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Versión en español

SUMMARY OF THE SCIENTIFIC PROGRAM

On Thursday, August 31st, at 3:00 pm, prior to the official opening of the event, the workshops were held, all of them with higher attendance than expected.

15:00 - 16:30 Registration TULUM ROOM (capacity: 60 people)

Workshop 1: Quality improvement in neonatal care

Lead: Ashok Deorari (India)

During the Workshop on Quality Improvement (QI) you will learn the step-wise team approach to identify a problem, and how to prioritize and develop SMART aim. Using tools for assessing the root causes of a problem based on routine health facility data, you will also learn how to test possible solutions in plan-dostudy-act cycles (PDSA) for improved health care. Experts will share best practices for the management of premature babies and how to embrace principles of QI for better quality of care.

Avoiding infections Alicia Matilde Benitez / Argentina

Cardiopulmonary care Victor Manuel Villagran Muñoz / Mexico

Breastfeeding benefits Antonio Calderon Moore / Mexico

Brain images to look for damage Manuel Cazares Ortiz / Mexico

Learning from QI: simple tips Ashok Deorari / India

The workshop was attended by neonatologists, nurses and ophthalmologists.

We reviewed the interventions tested to improve the quality of neonatal care, reducing mortality and morbidity.

To avoid infections, Nurse Benitez reviewed concepts of early and late sepsis, and current recommendations in the prevention of infections associated with neonatal care (hand washing, catheter care, rational use of antibiotics, among others). Among the benefits of breastfeeding Dr. Antonio Calderón Moore, spoke about the benefits of using human milk from the first day of life in the preterm newborn and strategies to establish and achieve breastfeeding at egress even in newborns extreme premature. The experience of the Colombian kangaroo program was presented and how this strategy greatly improves breastfeeding. In the topic of brain images to look for damage, Dr. Manuel Cazares Ortiz spoke about the importance of ultrasound in the immediate neonatal period, and subsequent ultrasound in the first weeks of life and the need to complete this study with MRI when there are intraventricular or intraparenchymal impairments, interesting examples were shown.

Dr. Deorari showed a video to improve the quality of neonatal care in India, and defined the concept of "Improvement of Neonatal Care".

After that, experiences of improvement in different countries were discussed, and the need for root cause analysis, continuous monitoring and feedback, necessary to consolidate the improvement processes in the countries, which to establish step by step requires a long learning curve . Unfortunately the rapporteur for cardiopulmonary care did not show up.

Workshop 2: In the theoretical workshop of Imaging for Retinopathy of the Premature, each speaker made use of the word with interventions of 10 minutes long.

Dr. Alfonso Almeida showed his practice in the examination and treatment of ROP cases using a slit lamp, which caused countless comments and reactions among the audience. Dr. Fernando Pérez and Dr. Luz Gordillo highlighted the characteristics of the exploration using indirect ophthalmoscopy and RetCam digital fundus photography, respectively. the gold standard being the first and telemedicine gaining ground with the use of digital systems. Likewise Dr. Consuelo Zepeda highlighted the small details that make digital photography a technique simple, but that requires training, as is a compression artifact, it can mask a large part of the findings, specially in Plus disease and may confuse the indication of early treatment.

Dr. Domenico Lepore evoked the history of the description of pathology findings in the first cases using fluorescein angiography performed in 1969, by Dr. John Flynn at the Jackson Memorial Hospital in Miami, as well as the description of the main changes not visible with indirect ophthalmoscopy and the great importance of evaluating cases of persistent avascular zone in patients treated with antiangiogenic agents.

Dr. Cindy Toth exposed the retinal findings of premature patients using OCT, which allows identifying in axial and lateral sections with a resolution of 5um and 15um, respectively, the subcellular layers of the retina:

A) Layer of nerve fibers, external and internal plexiform, b) Nuclear layer of ganglion cells, and internal nuclear, c) Nuclear layer of photoreceptors, d) External limiting membrane, e) Layer of internal ellipsoid segments, f) Segment interface external, g) Retinal and choriocapillary pigmentary epithelium.

Subsequently, new digital fundus imaging systems were introduced, such as the NEO Imaging System of the Horus company in India, as well as the ICON system manufactured by Dr Massey (Inventor of the Ret Cam, which suggests that the patent of the camera has already expired, 1997-2017 = 20 years).

The NEO system stands out to be very economical compared to the iconic product in the market and the ICON system is described by its creator better in quality for detailing the periphery compared to his previous invention. None of them responded publicly when they were asked for the cost.

Workshop 3: The Importance of brain health in ROP

Lead: Ana Maria Beauregard Escobar / Mexico

This workshop will address the tools for an integral examination of the vision,and how to carry out visual stimulation or rehabilitation according to the age of the infant to achieve a better development.

Each presentation will last 10 minutes and we will have 30 minutes of discussion.

Specialized clinical history
Irma Miriam Zamudio Valderrama / Mexico

Visual perception
Vanessa Bosch Canto / Mexico

What happens when the children don´t make synapses?
Rosana Vidal Pineda / Mexico

Associated damage in ROP and clinical signs
Angela Maria Fernandez Delgado / Colombia

Avoiding brain damage in anesthesia
Maria Elena Peralta Rodriguez / Mexico

Visual rehab in school age children with ROP sequel
Ana Maria Beauregard Escobar / Mexico

OPENING CEREMONY

17:30-19:00
Inauguration
Graham Quinn / Master of Ceremonies
Welcome to ROP Congress
Luis Porfirio Orozco Gomez

Introduction of ROP Congress
Clare Gilbert

Message from the Secretariat of health in Mexico
Gabriel O’Shea Cuevas

Opening Ceremony
Mayan Ceremony

Acknowledgements Ceremony:
Reports on previous World ROP Congresses
Lithuania 2006: Rasa Bagdoniene
India: 2009: Rajvardhan Azad
Shanghai 2012: Peiquan Zhao
Cancun 2017: Luis Porfirio Orozco Gomez

ROP around the world
ROP in Central and South America: factors associated with successful programme
Juan Carlos Silva

18:45 - 19:30

Scaling up ROP programmes in India: challenges and progress
Krishna Murthy / India

Control of ROP in China: challenges and progress
Yi Chen / China

The emerging threat of ROP in Africa
Rosaline Duke / Nigeria

19:30 Welcome Reception (video)
Mayan Reception

20:30 Faculty dinner

September 1st, Friday
World Action Plan for ROP:
07:00 - 8:00 Breakfast with the experts / view posters
Coordinator: Juan Carlos Bravo Ortiz

1. Antiangiogenics
For Ophthalmologists
Lead: Martin Flores Aguilar
Experts: Jorge Gutierrez Ponce
Abdiel Esquivel Aguilar
Gabriel Ochoa Maynes
Helen Mintz-Hittner
Norma Citlali Lara Molina

2. Neonatal care in ICU
For Nurses
Lead: Maria Jovita Plascencia Ordaz
Experts: Alicia Matilde Benitez
Zandra Grosso
Javier Perez Gutierrez
Elisa Ramos Padilla

3. ROP: Prevention and Treatment – From
One Baby at a Time To the Public Health Impact
For Neonatologists, Ophthalmologists, and Nurses
Lead:Clare Gilbert
Graham Quinn
Augusto Sola
Sergio Gustavo Golombek
8 hrs SESSION 1: Preterm birth
The global agenda for babies born too soon: Challenges and prospects
Ashok Deorari / India
ROP as a cause of blindness and the population at risk

Clare Gilbert / UK

Dr. Gilbert described the emergence of ROP as a cause of childhood blindness, with epidemiological data, in accordance with the development of health care systems and economic development in each country. An estimated of 32,300 cases of blind or visually impaired children appear annually. The incidence of ROP / blindness in these regions in decreasing order according to economic characteristics of the region and number of births. In many regions of the world, there is an increasing survival, with sub optimal neonatal care and low coverage of the ROP programs, therefore there is a high mortality in the premature patients. Describing that patients at risk of severe ROP are born of 24-30 SEG in countries with high income and 25-34 SEG in low and middle income countries, as well as the prevailing need for screening criteria to reflect the characteristics of risk population in each country.

Prevention of preterm birth: experiences from Cuba

Gisela Coca / Cuba

Some epidemiological data of Cuba were presented and there were highlighted some important strategies of its health system, which result in a lower number of premature births compared to other countries: 5% vs 10%, being premature, premature> 34 SEG mostly. These strategies are based on primary prevention of preterm birth, prenatal monitoring with ultrasound assessment in almost 100% of pregnancies. In Cuba, there are Obstetric Homes, where any pregnant woman at risk, with gestation of 26 weeks or more can be entered and visited by their relatives. The obstetric home offers food, clothing, rest, 24-hour surveillance by an obstetrician and nurse, it is also close to a hospital center. Neonatal care in Mexico / neonatologists perspectives.

Víctor Manuel Villagrán Muñoz / Mexico

The characteristics of births in Mexico were described, approximately 150,000 premature births per year, of which: 80% late premature, 12% intermediate premature, and 8% extreme premature. The situation of neonatal intensive care units in Mexico was also presented, and the programs applied in them aimed at improving patient care, such as the equipment for better supply and monitoring of oxygen therapy. There is a project of creating treatment centers in each state of the country with trained health care professionals and equipment for the detection and treatment of retinopathy of prematurity.

Neonatal care in Mexico / nurses perspectives
Dafne Fanny Marcel / Mexico

The characteristics of nursing in Mexico were exposed, 3.9/1000 inhabitants, for each 100 nurses there are 43 professionals or specialists, 31 technicians, 85% of the nursing staff are women, in Mexico there are 475,000 people employed as nurses.

Parents as part of the team
Angela Maria Fernandez Delgado / Colombia

In a very clear and emotional way, there were presented by means of videos, opinions of parents who have been an active part of the care of their children in neonatal intensive care units, thus having a social vision of a special situation. Highlighting the great medical and emotional benefits of this participation: Greater attachment to the patient, better management of emotions, learning of the needs and identification of signs of risk, learning of childcare techniques, practice of breastfeeding, creation of support groups.

Reduction in blindness due to ROP in Argentina.
Dr. Alicia Benitez

The timeline of the events that led to the reduction of blindness by ROP was described.
1999-2002 Recognition of ROP as a cause of blindness, workshops with the participation of ophthalmologists and neonatologists, advised by international experts.

2003 Implementation of the Multidisciplinary and Collaborative Group of ROP
2004-2008 Implementation of an initiative for the Ministry of Health together with UNICEF
2010 Approval of the ministerial resolution, National program for the control of ROP directed from the ministry of health.
2012 to date there is some evidence of the decrease in blindness by ROP.

In summary, strong national leadership, collaboration and commitment are needed to strengthen health systems and improve neonatal care in Argentina and achieve ROP cash control.

Multiple factors influenced the reduction of blindness by ROP in Argentina, including the development of broad support in the health system, generation of evidence, development of national development programs, mobilization of UNICEF and other social agencies and legislation.

The strategies and lessons of the experience in Argentina can be implemented by other developing countries.

10 hrs SESSION 2: Pathogenesis of ROP and predictive factors
Role of the oxygen in ROP
Monica Villa Guillen / Mexico

Predictors of ROP: weight gain, IGF

Dr. Guillen spoke about how poor weight gain in the premature can be considered a predictor of the onset and progression of the disease. The role of low levels of IGF-1 in premature babies as a risk factor and its possible therapeutic application in the future was discussed.

Oxidative Stress, Oxygen Administration and SpO2
Monitoring: From Theory to Clinical Practice
Sergio Gustavo Golombek / USA

Dr. Golombek spoke about the role of oxygen in the development of retinopathy of prematurity. He emphasized the spO2 peaks that are generated when resuscitating a premature or ventilating in periods of apnea (100% FIO2 is raised) and how this could impact the development and progression of the disease. He recommended to maintain oxygen saturation, in those with supplemental oxygen, between 89 and 94%.

Pharmacological interventions for ROP
Jacob Aranda / USA

Dr. Aranda talked about the different pharmacological advances in the management of premature babies through time. He talked about how at the time some (for example, oxygen and steroids) seemed innocuous and time proved otherwise. He talked about the use of caffeine as an apnea prevention and its utility to reduce the incidence of ROP. In addition, he reviewed the existing evidence to use other medications and how they affect the occurrence of ROP, such as propanolol, erythropoietin, D-penicillamine, vit E, etc. He left the audience with the open question of "Will we regret one day having used anti-angiogenesis?”.

Rapid fire papers / Discussion
Lead: Graham Quinn
Poor weight gain and ROP
Gil Binenbaum / USA

Dr. Binenbaum described how the monitoring of postnatal weight gain, applied to the G-ROP nomogram developed at the Children's Hospital of Philadelphia (CHOP), allows the identification of all patients with severe ROP, leaving in need of screening patients with:

1. Birth weight lower than 1.050g,
2. Gestational age less than 28 weeks
3. Weight gain less than 120 g during days 11-20 of life.
4. Gain less than 180 g during days 21-30 of life.
5. Weight gain less than 170g during days 31 to 49 of extrauterine life
6. Hydrocephalus.

It is not generalizable in countries where there is not adequate oxygen control, and ROP occurs in children with higher birth weight and gestational age.

Weight gain and ROP
Sila Bal / USA
Dr. Bal spoke about the relationship between poor weight gain, IGF-1 levels and the progression of retinopathy of prematurity.

Slow weight gain in the first days of life, is caused by low serum levels of IGF-1, associated with the subsequent development of ROP. Low levels inhibit vascular growth, a late increase in IGF-1 activates VEGF, causing neovascularization in ROP. A rapid increase in IGF-1 occurs with accelerated weight gain. Therefore, we evaluated the hypothesis that an acceleration in weight gain in postnatal life is related to a higher risk of severe ROP.

In a second analysis of the data from the G-ROP study, a retrospective cohort of infants undergoing ROP examination at 30 hospitals in North America between 2006-12, children with inadequate weight gain were excluded. The weight gain determined by daily measurements during weeks 29-33 and acceleration of weight gain during weeks 34-38 (WGA-34-38) was analyzed with linear regression. 6835 preterm infants were studied, average birth weight (SD) BW 1086 (357) g, GA 27.9 (2.5) weeks. 868 (12.7%) had severe ROP (19% WGR-29-33 in the lowest third, 12.4% in the middle third and 6.9% in the highest). Finding that the effect of acceleration in weight gain in ROP, depends on the rate of early weight gain in postnatal development. A very low weight gain rate (WGR) WGR-29-33 is associated with severe ROP, unrelated to the subsequent weight gain acceleration. In case the WGR-29-33 weight gain rate is moderate or high, and there is a subsequent rapid increase in weight gain, an association with the increased risk of developing severe ROP was found.

Thrombocytopenia as a risk factor for the development of ROP in the Postnatal Growth and ROP (G-ROP) Study
Alejandra G. from Alba Campomanes / USA

Thrombocytopenia is a factor independently associated with severe ROP, not precisely associated with the risk of bleeding, the increased risk of ROP is not related to the duration of thrombocytopenia, it is with its presence.

We analyzed retrospective data from a cohort of premature infants born in 30 hospitals in North America. 2006-2012 (The G-ROP Study). 7,238 premature infants, 917 (12.7%) severe ROP development. Mean birth weight was 1070 g (range 310-3000g) and average gestational age 28 weeks (range 22-35 weeks). Observing the results of serum platelet levels and retinal examinations. The association between thrombocytopenia and severe ROP according to the criteria of (ETROP Type 1 or Type 2) was evaluated with multivariate regression, controlling for birth weight, gestational age, necrotizing enterocolitis and sepsis. The mean values of platelets and the proportion of infants with thrombocytopenia defined in 3 groups (< 150,000, < 100,000, and < 50,000 platelets / microliter) were evaluated in each week of postmestrual age (PMA). Thrombocytopenia may vary in duration, so the PMA age was considered at the onset of thrombocytopenia and its duration.

Thrombocytopenia with onset prior to week 34 of age PMA is independently associated with severe ROP. This association is present even for threshold levels of platelets, not typically considered to be at risk of bleeding (< 150k, < 100k). Duration of platelet counts at these levels between week 29 and 34 of PMA age is associated with an increased risk of ROP, but even short periods < 50k confers an increased risk of ROP.

The presence of thrombocytopenia predisposes to ROP, especially if it occurs before week 27 of corrected gestational age where OR is 5, decreasing in weeks after OR 2.0.

Further studies of these associations and the potential of platelet transfusions as a preventive intervention to reduce the risk of ROP are necessary.

Visualizing the temporal progression of retinal growth in Neonates
Daniel Worrall / UK

Using Deep Neural Network Image Synthesis techniques, Dr. Worrall proposed a computational tool based on the conversion of images acquired from the retina of premature infants submitted to ROP screening according to local guidelines UK (Pediatric Child Health 2010; 15 (10): 667-670) in follow up and progression videos of each eye.
The screening and treatment of ROP depends on an early diagnosis, which includes the observation of vessel progression and retinal changes in the course of a few weeks, currently the clinical diagnosis is based on isolated visualizations of the patient's retina, without taking into account data on the onset of the disease, which can provide useful indicators of the progression and regression of the disease.

This study presents an algorithm that combines retinal images to form growth videos, and identify trends of "normal" and "abnormal" growth for the development of ROP. This being a useful tool to identify patterns of abnormal growth, and offer a more timely diagnosis based on the appearance of early changes.

Risk factors for the development of plus disease in the telemedicine approaches to evaluating of acute-phase ROP (e-ROP)

Ranjan Padhi Tapas

We studied 983 infants without disease plus in the first clinical ocular examination, 83 (8.4%) subsequently developed plus disease.

Significant factors for disease plus are: gestational age [odds ratio (OR) = 3.2 for 24 weeks vs. 28, p = 0.004], race [OR = 2.4 White vs Black, p = 0.01], respiratory support [OR = 7.1 need for high frequency ventilation vs. no ventilatory support], slow weight gain [1.5 for weight gain 12 vs. > 18 g / day, p = 0.03], fundus findings of the first revision: preplus / plus disease [OR = 2.7 preplus / plus vs. normal, p = 0.003], ROP stage [OR = 4.2 for stage 3 ROP vs. No ROP, p = 0.006] and hemorrhage [OR = 3.1 presence vs. absence, p = 0.003]. These factors predict plus disease within the area within the ROC curve of 0.85 (95% CI: 0.81-0.89). Birth weight, sex and multiple birth, are not associated with plus disease, (p> 0.05).

Gestational age, white race, need for ventilatory support, slow postnatal weight gain, presence of preplus disease and advanced stages of ROP, as well as bleeding are independent factors associated with the development of plus disease. These factors help to identify patients who need more vigilance.

SESSION 3: Prevention of ROP
Care during the first golden hour
Ashok Deorari / India

Automated systems for delivering and monitoring oxygen
Juan Carlos Barrera / Mexico

The role of nurses in preventing visual loss from ROP
Elisa Ramos Padilla / Mexico

The role of the pediatrician / neonatologists in preventing ROP
Raul Villegas Silva / Mexico

Parent engagement including kangaroo care
Zandra Grosso / Colombia

Rapid Fire Papers / Discussion
Lead: Alejandra G. de Alba Campomanes

A practical and effective approach to the prevention of childhood blindness due to ROP in Peru
Luz Gordillo / Peru

More than a decade of surveillance of retinopathy of prematurity (ROP within a National Program in Argentina)
Alicia Matilde Benitez / Argentina

Workshop 4: Strategies to prevent brain damage in the premature

Lead: Brian A. Darlow / New Zealand

The retina is an extension of the CNS and the eye a window to the brain. This session will review current interest in both nutritional practices / supplements and pharmacological agents targeting oxidative injury, inflammation and alterations in growth factors that affect both organs and may lead to neuroprotection and impact upon ROP and longer-term outcomes.

Each presentation will last for 10 minutes and there will be 30 minutes for questions and discussion.

Prenatal steroids
Monica Villa Guillen / Mexico

Magnesium sulfate
Edith Gonzalez / Mexico

Caffein
Antonio Calderon Moore / Mexico

Nutrition
Raul Villegas Silva / Mexico

Erythropoietin
Brian A. Darlow / New Zealand

Ventilation
Javier Lara / Mexico

Pharmacology intervention
Jacob Aranda / USA

Workshop 5: Kangaroo care and more
Lead: Zandra Grosso / Colombia

Kangaroo care of babies with low birth weight was conceived and implemented in countries which lacked human and technical resources for adequate care of the premature infant. It is physiological, human and emotionally appropriate for all premature infants and complements neonatal care. Kangaroo care can be used for preterm and low birth weight babies. It gives beneficial effects on the neurological development, weight gain and nutrition and promotes empowerment of mothers and families.

Kangaroo care
Zandra Grosso / Colombia

Oxygen toxicity
Adela Carapia Cortes / Mexico

Taking care of the temperature
Blanca Miriam Quintanar Salgado / Mexico

Keeping germs away
Dafne Fanny Marcel / Mexico

Bringing parents closer
Alicia Matilde Benitez / Argentina

Assisting the retinologist
Javier Perez Gutierrez / México

Workshop 6: Management of difficult cases of ROP

Lead: Graham Quinn / USA
Difficult cases
Luz Gordillo / Peru

Dr. Gordillo presented several complicated cases, their management and the results obtained.

Transpupillary Laser
Natalia Matti / Mexico

Slit-lamp Laser
Juan Carlos Bravo Ortiz / Mexico

Dr. Bravo explained the technique of laser application in premature babies through a slit lamp. He made some recommendations on how to carry the baby and how to prepare the lamp.

Combined Therapy
Martin Flores Aguilar / Mexico

Dr. Flores talked about the management of retinopathy of prematurity with the different therapeutic options that exist and mentioned how the use of lasers and antiantiangiogenics can be combined especially in cases such as those of a posterior aggressive retinopathy.

Differential diagnosis
Odalis Arambulo de Borin / Venezuela

Dr. Arambulo spoke about the differential diagnosis of retinopathy of prematurity. It included cases of toxoplasmosis, toxocariasis and retinoblastoma.

Aggressive later ROP
Michael Shapiro / USA

Dr. Shapiro spoke about the problems of the definition of posterior aggressive retinopathy and plus disease. He emphasized the need for unified criteria. As well as a new classification that covers in detail the findings in the Posterior Aggressive Disease. He talked about how the standardized image of "plus" can be confusing and of little help.

September 2nd, Saturday

7.00

Breakfast with the experts / View posters
Coordinator: Juan Carlos Bravo Ortiz 1.

Surgery: Stage IV and V For Ophthalmologists
Lead: Violeta Robredo Torres

Experts: Ermilo Sanchez Buenfil Lam Wai Ching Khaled Tawansy Parag K. Shah

Topics like Surgical management of grade IV and V retinopathy, Different surgical options available, the use of scleral cerclage as primary therapy and adjuvant with vitrectomy and The performance of lensectomy were discussed. There was talk of open surgery in ROP V and how the main thing in ROP surgery is to release traction without doing retinotomies and not try to apply the retina during surgery.This will happen over time if the tractions are released. We also spoke about the technical difficulty of these procedures and how it is convenient for a system to always be the same doctors who perform them.

Perinatal strategies for ROP prevention For Neonatologists
Lead: Monica Villa Guillen

Experts: Raul Villegas Silva Manuel Cazares Ortiz Juan Carlos Barrera Edith Gonzalez Brian A. Darlow

SESSION 4: Imaging in ROP Screening Ret Cam Luz Consuelo Zepeda Romero / Mexico

Dr. Zepeda talked about the Use of the RetCam system and how it came to revolutionize the way the ROP is understood, as an icon in the management of ROP already with 20 years in the market, currently facing serious competition with the emergence of new systems that allow photographing the retina of the newborn.

Smartphone Pedro Julio Acevedo / Colombia Dr. Acevedo spoke about the use of smartphones for the photo-documentation of retinopathy of prematurity. Highlighting some relative limitations such as the area to be photographed, which are exceeded due to their low cost and high accessibility.

Teleophthalmology
Diego Ossandon Villaseca / Chile

Dr. Ossandon explained how telemedicine has allowed to extend the ROP screening in Chile, being the exploration carried out by the nurse in charge of the program in each NICU, sending the image to a database that collects the patient's variables and allows to register the findings of serial valuations.

Fluorescein angiography: findings and usefulness

Domenico Lepore / Italy
Dr Lepore explained the Use of FAG, especially in patients managed with antiangiogenic agents to observe late recurrences and determine the need for laser in the remaining avascular retina. Highlighted the large proportion of patients who remain with avascular zones in zone IIB and III after injection with antiangiogenics, as well as the need to monitor these cases closely, and / or consolidate them with laser.

Optical coherence tomography
Cindy Toth / USA

He spoke about the use of OCT in ROP and macular findings (edema) and its possible correlation with visual prognosis. Dr. Cindy Toth exposed the retinal findings of premature patients using OCT, which allows to identify in axial and lateral sections with a resolution of 5um and 15um respectively the subcellular layers of the retina:

a) Layer of nerve fibers, external and internal plexiform, b) Nuclear layer of ganglion cells, and internal nuclear, c) Nuclear layer of photoreceptors, d) External limiting membrane, e) Layer of internal ellipsoid segments, f) Segment interface external, g) Retinal and choriocapillary pigmentary epithelium.

Potential for a paradigm change in screening using new technology

Anand Vinekar / India
Dr. Vinekar spoke about the use of telemedicine in India and the success of it. He explained the logistics that they used to carry the systems of photodocumentation and new Hindu manufacturing laptops to different sites.

Rapid Fire papers / Discussion

Lead: Alejandra G. de Alba Campomanes

Optical coherence tomography angiography in ROP
J. Peter Campbell / USA

Evaluating the use of a portable, non-contact fundus camera for ROP screening by non-ophthalmologist health care workers.

S. Grace Prakalapakorn / USA

Outcomes of Telescreening for Retinopathy of Prematurity in Rural South India
The Aravind Experience.
V. Narendran / India
Dr. Narendran spoke about his experience telemedicine in India and how it is possible with just one team to reach many communities.

SESSION 5: Treatment of ROP
Anti-VEGF agents - ophthalmologists perspectives
Anna Ells / Canada
Anti-VEGF agents - neonatologists perspectives
Brian A. Darlow / New Zealand
Dr. Darlow mentioned that neonatologists are somewhat skeptical about the use of antiantiogenics.

Experience of combined therapy in Mexico
Leonor Hernandez Salazar / Mexico

Prophylactic laser and fluorescein angiography after bevacizumab for ROP
Michael Blair / USA

Dr. Blair spoke about his recommendations for the use of adjuvant laser to antiangiogenic once the 64 corrected weeks of gestation are met and an avascular retina area remains. He talked about how the disease can be reactivated years later if these avascular zones are not treated

Anti-VEGF agents - Panel discussion
Lead: Anna Ells / Canada
Brian Darlow / New Zealand
Helen Mintz-Hittner / USA
Gabriel Dib Taissoun / Venezuela
Abdiel Esquivel Aguilar/ Mexico
Juan Carlos Barrera / Mexico

Two cases of retinopathy of prematurity were presented in the discussion panel. In general, in cases of posterior aggressive retinopathy, all used combined therapy, others used the antiangiogenic agent and waited to see the response. The common factor was that all used antiangiogenic in the disease in zone 1.

Laser treatment of difficult cases
Mangat Ram Dogra / India
Rapid Fire papers / Discussion
Lead: Luz Consuelo Zepeda Romero

Treatment- advanced ROP: missing links in the chain of events leading to late presentation in Eastern India

Ranjan Padhi Tapas / India
A data base created over 8 years in East India was retrospectively analyzed to find the reason for late presentation in babies with ROP stage 4 and / or 5 (advanced).

The main causes for late presentation were late and low quality referrals made by the first care provider (pediatrician or neonatologist) in 64.6% of the cases, in 6.9% of the cases, the father omitted the indication to seek ophthalmologic care, poor communication with parents to achieve follow-up was identified in 20.8% of cases.

This series shows barriers at multiple levels that affect the practice of ROP screening. About 85% of delays in care are related to the provider of medical services (pediatrician / neonatologist, followed by ophthalmologists) which must be prevented. This work draws attention to promote greater training, advocacy and better performance of ROP screening in the health provider.

Two cases of retinopathy of prematurity were presented in the discussion panel. In general, in cases of later aggressive retinopathy, all used combination therapy, others used the antiangiogenic agent and waited to see the response. The common factor was that all used antiangiogenic in the disease in zone 1.

Laser treatment of difficult cases

Mangat Ram Dogra / India
Rapid Fire papers / Discussion
Lead: Luz Consuelo Zepeda Romero
Treatment-naïve advanced ROP: missing links in the chain of events leading to late presentation in Eastern India

Tapas Ranjan Padhi / India

Two cases of retinopathy of prematurity were presented in the discussion panel. In general, in cases of posterior aggressive retinopathy, all used combination therapy, others used the antiangiogenic agent and waited to see the response. The common factor was that all used antiangiogenic in the disease in zone 1.

Laser treatment of difficult cases
Mangat Ram Dogra / India
Rapid Fire papers / Discussion
Lead: Luz Consuelo Zepeda Romero

Treatment-naïve advanced ROP: missing links in the chain of events leading to late presentation in Eastern India

Ranjan Padhi Tapas / India

A data base created over 8 years in East India was retrospectively analyzed to find the reason for late presentation in babies with ROP stage 4 and / or 5 (advanced).

The main causes for late presentation were late and low quality referrals made by the first health care provider (pediatrician or neonatologist) in 64.6% of the cases, in 6.9% of the cases, the father omitted the indication to seek ophthalmologic care, poor communication with parents to achieve follow-up was identified in 20.8% of cases.

This series shows barriers at multiple levels that affect the practice of ROP screening. About 85% of delays in care are related to the provider of medical services (pediatrician / neonatologist, followed by ophthalmologists) which must be prevented. This work draws attention to promote greater training, advocacy and better performance of ROP screening in the health provider.

A Phase 1 dosing study of bevacizumab for

ROP: plasma sVEGF levels and 6 month outcomes

David Wallace / USA

Dr. Wallace spoke about the work that is being done through the PEDIG in which they seek to determine the minimum useful dose for the management of ROP. So far they have made dilutions finding the same effect. He mentions that the usual dose (0.7mg) is probably 1000 times that needed to achieve the desired effect. Until now, despite the dilutions, the systemic suppression of VEGF remains the same.

Coffee break

SESSION 6: Follow up of preterm infants with and without ROP and rehabilitation. Other topics

How to set up and run an efficient and effective
ROP program
Andrea Zin / Brazil
Cortical visual impairment and ROP
Silvia Moguel Ancheita / Mexico
Refractive errors
Perumalsamy Vijayalakshmi / India
Rehabilitation of infants and children with visual loss from ROP
Vanessa Bosch
Surgery for Stage 4 ROP: Panel Discussion
Lead: Rajvardhan Azad / India
Violeta Robredo Torres / Mexico
Lam Wai Ching / Canada
Khaled Tawansy / USA
Subhadra Jalali / India
They spoke about the technical difficulties of these procedures and the necessity of training to use it. Different available options of lensectomy, cerclaje and vitrectomy were discussed.

Rapid Fire Papers / Discussion
Lead: Andrea Zin
Visual outcomes at age 27-29 years in a national
cohort of VLBW infants in New Zealand
Brian A. Darlow / New Zealand
Retinal vessel architecture in young adults born extremely preterm
Clare Wilson / UK
Review and new insights on the ocular manifestations in congenital zika syndrome
Camila Ventura / Brazil
Dr. Ventura spoke about the epidemic microcephaly that occurred in Brazil associated with ZIKA virus. He showed images of the ocular manifestations found including the foci of chorioretinitis. Highlighted the neurotropicity of the virus, which damages the eye with preference in the macula, optic nerve.

Workshop 7: How to deliver oxygen safely

Lead: Maria Jovita Plascencia Ordaz
This workshop will explore the evidence on the administration of the oxygen, the handling of the mixers; the knowledge of the potential damage of an inappropriate handling could be given to these patients. Each presentation will last 12 minutes and we will have 30 minutes of discussion.

Pulse oximetry
Elisa Ramos Padilla / Mexico
Hyperoxia in the Premature Brain
Javier Lara / Mexico
Blender
Adela Carapia / Mexico
Monitors
Dafne Fanny Marcel / Mexico
Alarms
Brian A. Darlow / New Zealand

Workshop 8: Setting up a telemedicine service

ROP NET
Lead: Juan Ubiera / Dominican Republic
Today, one of the major problems in ROP programs is the difficulty in accessing and transferring preterm infants, as well as the limited amount of medical staff available for the early detection of retinopathy. In this workshop, we will appreciate the importance of Telemedicine as a technological tool that allows us to overcome these obstacles. Each presentation will last 10 minutes and we will have 30 minutes of discussion.

Telemedicine in India
Anand Vinekar / India
What about Mexico?
Juan Carlos Juarez Echenique / Mexico
What’s new in Argentina?
Guillermo Monteoliva / Argentina
What’s new in Chile?
Diego Ossandon Villaseca / Chile
WhatsApp
Alejandro Vazquez de Kartzow / Chile
Using the net in Colombia
Pedro Julio Acevedo / Colombia

Workshop 9: Beyond ROP
Lead: Silvia Moguel Ancheita
The problem of children with retinopathy of prematurity does not end in trying to improve their oxygenation conditions and avoid retinal injury. Far beyond, as doctors we are responsible for evaluating the effects of premature on the child’s brain, its complications and delays, and commit ourselves to a better rehabilitation and integration to a better development of the person. In this workshop, we will review chain effects of premature damage, from vision, attention mechanisms, encephalopathy, neurological control, orbital rehab, and more, to legal conditions that should modify and ensure a better health policy that reaches all social strata. Let’s make a better world together for them! Join us!

Brain damage in ROP
Adriana Valdes Barrena / Mexico
Vision but not attention
Silvia Moguel Ancheita / Mexico
What to do in strabismus and nystagmus?
Martha Alicia Ramirez / Mexico
Amblyopic difficulties
Eva Camerina Lopez Diaz Barriga / Mexico
Orbital damage after ROP
Sara Isabel Plazola Hernandez / Mexico
Politicians and doctors working together
Daisy Maria Guardado De Alfonso / El Salvador
ROP México
CDMX 2017