A prospective randomized trial in which pre-term newborns were randomized to receiving oral propranolol with standard treatment or standard treatment alone found that oral propranolol showed a 48% relative risk reduction for progression to stage 3, 58% reduction for progression to stage 3 plus, and 100% reduction for progression to stage 4. Furthermore, there was a 52% relative risk reduction for the need for laser treatment or intravitreal bevacizumab. However 19% of the newborns experienced serious adverse effects including hypotension and bradycardia. A study in a mouse model of human ROP has shown that beta-blockade is protective against retinal angiogenesis and ameliorate blood-retinal barrier dysfunction. Follow up
Once diagnosed with ROP lifelong follow up (yearly) is performed in some centers. In others, only children treated for ROP are followed yearly. Follow up after laser or anti-VEGF treatment is individualized. Follow up of premature children (with or without ROP) is varying among centers and countries, mirroring the diverse states of health care system in different countries. Prognosis
Stages 1 and 2 do not lead to blindness. However, they can progress to the more severe stages. Threshold disease is defined as disease that has a 50% likelihood of progressing to retinal detachment. Threshold disease is considered to be present when stage 3 ROP is present in either zone I or zone II, with at least five continuous or eight total clock hours of disease, and the presence of plus disease.
Human piebaldism has been observed to be associated with a very wide range and varying degrees of endocrine disorders, and is occasionally found together with heterochromia of the irises, congenital deafness, or incomplete gastrointestinal tract development, possibly all with the common cause of premature cutting off of human fetal growth hormone during gestation. Piebaldism is a kind of neurocristopathy, involving defects of various neural crest cell lineages that include melanocytes, but also involving many other tissues derived from the neural crest. Oncogenic factors, including mistranscription, are hypothesized to be related to the degree of phenotypic variation among affected individuals. Genetics
Piebaldism is an autosomal dominant hereditary condition, which tends to produce high rates of inheritance and long chains of generational transmission. All who inherit the gene have at some time in life evidence of piebald hypopigmentation of the hair or skin, most likely both.Piebaldism may be associated with the genes KIT or SNAI2. Diagnosis
Usually diagnosed at birth with the appearance of patches of white skin on the arms, legs, stomach, forehead, and a white lock of hair. History
Early photographers took many photographs of African people with piebaldism as a form of entertainment and exoticism, and George Catlin is believed to have painted several portraits of Native Americans of the Mandan tribe who were affected by piebaldism.Historically, persons with extensive piebaldism have experienced abuse of the sort still suffered in the present by albinos, especially in Africa.