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Yucel OE, Eraydin B, Niyaz L, Terzi O. Incidence and risk factors for retinopathy of prematurity in premature, extremely low birth weight and extremely low gestational age infants. BMC Ophthalmol 2022; 22:367. [PMID: 36096834 PMCID: PMC9469514 DOI: 10.1186/s12886-022-02591-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. METHODS The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. RESULTS Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. CONCLUSIONS ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.
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Affiliation(s)
- Ozlem Eski Yucel
- Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine, 55139, Atakum, Samsun, Turkey.
| | - Bilge Eraydin
- Department of Ophthalmology, Bafra State Hospital, Samsun, Turkey
| | - Leyla Niyaz
- Department of Ophthalmology, Ondokuz Mayis University Faculty of Medicine, 55139, Atakum, Samsun, Turkey
| | - Ozlem Terzi
- Department of Public Health, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Sabri K, Ells AL, Lee EY, Dutta S, Vinekar A. Retinopathy of Prematurity: A Global Perspective and Recent Developments. Pediatrics 2022; 150:188757. [PMID: 35948728 DOI: 10.1542/peds.2021-053924] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a significant cause of potentially preventable blindness in preterm infants worldwide. It is a disease caused by abnormal retinal vascularization that, if not detected and treated in a timely manner, can lead to retinal detachment and severe long term vision impairment. Neonatologists and pediatricians have an important role in the prevention, detection, and management of ROP. Geographic differences in the epidemiology of ROP have been seen globally over the last several decades because of regional differences in neonatal care. Our understanding of the pathophysiology, risk factors, prevention, screening, diagnosis, and treatment of ROP have also evolved over the years. New technological advances are now allowing for the incorporation of telemedicine and artificial intelligence in the management of ROP. In this comprehensive update, we provide a comprehensive review of pathophysiology, classification, diagnosis, global screening, and treatment of ROP. Key historical milestones as well as touching upon the very recent updates to the ROP classification system and technological advances in the field of artificial intelligence and ROP will also be discussed.
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Affiliation(s)
- Kourosh Sabri
- Department of Ophthalmology, McMaster University, Ontario, Canada
| | - Anna L Ells
- Calgary Retina Consultants, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Y Lee
- Department of Ophthalmology, McMaster University, Ontario, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, India
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Kumawat D, Sachan A, Shah P, Chawla R, Chandra P. Aggressive posterior retinopathy of prematurity: a review on current understanding. Eye (Lond) 2021; 35:1140-1158. [PMID: 33514899 PMCID: PMC8115681 DOI: 10.1038/s41433-021-01392-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023] Open
Abstract
A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.
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Affiliation(s)
- Devesh Kumawat
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anusha Sachan
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Shah
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Simkin SK, Misra SL, Han JV, McGhee CNJ, Dai S. Auckland regional telemedicine retinopathy of prematurity screening network: A 10-year review. Clin Exp Ophthalmol 2019; 47:1122-1130. [PMID: 31313447 DOI: 10.1111/ceo.13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Retinopathy of prematurity (ROP) is a potentially blinding condition affecting the retinae of premature infants. Effective screening is necessary for timely treatment. BACKGROUND The Auckland Regional Telemedicine ROP (ART-ROP) network, utilizes wide-field digital imaging for ROP screening. This study reviews the ART-ROP network. DESIGN Retrospective analysis of the ART-ROP database. PARTICIPANTS Files of infants in ART-ROP from 2006 to 2015. METHODS Data on infant demographics, ROP stage, treatment and outcome was collected. MAIN OUTCOME MEASURES The efficacy of ART-ROP in the management of ROP. RESULTS A review of 1181 infants across three neonatal intensive care units, was completed. Infants had a mean of four screening sessions with no infants who met ROP screening criteria being missed. Type 1 ROP was present in 83 infants, who had significantly lower average birth weight 786 ± 191 g compared to 1077 ± 285 g (P < .001), and gestational age 25.3 ± 1.7 weeks compared to 27.8 ± 2.2 weeks (P < .001) than the screened cohort. The number of infants requiring screening increased (R2 = .7993), yet treatment rates decreased (R2 = .9205) across the time period. Out-patient clinic follow-up was attended by 75.10% of infants screened and there was no missed ROP in those infants seen. CONCLUSIONS AND RELEVANCE ART-ROP solely uses wide-field digital imaging for ROP diagnosis, and management, including discharge, of infants. This detailed review of ART-ROP indicates an increase in screening demand, but a decrease in the rate of type 1 ROP. The ART-ROP telemedicine model demonstrates real potential to address workforce shortage in ROP screening.
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Affiliation(s)
- Samantha K Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Shuan Dai
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Padidam S, Le K, Lin X. Refractive Trend of Stage 3 Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2018; 55:403-406. [PMID: 30452767 DOI: 10.3928/01913913-20180905-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the yearly refractive trend in patients with stage 3 retinopathy of prematurity (ROP) over a 7-year time period. METHODS This was a retrospective review of 70 eyes of 35 patients with stage 3 ROP. RESULTS Of the 70 eyes, 46 received laser ablation and 24 did not. There was a similar distribution between zone II and zone III disease in both groups (P = .87). The average final refraction in the laser group was -0.83 diopters (D) in comparison to +1.61 D in the no laser group. The final refractive change was -3.55 D in the laser group and -0.25 D in the no laser group. A greater myopic shift was observed in the first 2 years of life than between years 2 and 7 in both groups. CONCLUSIONS Infants who underwent laser treatment for stage 3 ROP tended to have higher myopia than those with stage 3 ROP who did not require treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(6):403-406.].
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Kara C, Hekimoğlu E, Petriçli İS, Akıl H. Intravitreal bevacizumab as rescue therapy following treatment failure with laser photocoagulation in retinopathy of prematurity. J Curr Ophthalmol 2018; 30:80-84. [PMID: 29564414 PMCID: PMC5859210 DOI: 10.1016/j.joco.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/30/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal bevacizumab (IVB) in case of treatment failure with laser photocoagulation in retinopathy of prematurity (ROP). METHODS A retrospective review of infants treated with IVB injection due to treatment failure with laser photocoagulation was performed. The anatomical results and complications were evaluated after treatment. RESULTS 9 eyes of 6 premature infants with a mean gestational age of 26.8 ± 3.0 weeks (range, 23-32 w) and mean birth weight of 958 ± 319 g (range, 600-1400 g) were identified. Six of the eyes had zone 1 disease, and all of these eyes were classified as aggressive posterior ROP (APROP). Three of the eyes had zone 2 disease, and one of these eyes was classified as APROP, and the other two eyes were classified as high-risk pre-threshold disease. All of the eyes showed regression of the disease except one patient, both eyes of whom progressed to stage 4A. None of the patients developed ocular and systemic complications at the end of the six-month follow-up period. CONCLUSION IVB could be an option in patients with ROP in whom laser photocoagulation failed.
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Affiliation(s)
- Caner Kara
- Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey
| | | | - İkbal Seza Petriçli
- Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey
| | - Handan Akıl
- Nevsehir State Hospital, Department of Ophthalmology, Nevsehir, Turkey
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Holmström G, Hellström A, Jakobsson P, Lundgren P, Tornqvist K, Wallin A. Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register. Br J Ophthalmol 2016; 100:1656-1661. [DOI: 10.1136/bjophthalmol-2015-307263] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 02/02/2016] [Accepted: 02/22/2016] [Indexed: 11/03/2022]
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Brown KA, Heath Jeffery RC, Bajuk B, Shadbolt B, Essex RW, Todd DA. Sight-Threatening Retinopathy of Prematurity: Changing Trends in Treatment. J Pediatr Ophthalmol Strabismus 2016; 53:90-5. [PMID: 27018882 DOI: 10.3928/01913913-20160122-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 12/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the incidence and treatment of severe retinopathy of prematurity (ROP) in infants younger than 30 weeks' gestational age (GA) in New South Wales and the Australian Capital Territory, Australia, from 2003 to 2008. These data were then compared to data from previously reported epochs (1986 to 1987, 1992 to 1997, and 1998 to 2002). METHODS Data were divided into two sub-epochs (2003 to 2005 and 2006 to 2008) to study trends and combined to compare over 22 years. RESULTS From 2003 to 2008, 2,550 of 3,004 (84.9%) infants survived, 200 (7.8%) were diagnosed as having severe ROP, and 119 (59.5%) required laser therapy. No significant difference in the incidence of severe ROP or treatment rate in infants younger than 27 and 30 weeks' GA from 2003 to 2005 and 2006 to 2008 occurred. Similarly, between 1986 and 2008 there was no difference in the incidence of severe ROP. However, the treatment rate significantly increased during this time. CONCLUSIONS The incidence of severe ROP has been stable since 1986. However, laser treatment significantly increased to include 8 infants with stage 2 ROP from 2003 to 2008.
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van den Akker-van Marle ME, van Sorge AJ, Schalij-Delfos NE. Cost and effects of risk factor guided screening strategies for retinopathy of prematurity for different treatment strategies. Acta Ophthalmol 2015; 93:706-12. [PMID: 26149829 DOI: 10.1111/aos.12798] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/30/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the cost and effects of risk factor guided screening strategies for retinopathy of prematurity. METHODS Clinical data from the Netherlands Retinopathy of Prematurity study (NEDROP study) that included all infants screened for ROP and born in 2009 were used to assess the cost and effects of several screening strategies for ROP using different criteria: (1) gestational age (GA), (2) birthweight (BW), (3) combined GA-BW and (4) combined GA-BW and presence of risk factors. Two treatment strategies were evaluated: the infants actually treated in the NEDROP study (n = 17) and all infants detected with severe ROP (n = 29). RESULTS The most efficient screening strategy to include all infants treated for both treatment strategies is to screen all infants with a GA of 30 weeks or less and a BW of 1250 g or lower together with infants with a GA of 30-32 weeks and a BW of 1250-1500 g with at least one risk factor. The marginal cost ranged from €43 848 to € 226 914 per additional infant with improved vision. CONCLUSION The current Dutch guideline may be improved: the same effectiveness can be obtained for lower costs. Releasing the precondition that no infants with severe ROP might be missed will lead to lower costs, but this will also lead to a lower number of infants with improved visual acuity. The costs of detecting all infants with severe ROP seem acceptable for society when the QALY gain and savings from a societal perspective resulting from improved vision are taken into account.
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Affiliation(s)
| | - Arlette J. van Sorge
- Department of Ophthalmology; Leiden University Medical Center; Leiden The Netherlands
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Darlow BA. Retinopathy of prematurity: New developments bring concern and hope. J Paediatr Child Health 2015; 51:765-70. [PMID: 25757043 DOI: 10.1111/jpc.12860] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 12/22/2022]
Abstract
Blindness from retinopathy of prematurity (ROP) in Australian and New Zealand is an uncommon event although 3% of <31 weeks gestation infants receive treatment for the disease. New world-wide estimates of the incidence of blindness from ROP are much higher than previously at 20 000 children annually. The impact of severe ROP can be reduced through good evidence-based care of very preterm infants and careful organisation of eye examinations and follow-up services. Recent oxygen saturation targeting trial results might mean the adoption of higher targets than formerly in very preterm infants and will require vigilance to ensure all eligible infants are examined appropriately. A true screening examination for acute ROP might involve non-opthalmologists obtaining photographic retinal images and remote reading of these. Although treatment with laser gives good outcomes, there is interest in intravitreal anti-vascular endothelial factor agents, but issues concerning the systemic safety and retinal results of such treatment are unresolved.
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Affiliation(s)
- Brian A Darlow
- Department of Paediatrics, University of Otago at Christchurch, Christchurch, New Zealand
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Pulido CM, Quiram PA. Current understanding and management of aggressive posterior retinopathy of prematurity. World J Ophthalmol 2015; 5:73-79. [DOI: 10.5318/wjo.v5.i2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/12/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Aggressive posterior retinopathy of prematurity (ROP), previously referred to as “Rush disease”, is a rapidly progressive form of ROP. This form of ROP typically presents in very low birth weight babies of early gestational age. Historically, anatomical and functional outcomes have been poor with standard treatment. This review is designed to discuss current knowledge and treatment regarding this aggressive form of ROP. Recommendations regarding management of these difficult cases are detailed.
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Gunn DJ, Cartwright DW, Gole GA. Prevalence and outcomes of laser treatment of aggressive posterior retinopathy of prematurity. Clin Exp Ophthalmol 2014; 42:459-65. [PMID: 24330069 DOI: 10.1111/ceo.12280] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 10/17/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND To describe outcomes in a cohort of extremely premature infants treated for aggressive posterior retinopathy of prematurity by diode laser panretinal photocoagulation. DESIGN Retrospective study. PARTICIPANTS Fifteen eyes in eight infants. METHODS A review was carried out on infants between 23 and 25.6 weeks gestational age admitted to The Royal Brisbane and Women's Hospital neonatal intensive care unit between 1992 and 2009. MAIN OUTCOME MEASURES Success of treatment, visual and refractive outcomes. RESULTS Five hundred fifty-four infants were admitted to neonatal intensive care unit, 373 survived till screening, and 304 had retinopathy of prematurity. Sixty-six infants required treatment, and eight of these had aggressive posterior retinopathy of prematurity (2.5% of all infants with retinopathy of prematurity). Mean gestational age was 24.2 weeks, mean birthweight was 634 g, and treatment occurred at mean 34.1 weeks post-menstrual age. The mean total number of burns per eye was 2967. Five of 15 treated eyes required retreatment. Two patients subsequently died of unrelated causes. Regression occurred in 9 of 11 remaining eyes; one eye progressed to stage 4b and another to stage 5 retinopathy of prematurity. Vitrectomy was performed in two eyes. Five eyes had 6/12 vision, one had 3/60, and three had no perception of light. Of the remaining two eyes, one had good fixation and the other had poor fixation. CONCLUSIONS Despite good structural outcomes, visual outcomes for conventional laser treatment of aggressive posterior retinopathy of prematurity are poor.
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Affiliation(s)
- David J Gunn
- Department of Ophthalmology, Royal Children's Hospital, Brisbane, Queensland, Australia
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Abstract
In prematurely born children, various visual and ophthalmologic sequelae occur because of both retinopathy of prematurity (ROP) and preterm birth per se. Several long-term follow-up studies have described the outcome of ROP. Visual impairment and blindness are well-known consequences, but the prevalence varies globally because of differing neonatal and ophthalmologic care. Improving treatment options and criteria for the treatment of ROP are continuously changing the ophthalmologic outcome. The anatomic outcome has improved with treatment, but good anatomic outcome in treated severe ROP does not always reflect the functional outcome. There is no consensus regarding long-term follow-up of prematurely born children.
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Affiliation(s)
- Gerd Holmström
- Department of Neuroscience/Ophthalmology, University Hospital, Uppsala University, Uppsala 75185, Sweden.
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