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• W2151176400 abstract "We have concerns about some points made by Ann Hellström and colleagues (Dec 5, p 1827).1Hellström A Hard AL Niklasson A Svensson E Jacobsson B Abnormal retinal vascularisation in pretern child as a general vascular phenomenon.Lancet. 1998; 352: 1827Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Many features of retinal vascularisation in preterm babies are unclear for both paediatric ophthalmologists and neonatologists. Although clinical indices in these infants are closely monitored in the neonatal intensivecare unit, no significant correlation has emerged thus far between retinopathy of prematurity and factors that determine the general condition of preterm babies.Previous attempts to identify systemic factors that might be used as a guide for the management of retinopathy of prematurity have been unsuccessful. So far the presence of threshold retinopathy of prematurity, as defined by the Cryotherapy for Retinopathy of Prematurity Cooperative Group,2Cryotherapy for Retinopathy of Prematurity Cooperative GroupMulticentre trial of cryotherapy for retinopathy of prematurity: preliminary results.Arch Ophthalmol. 1988; 106: 471-479Crossref PubMed Scopus (789) Google Scholar is the only clinically significant predictor of the benefits of cryotherapy.Since even this degree of retinopathy of prematurity shows no correlation with the general condition of preterm neonates,3Schulenberg WE Acheson JF Cryosurgery for acute retinopathy of prematurity: factors associated with treatment success and failure.Eye. 1992; 6: 215-220Crossref PubMed Scopus (7) Google Scholar it is hazardous to suggest, as Hellström and colleagues do, that retinal abnormalities in preterm babies are an expression of anomalous vascularisation in general. The major shortcoming of this study was the investigators' failure to distinguish between retinopathy of prematurity and other types of retinal vascular anomalies that might be seen in preterm babies. This shortcoming leads to an error in the attempt to explain a more restricted (local) event (retinopathy of prematurity anomalies) with a broader pattern (abnormal vascularisation in general).Hellström and colleagues fail to consider sequelae of retinopathy of prematurity, such as linearisation of major branches of retinal vessels caused by mild dragging of the optic disc. A preterm child with a history of cicatrical retinopathy of prematurity might thus be expected to present less vessel tortuosity than one born at term. Common findings in children who have a history of retinopathy of prematurity are retinal thinning with diffuse hypopigmentation, mild linearisation, or mild tortuosity of the major vessel branch, mottled pigmentation of the macula, peripheral linear vitreous contraction, and peripheral retinal anomalies such as degenerative abnormalities in myopia.4Page JM Schneeweiss S Whyte HE Harvey P Ocular sequence in premature infants.Pediatrics. 1993; 92: 787-790PubMed Google Scholar After the fundus examination, the ophthalmologist can say whether the child was a preterm neonate with retinopathy of prematurity or a simple preterm baby. Thus, it is difficult to believe that retinal vascular abnormalities could be so directly correlated with systemic vascular abnormalities. Furthermore, different stages of retinopathy of prematurity can result in different vascular abnormalities: mild dragging of the optic disc is, for example, quite common in disease that involves the posterior pole.We believe that many features of the pathogenesis of retinopathy of prematurity are unclear, and at least some of the retinal features of prematurity need to be explained before they can be included in a more general pattern of vascular development. We have concerns about some points made by Ann Hellström and colleagues (Dec 5, p 1827).1Hellström A Hard AL Niklasson A Svensson E Jacobsson B Abnormal retinal vascularisation in pretern child as a general vascular phenomenon.Lancet. 1998; 352: 1827Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Many features of retinal vascularisation in preterm babies are unclear for both paediatric ophthalmologists and neonatologists. Although clinical indices in these infants are closely monitored in the neonatal intensivecare unit, no significant correlation has emerged thus far between retinopathy of prematurity and factors that determine the general condition of preterm babies. Previous attempts to identify systemic factors that might be used as a guide for the management of retinopathy of prematurity have been unsuccessful. So far the presence of threshold retinopathy of prematurity, as defined by the Cryotherapy for Retinopathy of Prematurity Cooperative Group,2Cryotherapy for Retinopathy of Prematurity Cooperative GroupMulticentre trial of cryotherapy for retinopathy of prematurity: preliminary results.Arch Ophthalmol. 1988; 106: 471-479Crossref PubMed Scopus (789) Google Scholar is the only clinically significant predictor of the benefits of cryotherapy. Since even this degree of retinopathy of prematurity shows no correlation with the general condition of preterm neonates,3Schulenberg WE Acheson JF Cryosurgery for acute retinopathy of prematurity: factors associated with treatment success and failure.Eye. 1992; 6: 215-220Crossref PubMed Scopus (7) Google Scholar it is hazardous to suggest, as Hellström and colleagues do, that retinal abnormalities in preterm babies are an expression of anomalous vascularisation in general. The major shortcoming of this study was the investigators' failure to distinguish between retinopathy of prematurity and other types of retinal vascular anomalies that might be seen in preterm babies. This shortcoming leads to an error in the attempt to explain a more restricted (local) event (retinopathy of prematurity anomalies) with a broader pattern (abnormal vascularisation in general). Hellström and colleagues fail to consider sequelae of retinopathy of prematurity, such as linearisation of major branches of retinal vessels caused by mild dragging of the optic disc. A preterm child with a history of cicatrical retinopathy of prematurity might thus be expected to present less vessel tortuosity than one born at term. Common findings in children who have a history of retinopathy of prematurity are retinal thinning with diffuse hypopigmentation, mild linearisation, or mild tortuosity of the major vessel branch, mottled pigmentation of the macula, peripheral linear vitreous contraction, and peripheral retinal anomalies such as degenerative abnormalities in myopia.4Page JM Schneeweiss S Whyte HE Harvey P Ocular sequence in premature infants.Pediatrics. 1993; 92: 787-790PubMed Google Scholar After the fundus examination, the ophthalmologist can say whether the child was a preterm neonate with retinopathy of prematurity or a simple preterm baby. Thus, it is difficult to believe that retinal vascular abnormalities could be so directly correlated with systemic vascular abnormalities. Furthermore, different stages of retinopathy of prematurity can result in different vascular abnormalities: mild dragging of the optic disc is, for example, quite common in disease that involves the posterior pole. We believe that many features of the pathogenesis of retinopathy of prematurity are unclear, and at least some of the retinal features of prematurity need to be explained before they can be included in a more general pattern of vascular development. Abnormal retinal vascularisation in preterm childrenAuthors' reply Full-Text PDF" @default.
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• W2151176400 title "Abnormal retinal vascularisation in preterm children" @default.
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