Retinopathy of prematurity in infants of birth weight > 2000 g after haemorrhagic shock at birth.

BACKGROUND: The risk of retinopathy of prematurity (ROP) is associated with low birth weight and low gestational age. For ROP screening examination is recommended in infants weighing < or = 1500 g or of less than 32 weeks' gestational age. METHODS: From 1991 ROP screening was performed in 452 premature infants with either a birth weight < or = 1500 g (n = 303) or a birth weight > 1500 g (n = 149) and who required additional oxygen supplementation or underwent surgery with general anaesthesia before estimated term. RESULTS: Unexpectedly, three infants with birth weights between 2080 and 2325 g and a gestational age of 32 or 33 weeks developed stage 2 or 3 ROP. One of these underwent cryocoagulation. In three infants, preterm birth was induced by sudden placental abruption with severe prenatal blood loss followed by haemorrhagic shock. The umbilical cord packed cell volume was reduced to 0.14-0.19 (normal 0.43-0.63). All three infants underwent surgery with general anaesthesia within the first weeks of life. Of the remaining 449 infants none with a birth weight > 1650 g developed any stage of ROP. CONCLUSION: Severe prenatal blood loss requiring blood transfusions and surgery with general anaesthesia may induce higher stages of ROP even in infants with birth weights exceeding the usual screening criteria.     

Increased incidence of retinopathy of prematurity and evolving treatment modalities at a Canadian tertiary centre

ObjectiveTo determine the incidence of retinopathy of prematurity and severity of disease at a large Canadian tertiary care centre, as well as to determine risk factors for disease and current treatment practices.MethodsThis was a retrospective cohort study of infants admitted to the neonatal intensive care unit (NICU) at McMaster Children’s Hospital, who underwent screening for retinopathy of prematurity between August 2010 and August 2016.ResultsThe overall incidence of retinopathy of prematurity was 67.1% (418/623 infants); severe retinopathy of prematurity was seen in 14.3% (89/623). This signified an increase compared to our previous study at the same institution, where the incidence of retinopathy of prematurity was 40.4% and severe retinopathy of prematurity was 9.2% between 2006 and 2010. Stage 1 disease showed the greatest increase, from 9.0% (38/423) to 21.0% (131/623). Our cohort had a higher proportion of infants born at 24 weeks GA or less (15.7% vs 8.7%). Predictors of retinopathy of prematurity in a multivariate regression model were gestational age (OR = 0.829, p = 0.002), birth weight (OR = 0.712, p = 0.003) and length of NICU stay (OR = 0.844, p = 0.00). Treatment was performed in 10.5% (44/418) of infants with retinopathy of prematurity, with infants earlier in the study period mainly receiving laser photocoagulation and infants born in more recent years receiving intravitreal bevacizumab.ConclusionsThere has been an increase in retinopathy of prematurity incidence, both in early (stage 1) disease and in severe retinopathy of prematurity. This is partially explained by the almost doubling of the proportion of infants born at 24 weeks gestational age or less. Since mid-2013, intravitreal anti-VEGF therapy has replaced laser photocoagulation as the preferred treatment modality.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.     

Guidelines for ophthalmological screening of premature infants in Germany

These revised guidelines replace the previous guidelines on the screening of preterm infants for retinopathy of prematurity (ROP) that were published in 1999. Recently published research provided the impetus for this revision. These guidelines propose the following criteria for an efficient screening programme for the early detection and treatment of ROP in Germany: Inclusion criteria for ROP screening: All preterm infants with a gestational age of less than 32 weeks (if gestational age is unknown; of <1500 g birth weight) should be examined. In addition, all preterm infants with 32-36 weeks gestational age are included if postnatal oxygen was supplemented for more than 3 days. The first examination should be performed within the 5(th) week of postnatal age (day 36-42), but not prior to 31 weeks gestational age. Indications for laser photocoagulation: in Zone I: 1. any stage with "plus disease", 2. stage 3 without "plus disease." In Zone II: stage 3 with extraretinal proliferations in 5 continuous or 8 cumulative clock hours in combination with "plus-disease". In certain cases an earlier treatment may be indicated.     

Incidence and Risk Factors of Retinopathy of Prematurity in Babol,North of Iran

Purpose: To determine the incidence and risk factors for the development of retinopathy of prematurity (ROP) among premature infants.

Methods: New born infants with gestational age < 37 weeks were studied from October 2004 to April 2008. Potential risk factors, like gestational age (GA), birth weight (BW), supplemental oxygen therapy, acute respiratory distress syndrome (ARDS), sepsis, blood transfusion, and phototherapy were assessed.

Results: One hundred seventy-three newborn infants were evaluated. Mean BW ± standard deviation (SD) was 1680.64?±?462.5?g and Mean GA ± SD was 32.24?±?2.36 weeks. Incidence of ROP was 19% including 11.5% in prethreshold and 7.5% in threshold stages.

The incidence of ROP was 47.3% for infants with gestational age ≤ 32 weeks. All 33 infants with ROP had a gestational age of ≤ 34 weeks. The incidence of ROP was 33.3% for infants with BW < 1500 gr. ROP developed in 2 (6%) infants with BW > 2000 gr. Blood transfusion (Odds Ratio [OR]?=?2.45, P?=?0.031), phototherapy (OR?=?2.405, P?=?0.038), gestational age (OR?=?14.2, P?=?0001) and ARDS (OR?=?2.1, P?=?0.047) were associated to ROP. With multivariate logistic regression analysis, low GA and blood transfusion were related to ROP.

Conclusions: The results show that the incidence of ROP is relatively high in our region. Low GA, low BW, phototherapy, ARDS, and blood transfusion were the main risk factors for development of ROP.     

A population based, prospective study of the development of ROP in prematurely born children in the Stockholm area of Sweden.

A prospective population based study including 260 children with a birth weight of 1500 g or less was performed in the Stockholm county. The total incidence of retinopathy of prematurity (ROP) was 40.4%, while severe ROP--that is, stage 3 or more, was seen in 20.0%. Cryotherapy was performed in 10.8%. Logistic regression analysis revealed independent association of both gestational age and birth weight with ROP. The association of gestational age and ROP was significantly stronger, indicating that the degree of immaturity of the eye is a main predictive factor for the development of ROP. The purpose of a general screening for ROP is to identify children requiring cryotherapy. Based on these results it seems appropriate to include children with a gestational age of 32 weeks or less in such a programme and a first examination at 5-6 weeks of postnatal age is suggested.     

Screening for retinopathy of prematurity: evaluation and modification of guidelines

AIMS: To evaluate current screening guidelines for ROP (retinopathy of prematurity) and to determine whether they can be modified. METHODS: In accordance with the authors' present criterion, infants born in Stockholm County, Sweden, from 1 August 1998 to 31 July 2000, with a gestational age of < or =32 weeks, were screened for ROP. The effectiveness of screening was studied. RESULTS: The incidence of ROP was 25.5% in this study. A dropout group comprising almost 20% of the population studied (< or =32 weeks), was never referred, were lost to follow up, or died before screening was completed. No infant with a gestational age of >31 weeks at birth developed severe ROP (stages 3-5) and no infant with a gestational age of >29 weeks was treated for ROP. CONCLUSION: 80% of infants in this population with a gestational age at birth of < or =32 weeks, the current screening criterion, were effectively screened for ROP. The authors recommend that the screening criterion be lowered to 相似文献   

Risk Factors for Retinopathy of Prematurity Requiring Photocoagulation

Purpose To analyze risk factors other than birthweight (BW) and gestational age for retinopathy of prematurity (ROP) requiring photocoagulation in infants (BW 1500g).Methods We divided 45 eyes with ROP into three groups (A, without photocoagulation; B, with 6 clock hours photocoagulation; C, with 6 clock hours photocoagulation) and analyzed maternal and neonatal factors by multiple logistic regression.Results Among 13 factors, the number of days of infection, defined as C-reactive protein (CRP) greater than 1.0mg/dl, was a significant risk between groups A and B+C [Odds ratio (OR), 1.549; 95% Confidence interval (CI), 1.008–2.381; P = 0.046]. Among six after-birth factors, the number of days of infection (OR, 1.404; 95% CI, 1.023–1.928; P = 0.036) was significant between groups A and B+C, and the number of blood transfusions (OR, 4.959; 95% CI, 1.002–24.54; P = 0.050) and use of rescue surfactant (OR, 413.9; 95% CI, 1.163–147306; P = 0.044) were significant between groups B and C.Conclusions CRP should be routinely monitored while observing the progress of preterm infants. The probability of requiring photocoagulation increased in infants who received a blood transfusion or rescue surfactant. Jpn J Ophthalmol 2004;48:68–71 © Japanese Ophthalmological Society 2004     

Do current retinopathy of prematurity screening guidelines miss the early development of pre-threshold type 1 ROP in small for gestational age neonates?

PURPOSE: To investigate whether current UK retinopathy of prematurity (ROP) screening guidelines miss the early development of pre-threshold type 1 ROP in some neonates born small for gestational age (SGA) and consider if the guidelines should be changed. Methods: Data were collected on neonates of < or =31 completed weeks gestation and/or birth weight (BW) < or =1500 g born over a 37-month period. Babies who did not complete the screening programme in Cambridge and those with other ocular abnormalities were excluded. We compared the time course of ROP progression and the development of the early treatment for ROP pre-threshold ROP in relation to the gestational age and the BW of the babies. RESULTS: A total of 105 neonates were included, 11 (10.5%) were born SGA (less than 9th centile of predicted BW). Of these 11, 2 (18.2%) had pre-threshold ROP at their first screen (median post-natal age (PNA) 6.5 weeks, median postmenstrual age (PMA) 33.5 weeks). No other neonate in this group developed pre-threshold ROP.Of the 94 other neonates, none had pre-threshold ROP at first screen (median PNA 7.1 weeks). Pre-threshold ROP developed in 12 (12.8%) of these babies between 8 and 12 (median 11.5) post-natal weeks, at a PMA of 33-38 (median 35.5) weeks. CONCLUSION: Current UK ROP screening guidelines recommend first screening at 6-7 post-natal weeks. Our study suggests that pre-threshold type 1 ROP can develop before this especially in SGA babies. We suggest that screening should either start at 4 post-natal weeks in such babies, or be based on PMA rather than PNA, to allow timely laser therapy.     

Perinatal Risk Factors for the Retinopathy of Prematurity in Postnatal Growth and Rop Study

Objective: To evaluate perinatal risk factors for retinopathy of prematurity (ROP), in a large, broad-risk cohort of premature infants.

Study design: Secondary analysis of data from the Postnatal Growth and ROP (G-ROP) Study, a retrospective cohort study of infants undergoing ROP examinations at 29 North American hospitals in 2006–2012.

Results: Among 7483 infants, 3224 (43.1%) had any ROP and 931 (12.4%) had severe ROP (Type 1 or 2 ROP). In multivariable logistic regression analysis, significant risk factors for any ROP were lower birth weight (BW, odds ratio (OR) = 5.2, <501 g vs. >1250 g), younger gestational age (GA, OR = 32, <25 vs. >29 weeks), 1-min Apgar score <4 (OR = 1.2), race (OR = 1.6, White vs. Black), outborn (OR = 1.5), and delivery room intubation (OR = 1.3); and for severe ROP were lower BW (OR = 20, <501 g vs. >1250 g), younger GA (OR = 30, <25 vs. >29 weeks), male (OR = 1.5), Hispanic ethnicity (OR = 1.8), race (OR = 1.6, White vs. Black), outborn (OR = 1.6), and delivery room intubation (OR = 1.6). Together, these factors predicted well for any ROP (area under ROC curve (AUC) = 0.87) and severe ROP (AUC = 0.89), but BW and GA were the dominant factors for ROP (AUC = 0.86) and severe ROP (AUC = 0.88).

Conclusions: Based on the largest report to date with detailed ROP data from infants meeting current screening guidelines, ROP risk is predominantly determined by the degree of prematurity at birth, with other perinatal factors contributing minimally.     

The relation between the clinical state of the premature and the development of 3rd stage of retinopathy of prematurity

The aim of the study was to determine the prognostic value of some pathologies related to prematurity in the development of stage 3 ROP in children with extremely low birth-weight. The group of 35 prematures with diagnosed 3rd stage ROP and 64 prematures without ROP was examined. The presence of the respiratory distress syndrome (RDS), persistent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular haemorrhages (IVH) were analyzed. RDS was more frequent in prematures with 3rd stage ROP (p=0.005, OR=3.59). There was significant difference between the frequency of IVH in both groups (p = 0.03), but the odds ratio was significantly high only in the children with the 3rd stage IVH (OR=2.42). PDA was diagnosed more frequently in children with 3rd stage ROP but the difference was not statistically significant (p= 0.1 52, OR=1.80). There was significant difference between the groups when comparing the incidence of NEC (p=0.03, OR=3.34). The pathologies of the prematurity such as RDS, NEC and grade III IVH are the predictive factors for the development of stage 3 ROP (p=0.03, OR=3.34).     

广东省早产儿规范氧疗前后视网膜病变的变化

目的:了解广东省早产儿视网膜病(retinopathy of prematurity,ROP)筛查工作的开展情况和ROP的特点。方法:在广东省珠三角、粤东、粤北、粤西片区中各随机抽取新生儿科床位数≥50张,且最迟2005年始有眼科专业医师进行常规ROP筛查的2所三甲综合医院和2所二/三甲妇幼保健院,采用封闭式表格信函调查2002-01/2007-12在所选医院/保健院住院、出生胎龄≤36wk且出生体质量≤2000g且存活达2mo或以上的早产儿的临床及ROP筛查随访资料,然后电话核实;调查资料统计学分析采用u检验、χ2检验。结果:2004年以前未筛查早产儿占82.8%;2005年以后未筛查早产儿占24.9%,其中35～36wk未筛查早产儿占72.7%,29～32wk早产儿的筛查率93.6%,≤28wk的早产儿无漏筛病例。2002/2004年ROP筛查率较低,2005/2007年ROP筛查率显著提高,两时间段比较差异有非常显著性的统计学意义(P<0.01)。2004年以前多数医院(85.7%)使用直接眼底镜进行ROP筛查,2005年以后多数医院(71.4%)改用间接眼底镜进行ROP筛查。2004年以前ROP发生的真实情况无法了解。2005/2007年早产儿ROP发生率为6.2%,2005年以后出生体质量<1000g的早产儿ROP发生率为33.1%(105例),出生体质量1000～1499g10.8%(250例),出生体质量≥1500g的早产儿无ROP病例,≤28wk的早产儿ROP发生率为41.5%(56例),>28～32wk为9.8%(284例),>32～34wk为0.7%(15例),>34～36wk的早产儿无ROP发生。结论:规范氧疗后ROP筛查率明显提高,ROP发生率降低;《指南》[1]促进了ROP筛查工作的开展,筛查工具仍有待规范化。     

Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors

Aims:

The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait.

Materials and Methods:

This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003.

Statistical Analysis:

By univariate and multivariate logistic regression analysis.

Results:

Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; (P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment.

Conclusion:

The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP.     

Combination of laser photocoagulation and intravitreal bevacizumab (Avastin®) for aggressive zone I retinopathy of prematurity

Background This report describes the use of combined laser photocoagulation and intravitreal bevacizumab administration for aggressive zone I retinopathy of prematurity (ROP). Methods A male patient, born at 25 weeks gestation with a birth weight of 884 g, received indirect laser photocoagulation and a 0.75 mg intravitreal bevacizumab injection to each eye for aggressive stage 3 zone I ROP. Structural outcomes were evaluated 3 months after treatment. Results At 3-month follow-up, treatment had resulted in ROP regression, prompt resolution of plus signs and neovascular proliferation in both eyes, and no signs of systemic or ocular adverse events. Conclusions The combination of indirect laser photocoagulation and intravitreal bevacizumab injection was well tolerated and induced prompt regression of aggressive zone I ROP.     

Screening for Retinopathy of Prematurity in a Large Tertiary Neonatal Intensive Care Unit in Turkey: Frequency and Risk Factors

Purpose: We aimed to determine applicable guidelines for screening of retinopathy of prematurity (ROP), and evaluate the contribution of risk factors for severe ROP.

Methods: A prospective cohort study of neonates with a gestational age (GA) < 34 weeks or birth weight < 2000g who were admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary level hospital was conducted. The study group was classified into three groups according to eye examination findings as no ROP, mild ROP and severe ROP.

Results: Of the 700 neonates screened, the frequencies of ROP for any stage and severe ROP were 32.7% and 3.1%, respectively. Laser photocoagulation was needed in 9.6% of neonates with ROP. None of the neonates with a GA ≥ 31 weeks required treatment. Any ROP was detected in 199 (53.6%) of the babies < 32 weeks (n?=?371), 22 (5.9%) of whom were treated with laser photocoagulation. Independent risk factors for severe ROP in babies < 32 weeks GA were birth weight, duration of mechanical ventilation and patent ductus arteriosus (PDA).

Conclusion: This is the largest prospective cohort study including infants younger than 34 weeks GA from Turkey. Our data which belongs to the last 1-year period shows lower incidence of severe ROP when compared to previous reports from Turkey. According to our data, screening babies smaller than 32 weeks GA or 1500g birth weight seems reasonable. In the presence of long duration of mechanical ventilation and PDA, screening should be intensified.     

早产儿视网膜病变筛查和阈值期治疗的研究

目的研究早产儿视网膜病变(ROP)的发生率,评估ROP阈值期治疗效果。方法使用双目间接检眼镜对108例早产儿进行ROP筛查,将筛查结果进行统计学分析,达到阈值病变的患儿及时进行视网膜激光光凝或经巩膜、视网膜冷凝术。结果筛查108例早产儿,发现ROP23例,发生率为21.3%。在所有ROP患儿中,ROP1期13例,占56.5%;ROP2期3例,占13.0%;ROP3期7例,占30.4%。其中ROP3期患儿均伴有附加病变,达到阈值病变标准。ROP患儿出生体重为(1.43±0.25)kg(t=4.059,P<0.001);孕周为(31.0±2.3)周(t=2.637,P=0.013);吸氧时间为1~49d,平均17d(n=23,Z=-3.630,P<0.001);需要机械辅助呼吸患儿18例(χ2=12.009,P=0.001);上述指标与非ROP患儿比较,差异均有统计学意义;而与是否多胎的差异无统计学意义(χ2=1.013,P=0.314)。Logistic回归分析:出生体重低(β=-2.542,OR=0.079,P=0.032)和使用机械辅助呼吸(β=1.341,OR=3.823,P=0.025)的患儿是发生ROP的相关高危因素。7例阈值期病变患儿中,6例进行激光光凝或冷凝治疗。术后随访2个月至2年,手术眼的结构和视功能未见异常。1例阈值期病变患儿未予治疗,于1个月后出现视网膜脱离。结论出生体重轻、孕周少、吸氧时间长、需要机械辅助呼吸的早产儿发生ROP的风险较高。对阈值期病变患儿应及时进行激光光凝或冷凝治疗。     

广东省三家医院早产儿视网膜病变发生特点及转归分析

目的 观察并分析广东省3家医院早产儿视网膜病变（ROP）的发生发展特点及治疗后转归情况。方法 前瞻性研究。采用双目间接检眼镜对出生或收治于广东省3家妇幼保健院的出生体重＜2000 g早产儿和低体重儿638例进行ROP筛查。排除未完成随访的52例,共586例1172只眼纳入研究。首次眼底筛查时间为出生后4.0～6.0周或矫正胎龄32.0周。对阈值期前1型病变考虑激光光凝治疗,阈值期病变48 h内首选激光治疗。所有患儿均随访至周围视网膜完全血管化,ROP病变自然退行或治疗后病变退行且治疗后至少1个月。观察并分析ROP发生率,ROP发生时患儿矫正胎龄、出生日龄,ROP治疗时患儿矫正胎龄、出生日龄,ROP病变进展天数以及随访期间治疗眼的预后情况。对ROP患儿胎龄与其ROP发生、治疗时出生日龄之间行Spearman相关性分析。结果1172只眼中,发生ROP者118只眼,占10.07%;视网膜完全血管化1054只眼,占89.93%。发生ROP者胎龄中位数30.2周,矫正胎龄中位数36.4周;发生ROP时出生日龄中位数40.5 d。共60只眼需进行ROP治疗。其胎龄中位数29.3周,矫正胎龄中位数37.5周;需治疗时的出生日龄中位数59.5 d。相关性分析发现,胎龄与ROP发生、需治疗时出生日龄均呈负相关（R=-0.65,-0.80;P=0.000）。ROP 1期进展至2期、2期进展至3期、3期进展至需治疗的3个阶段,其病情进展天数中位数分别为14.0、10.5、3.0 d。随着病变加重,病情进展时间缩短,并呈非正态分布。各进展阶段病情进展天数中位数比较,差异有统计学意义（H=30.69,P=0.000）。治疗眼治疗后追光、注视反应正常,视盘、黄斑、视网膜结构正常,无视网膜血管行径异常,亦未发现玻璃体、视网膜增生病变形成。结论 广东省3家医院ROP发生时间在矫正胎龄36.4周左右,ROP治疗时间在矫正胎龄37.5周左右。随着ROP病变加重,其病情进展时间缩短。治疗眼预后良好。     

严重早产儿视网膜病变危险因素分析

目的分析严重早产儿视网膜病变（ROP）的危险因素，为合理制定ROP筛查标准提供参考依据。方法回顾性分析2002年12月至2004年4月期间我院眼科就诊的168例孕龄<37周的早产儿临床资料。记录其性别、胎数(BC)、孕龄（GA）、出生体重（BW）、氧疗时间以及双眼充分散瞳后双目间接检眼镜检查所见的视网膜血管发育情况。按ROP国际分类法（ICROP）记录检查结果，1、2、3期为轻度ROP，阈值病变、4期和5期为严重ROP。应用多元Logistic回归分析分析ROP与性别、BC、GA、BW、氧疗时间等因素之间的关系。结果168例早产儿336只眼中，严重ROP 47例91只眼，分别占患儿例数和眼数的28.0%、27.1%。其中，阈值病变20只眼，占6.0%；4期病变11只眼，占3.3%。4期病变中，4A期2只眼，占0.6%；4B期9只眼,占2.7%。5期60只眼，占17.8%。各因素中，GA、BW和氧疗时间对严重ROP的发生有影响（P值分别为0.000、0.000和0.015，α=0.05），性别和BC与ROP无关（P值分别为0.640和0.084，α=0.05）。亚变量统计分析显示，当GA≤30周或BW≤1500 或氧疗时间>4d时早产儿患严重ROP的危险性显著增加。结论严重ROP的发生受GA、BW和氧疗时间的影响，而与性别和BC无关。GA≤30周或BW≤1500g或氧疗时间>4d的早产儿患严重ROP的危险性显著增加，建议重点对此类早产儿进行筛查。（中华眼底病杂志，2005，21：271-274）     

Retinopathy of prematurity. Clinical findings in a Danish County 1982-87

The study includes all infants in a Danish county born 1982-87 considered at risk of acquiring retinopathy of prematurity (n = 411; 178 girls, 233 boys). 325 had birthweight (BW) less than or equal to 1750 g and/or gestational age (GA) less than or equal to 34 weeks. The remaining referrals were on account of functional immaturity/significant oxygen treatment (n = 86). With a median onset age of 6.5 weeks (range 5-9 weeks) ROP was recorded in 63 infants. A negative correlation (r = -0.34) between GA and ROP onset age suggested a later onset in the very immature infant. ROP appeared in 60% of those born at GA less than or equal to 28 weeks (n = 30) and in 50% of survivals with BW less than or equal to 1000 g (n = 20). With BW and GA beyond the limits of 32 weeks and 1750 g only 5 cases of ROP were observed. Out of the 14 infants with at least stage 3 ROP 6 became blind in both eyes after few months (GA at delivery 25-31 weeks/BW 920-1595 g). All considered, 57 of the 63 with ROP showed spontaneous regression, however, leaving myopia of prematurity in 8 subjects.     

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity

PURPOSE: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP). METHODS: Thirty-six eyes of 18 premature infants less than 34 weeks gestational age and/or less than 1600 g birth weight with prethreshold ROP were prospectively randomized to treatment with either indirect laser photocoagulation or cryotherapy. Prethreshold ROP was defined as any stage of ROP in zone I with plus disease; or stage 3 with three or more contiguous clock hours or five or more total clock hours of involvement of retina in zone II with plus disease but less than threshold disease. Regression of the ROP was assessed for a minimum period of 6 months. RESULTS: Regression of ROP occurred in all 36 eyes (100%) in both groups. CONCLUSIONS: Excellent results are achieved if ROP is treated at the prethreshold stage with both indirect laser photocoagulation and cryotherapy. Although laser has definite advantages, cryotherapy can be considered as an alternative modality of treatment in developing countries due to economic reasons.     

Retinopathy of prematurity in infants less than 29 weeks' gestation at birth

From January 1986 to December 1991 we examined the eyes of 206 infants born at Westmead Hospital, Neonatal Intensive Care Unit who were less than 29 weeks' gestation at birth to determine the incidence of retinopathy of prematurity. Eighty-five infants (41.3%) had no retinopathy of prematurity (ROP) in either eye, 82 infants had stages 1 or 2 ROP (39.8%), 29 had stage 3 ROP (14.1%) and 11 had stage 4 ROP (5.3%). Of these, cryotherapy was performed in 18; six now have bilateral retinal detachment and are blind The more severe stages of ROP were significantly associated with an increase in the number of days of oxygen supplementation, an increase in the number of days of mechanical ventilation and the presence of patent ductus arteriosus. Infants receiving steroids for mechanical ventilator dependence had a significantly greater chance of requiring cryotherapy (11 or 22 receiving steroids versus seven of 43 without steroids; P < 0.01).