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Purpose: To review systemic modifiable factors that might downregulate pathologic levels of vascular endothelial growth factor (VEGF) in prethreshold retinopathy of prematurity (ROP), and thereby reduce the risk of blindness in affected infants. Methods: Review of the author's clinical experience as compared to the STOP-ROP study, and discussion and literature review of the potential effects of oxygen supplementation, light adaptation state, and correction of severe anemia on the course of prethreshold retinopathy of prematurity (ROP). Results: Moderate oxygen supplementation, combined with light adaptation to reduce retinal oxygen consumption and correction of severe anemia, were associated, in the author's experience, with improvement in the clinical course of prethreshold ROP. Withdrawal of these measures was often associated with deterioration of ROP. Conclusion: Systemic measures can be taken that may reduce the risk of blindness in infants with prethreshold ROP. For those infants who require laser treatment for threshold ROP, prior efforts to moderate excessive levels of VEGF may improve the chances of a successful surgical result, by slowing the momentum of the disease.

Objective To report an unusual case of diffuse retinal hemorrhage associated with strangulation in a neonate with a tightly wrapped nuchal cord around his neck at birth who was noted to have eyelid and subconjunctival petechial hemorrhages upon delivery. Methods Clinical diagnostic examination as well as postmortem gross and histopathologic examination of ocular and central nervous system structures was performed. Results Funduscopic and gross pathologic examination of the eyes revealed extensive unilateral retinal hemorrhage of the right eye only. This was corroborated by histopathologic studies, which revealed unilateral diffuse hemorrhage throughout all nuclear layers of the retina with a particularly dense nerve fiber layer and sub-internal limiting membrane hemorrhage in the macula along with extraocular muscle and episcleral hemorrhage. Clinical, gross, and microscopic examination also revealed multiple areas of hemorrhage involving the right side of the brain and throughout the cerebellum. Conclusion Although retinal findings in nonaccidental trauma are common, accidental strangulation retinopathy in neonates is a rare occurrence. To the authors' knowledge, this case is the only documented histopathologic study of hemorrhagic retinopathy associated with strangulation in the literature.