Topical application of Ringer’s lactate for Stage 1 Retinopathy of Prematurity: A potential treatment hypothesis

IF 2.1 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Medical hypotheses Pub Date : 2024-11-17 DOI:10.1016/j.mehy.2024.111523

Vignesh Elamurugan , Siddharth Narendran , Toshit Varshney , K.Naresh Babu , Renu P Rajan , Pragathi Shankaralingappa , Gopinathan Mathiyazhagan

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引用次数: 0

Abstract

Retinopathy of Prematurity (ROP) is a disorder affecting the developing retinal vasculature in preterm infants and is one of the major preventable causes of childhood blindness worldwide. The pathogenesis of ROP is characterized by two distinct phases: Phase 1 occurs when preterm infants are exposed to relative hyperoxia compared to in-utero conditions, either from atmospheric oxygen or supplemental therapy. This exposure causes vaso-obliteration and disrupts peripheral retinal vascularization. In Phase 2, the resulting peripheral avascular retina becomes hypoxic, triggering the release of pro-angiogenic factors like VEGF. This leads to proliferative retinopathy, potentially causing complications such as retinal detachment and permanent blindness in affected neonates. Current management strategies in ROP include intravitreal anti-VEGF injections and laser photocoagulation.

Lactate is a well-known pro-angiogenic molecule. We hypothesize that topical administration of lactate in the form of Ringer’s lactate solution in the eye in Phase 1 of ROP would allow normal retinal vascularisation, potentially preventing the progression of ROP to Phase 2. This approach warrants investigation as a potential therapy to reduce the incidence of phase 2 ROP and its complications.

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局部应用乳酸林格氏液治疗 1 期早产儿视网膜病变：一种潜在的治疗假设

早产儿视网膜病变（ROP）是一种影响早产儿视网膜血管发育的疾病，是全球儿童失明的主要可预防原因之一。早产儿视网膜病变的发病机制分为两个不同的阶段：第一阶段发生在早产儿暴露于相对于胎儿期的高氧环境时，高氧来自大气中的氧气或补充治疗。这种暴露会导致血管闭塞，破坏外周视网膜血管形成。在第二阶段，外周无血管视网膜变得缺氧，引发血管生成因子（如血管内皮生长因子）的释放。这会导致增殖性视网膜病变，有可能引起视网膜脱离等并发症，并导致患病新生儿永久失明。目前治疗视网膜病变的策略包括玻璃体内注射抗血管内皮生长因子和激光光凝。我们假设，在 ROP 第一阶段，以林格氏乳酸盐溶液的形式在眼内局部注射乳酸盐，可使视网膜血管正常化，从而有可能防止 ROP 进展到第二阶段。这种方法作为一种潜在的疗法，可降低 ROP 第 2 期的发病率及其并发症，值得研究。

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来源期刊

Medical hypotheses 医学-医学：研究与实验

CiteScore

10.60

自引率

2.10%

发文量

167

审稿时长

60 days

期刊介绍： Medical Hypotheses is a forum for ideas in medicine and related biomedical sciences. It will publish interesting and important theoretical papers that foster the diversity and debate upon which the scientific process thrives. The Aims and Scope of Medical Hypotheses are no different now from what was proposed by the founder of the journal, the late Dr David Horrobin. In his introduction to the first issue of the Journal, he asks ''what sorts of papers will be published in Medical Hypotheses? and goes on to answer ''Medical Hypotheses will publish papers which describe theories, ideas which have a great deal of observational support and some hypotheses where experimental support is yet fragmentary''. (Horrobin DF, 1975 Ideas in Biomedical Science: Reasons for the foundation of Medical Hypotheses. Medical Hypotheses Volume 1, Issue 1, January-February 1975, Pages 1-2.). Medical Hypotheses was therefore launched, and still exists today, to give novel, radical new ideas and speculations in medicine open-minded consideration, opening the field to radical hypotheses which would be rejected by most conventional journals. Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.