual acuity. Design Observational cohort study based on Swedish health registers. ...Methods Congenital eye malformations were studied in 32 091 children born from 1982 through 2007 and severe visual impairment was studied in 24 628 children born from 1985 through 2005 after IVF in Sweden. Comparisons were made with all children born in Sweden during corresponding periods with adjustment for various confounders. The main outcome measure was the presence of a congenital eye malformation and poor visual acuity. Results Thirty-six (1.1 per 1000) IVF infants with ocular malformations were identified, and the risk, compared with non-IVF children, was not increased when adjusted for maternal age, parity, smoking, and body mass index (odds ratio, 1.05; 95% confidence interval, 0.75 to 1.47). Severe visual impairment was identified in 25 cases (1.0 per 1000), and the risk increase was statistically significant (odds ratio, 1.65; 95% confidence interval, 1.12 to 2.45) and was only slightly reduced when adjustment as above was made (odds ratio, 1.55; 95% confidence interval, 1.04 to 2.32). When adjustment was made for known length of unwanted childlessness, the OR decreased to 1.15 (95% confidence interval, 0.61 to 2.16). Only 3 of the 25 children with visual impairment had ocular malformations. Conclusions Although there is an increased risk for visual impairment among children born after IVF, the individual risk is small and may be secondary to parental characteristics. No increased risk for eye malformations was found.
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