Trends in the management of stage 3 retinopathy of prematurity.

AIMS/BACKGROUND: The clinical outcome of 66 consecutive infants with stage 3 retinopathy of prematurity (ROP) is reported. METHODS: Thirty four infants (64 eyes) were treated with cryotherapy and 32 infants (59 eyes) underwent laser photocoagulation. RESULTS: Infants with anterior-mid zone II ROP had a high rate of disease regression whether treated by cryotherapy or laser photocoagulation. Infants with posterior zone II or zone I ROP had a 40% success rate with cryotherapy, and 87.5% when treated with laser photocoagulation. CONCLUSION: Evolving experience and changing management policies in infants with posterior ROP has led to improved results.     

Advanced cicatricial retinopathy of prematurity--outcome and complications.

AIMS: To assess the outcome and complications of patients with advanced retinopathy of prematurity (ROP). METHODS: All patients with eyes achieving stage 4 or 5 retinopathy of prematurity were reviewed. Twenty one eyes were diagnosed during ROP screening in maternity hospitals and 10 eyes were of infants transferred for treatment. RESULTS: Thirty one eyes of 17 patients were included. Thirteen eyes were treated for acute disease but progressed to stage 4 or 5; seven had cryotherapy and six diode laser photocoagulation. Cataract was found in 17 eyes (54.8%), glaucoma in seven eyes (22.6%), microphthalmos in 15 (48.4%), and corneal opacification in four eyes (12.9%). Fifteen eyes had surgical procedures; two (6.5%) had trabeculectomy, four (12.9%) had lensectomy, and nine (29%) retinal detachment repair. Transferred infants had their initial eye examination later than infants in hospitals screened by the authors and 80% of them had progressed beyond threshold ROP by the time they were transferred for treatment. Twenty nine eyes (93.6%) had visual acuities of 3/60 or less and only two eyes (6.5%) achieved 6/18 or less. CONCLUSION: The visual outcome of the eyes undergoing retinal re-attachment surgery was disappointing. Cataract, microphthalmos, and glaucoma were the most frequent complications, and surgical intervention was often required. The need for children who are blind as a result of ROP to have long term follow up is shown.     

早产儿视网膜病变的治疗研究进展

早产儿视网膜病变(retinopathy of prematurity,ROP)是早产儿和低体重儿发生的一种视网膜血管增生性病变。目前的治疗方法有冷凝治疗,光凝治疗,巩膜扣带术治疗,玻璃体切除术治疗,药物及基因治疗尚在动物实验研究中。     

Efficacy of cryotherapy for retinopathy of prematurity.

This is a retrospective study of the benefit of transconjunctival cryotherapy for retinopathy of prematurity (ROP) in 43 eyes of 22 infants (birth weight 716-1675 g) from July 1985 to January 1988. Nine eyes were treated at ROP stage 4A (early), 14 eyes at stage 3 plus disease, and 20 eyes at stage 3. Cryotherapy was applied to the retinal avascular zone. In 13 eyes the ridge of extraretinal fibrovascular proliferation was also treated. Two eyes with peripheral exudative retinal detachment in two quadrants had additional treatment of the area of elevated retina. Reexamination was performed at the age of 26 to 52 months (average 38 months). Regression of the ROP was found in all eyes. Seven eyes showed a lateral traction of the temporal vascular arcades, six of these eyes had a slight macular ectopia. None of the eyes progressed to stage 4B or 5. Visual acuity was 6/60 or better. Twelve children (60%) achieved 6/18 or better and 5 (25%) 6/9 or more. Our data indicate that cryotherapy for ROP grade 3 and early stage 4A prevents the progression to advanced stages. The results also imply a functional benefit of cryotreatment in infants with progressive severe ROP.     

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。     

Retinopathy of prematurity: evaluation of risk factors

Objectives: The purpose of this study was to determine what risk factors play a role in the development of retinopathy of prematurity (ROP). Study design: Data were collected on 157 infants born and cared for in one institution between January 1991 and July 1994. Initially we evaluated all children enrolled in the study to determine potential risk factors for the development of ROP. We subsequently compared multiple variables for ROP positive singletons with ROP positive twins to determine ROP risk factors for each group and to determine if one group was more susceptible to a given risk factor. Results: Of the 157 infants examined, 72 infants (46%) developed ROP. Infants who developed ROP had a lower gestational age, a lower birth weight, a higher number of days on oxygen/ventilator. more days in the intensive care unit (ICU), a greater need for steroids and a higher incidence of sepsis when compared to infants who did not develop ROP. There was no significant difference noted between singleton and twin gestation infants that developed ROP when comparing gestational age, weight, ventilator time or length of ICU stay. Total number of days on oxygen therapy was higher in the singleton group and this difference did reach statistical significance. Conclusions: Several risk factors are associated with a higher incidence of ROP. These variables may not be independent risk factors but may be a sign of the increased severity of illness associated with those infants who are born earlier with a lower birth weight. Multiple gestational births do not appear to increase the risk of developing ROP when compared to a similar group of singleton birth infants. This revised version was published online in July 2006 with corrections to the Cover Date.     

Indirect diode laser treatment and cryotherapy in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a major cause of blindness in babies. To explore the incidence, treatment and short-term outcome of the disease in Romania, a small scale study on 24 preterm infants with gestational age < 32 weeks and birthweight < 1500 g was undertaken. Gestational age was < 28 weeks in 66.6% and birthweight was < 1000 g in 70.8% of the children. The average age at the first examination with the indirect ophthalmoscope was 31.8 weeks, only two children having been seen at less than 6 weeks of age. 66.6% of the babies had ROP in various stages with 93.8% of these having bilateral (symmetrical or asymmetrical) abnormalities. 37.5% of the babies with ROP were in stage 5. 12.5% (2 patients) had bilateral threshold disease: one infant was treated with diode laser delivered with the laser indirect ophthalmoscope and the other with cryotherapy. In three eyes of these two infants the disease regressed. No major short term complications were noted and no second session of treatment was necessary. In our patients, the well-recognised correlation between the incidence and severity of the disease and gestational age and, to a lesser extent, birthweight was confirmed. Lack of equipment was the main reason for the delay in diagnosis. The extent of the disease in our patients, in a country where the number of surviving preterm babies is expected to increase in the coming years, warrants the initiation of a national screening programme for retinopathy of prematurity in Romania.     

阈值前病变１型和阈值期早产儿视网膜病变的激光和冷冻治疗

目的评价激光和（或）冷冻治疗阈值前病变１型和阈值期早产儿视网膜病变(ROP)的疗效。方法回顾分析2003年 1 月30日至2005年1月13日期间通过ROP筛查发现并施行视网膜激光和（或）冷冻治疗的阈值前病变１型和阈值期ROP共15例（29只眼），随访比较治疗前后的ROP病变情况，记录任何有关的局部和全身并发症。结果激光和（或）冷冻治疗的29只眼中，19只眼（65.5%）病变完全退化，7只眼（24.1%）残存牵引状视网膜，3只眼（10.3%）进展为视网膜脱离。初次治疗病变即完全退化者12只眼（41.4%），再次治疗后完全退化者7只眼（24.1%）。治疗中2只眼出现一过性角膜混浊，1只眼发生玻璃体积血，1只眼黄斑区误光凝1处。所有病例均未出现全身并发症。结论对阈值前病变１型和阈值期ROP进行及时的激光和（或）冷冻治疗具有比较满意的疗效。（中华眼底病杂志，2005，21：278-281）     

Eleven years'' experience with retinopathy of prematurity: visual results and contribution of cryoablation.

We report our 11 years' experience of cryotherapy for retinopathy of prematurity (ROP). Charts of 624 infants weighing under 1250 g who were admitted to our Neonatal Intensive Care Unit during 1977-87 were reviewed. Three hundred and eighty nine babies survived, and the total ROP prevalence was 57.5%. Cryotherapy was applied to 35%. Only one case (0.25%) of blindness was detected, and four babies (1%) had a final visual acuity of less than 20/200 in one eye. The complication rate following cryoablation was very low.     

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: Screening and optimal use of the ophthalmologist's time

In recent years it has been standard practice to recommend that indirect ophthalmoscopy be carried out between six and nine weeks of age in very low birthweight infants to screen for the presence of retinopathy of prematurity (ROP). Following this recommendation we examined 85 infants over a two-year period. Acute ROP occurred in 29 (34%), and two (2.4%) developed cicatricial disease. One-third of infants were initially examined slightly earlier or later than the strict six to nine week limits, but all except three infants were examined between 35 and 42 weeks gestation. One infant born at 26 weeks gestation, was examined 'too late' in that she had stage 4 disease when first seen at 11 weeks of age. Recent information on the natural history of ROP, and confirmation of the efficacy of treatment with cryotherapy, suggested that the timing of an initial screening examination for ROP needed reassessment. From our experience and a review of the literature we recommend that infants of less than 1000 g birthweight or less than 28 weeks gestation have an initial examination at six weeks of age; for infants of 1000 to 1250 g birthweight or 28 to 30 weeks gestation examination continue to be at six to nine weeks of age; and for infants of more than 1250 g birthweight or 31 weeks gestation screening at six to nine weeks of age is only necessary if the infant has had an unstable course or prolonged oxygen requirements. Such a protocol would not place too great a burden on ophthalmological services and would direct efforts towards the group of infants most at risk of severe visual handicap.     

Laser photocoagulation for stage 3+ retinopathy of prematurity

Twenty-two infants with "threshold" stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).     

重症早产儿视网膜病变的高危因素分析

目的探讨重症早产儿视网膜病变(ROP)的发生率及高危因素分析对临床筛查的指导意义。方法回顾性分析2013年1月至2015年12月756例早产儿临床资料,记录其孕周、出生体重、吸氧时间、吸氧浓度、APgar评分(1分钟in)、APgar评分(5 min)、败血症、呼吸暂停、机械通气、输血等。应用t检验、卡方检验以及Logistic回归分析分析重症ROP与孕周(GA)、出生体重(BW)、吸氧时间、吸氧浓度、APgar评分(1 min)、APgar评分(5 min)、败血症、呼吸暂停、机械通气、输血等因素之间的关系。结果 756例早产儿,严重ROP发生3.3%。各因素中,孕周较少、低出生体重、长时间吸氧、高浓度吸氧、APgar评分(5 min)<4分,机械通气、输血是重症ROP的高危因素,统计学有显著差异。结论严重ROP的发生受孕周较少、低出生体重、长时间吸氧、高浓度吸氧、APgar评分(5 min)<4分,机械通气、输血影响。特别是GA≤28周或BW≤1000 g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及时筛查。     

Outcomes of primary scleral buckling for stage 4 retinopathy of prematurity

BACKGROUND: Scleral buckling is an option for stage 4 retinopathy of prematurity (ROP). This study evaluated the anatomic results of a primary scleral buckling procedure for the treatment of this condition. METHODS: Retrospective analysis of cases in which premature infants were treated solely with a primary scleral buckling procedure for stage 4 ROP by 1 retinal specialist between January 1990 and April 2001. The 20 eyes, of 14 infants, had previously been treated with cryotherapy or laser photocoagulation ablation for threshold ROP, but stage 4 ROP had developed. Maintenance of an attached macula was the desired anatomic result of surgical treatment. RESULTS: Of the 20 eyes, 14 (70%) had an attached macula postoperatively. During a follow-up period of 3.5 to 28 months the retina redetached in 2 eyes, which became phthisical. The other 6 eyes also became phthisical, despite additional surgical treatment. INTERPRETATION: Primary scleral buckling has a high anatomic success rate in infants with stage 4 ROP, a rate thought to be higher than would occur with natural progression of the disease. Because an attached macula is associated with improved visual potential, timely primary scleral buckling is reasonable for these infants, offering a 60% chance of useful vision.     

Vitreous hemorrhage in patients with high-risk retinopathy of prematurity

PURPOSE: To investigate outcomes in premature infants with high-risk retinopathy of prematurity and secondary vitreous hemorrhage. DESIGN: Retrospective chart review. METHODS: Patients were selected from a database of infants undergoing retinopathy of prematurity screening from September 1997 to November 1999. Infants with high-risk retinopathy of prematurity (zone I or posterior zone II threshold disease) with and without vitreous hemorrhage were compared. MAIN OUTCOME MEASURES: Final stage of retinopathy of prematurity and short-term structural outcome were assessed. Visual acuity and refraction were measured when possible. RESULTS: Twenty-two eyes of 11 patients (group 1) had high-risk (posterior zone II or zone I threshold) retinopathy of prematurity without vitreous hemorrhage. Group 1 patients had a 91% favorable short-term structural outcome. Eight eyes of five infants developed vitreous hemorrhage with high-risk retinopathy of prematurity (group 2). Group 2 patients had only a 12.5% favorable short-term structural outcome. Seven of eight (87.5%) progressed to stage IVa or IVb retinopathy of prematurity. Six eyes underwent vitreoretinal surgery after a median duration of hemorrhage of 36 +/- 29 days (4-70 days). Three eyes developed stage V detachments and three progressed to phthisical degeneration. Final visual acuity was no light perception in three eyes. CONCLUSION: Vitreous hemorrhage, in association with advanced retinopathy of prematurity, is a poor prognostic sign.     

Retinopathy of prematurity in Toyama area of Japan

This study attempted to establish the incidence and severity of retinopathy of prematurity (ROP) at a neonatal intensive care unit in Toyama, Japan. The fundi of infants with low birth weights were examined weekly. Retinopathy was found in 82 (55.8%) of 147 infants. Of these infants, 38 had stage 1 ROP, according to the International Classification of ROP; 15, stage 2; 27, stage 3; 1, stage 4; and 1, stage 5.     

Management of retinopathy of prematurity

Seventeen patients with symmetrical stage 3 retinopathy of prematurity (ROP) and plus disease as described in the International Classification of ROP had one eye randomized to cryotherapy and the other to control. Seventy-seven percent of the patients were under 1000 grams at birth and females outnumbered males by a 2 to 1 ratio. The average chronologic age at which cryotherapy was performed was three months. Twelve of seventeen treated eyes (71%) showed resolution of the ROP and 10 of 17 untreated eyes (59%) became significantly worse. However, only five patients had improvement in the treated eye and progression in the untreated eye, a number too small to provide statistical significance. Six eyes with Stage IV ROP were operated by encircling scleral buckling techniques because of total retinal detachment secondary to peripheral traction and cicatrization arising from the ridge. In five patients the unoperated eye had already developed a retrolental membrane, and in one patient bilateral detachments were present. Five of the six operated retinas were reattached.     

Refractive errors and ocular motility disorders in preterm babies with and without retinopathy of prematurity.

Ocular motility, refraction and visual acuity (VA) were evaluated at the age of 4 years in 136 preterm infants with gestational ages (GAs) at birth of less than 32 weeks. Group 1 (non-retinopathy of prematurity, ROP) included 87 children that had never developed ROP. Group 2 contained 19 children whose ROP had regressed spontaneously. Group 3 (cryo-ROP) was composed of 30 patients who had undergone cryotherapy for severe ROP. Strabismus was found in 13.9% of the total population. chi(2) analysis revealed that strabismus was significantly (p < 0.01) associated with prematurity (i.e. GA <29 weeks), ROP and cryotherapy. Myopia of more than 3 dpt was significantly (p < 0.001) more common in the cryo-ROP infants than in the regressed-ROP and non-ROP groups. The distribution of hypermetropia was similar in all three groups. VA was measured with the E chart. Of the 272 eyes examined, 251 (92.3%) displayed VA of more than 20/25. The majority of these eyes were from the non-ROP group (65.4%), 15.3% had regressed ROP and 21.1% belonged to the cryo-ROP group. Fifteen eyes (8 non-ROP, 3 regressed ROP and 4 cryo-ROP) presented VAs between 20/25 and 20/60. VA of less then 20/60 was found in 6 eyes (2 non-ROP, 1 regressed ROP, 3 cryo-ROP). Cryotherapy did not appear to preclude the development of good VA.     

Intraventricular haemorrhage and stage 3 retinopathy of prematurity

BACKGROUND/AIMS: A recent report has highlighted the decreasing prevalence in recent years of severe intraventricular haemorrhage (IVH) in very low birthweight (VLBW) infants (<1500 g). This study attempted to identify the severity of the grade of IVH in infants with stage 3 retinopathy of prematurity (ROP), and to re-examine the association between threshold ROP and IVH. METHODS: This was a retrospective study carried out over 3 years, between December 1995 and December 1998 of neonates admitted to a single neonatal intensive care unit. 28 infants with stage 3 ROP were identified from the ROP screening database. Cranial ultrasound scans were available on 24 of these infants. The scans were reviewed and the severity of IVH was graded from grade 1 to grade 4. The birth weight, sex, ethnic origin, and gestational age of the babies were recorded. The number of infants progressing to threshold disease and the treatment provided was documented. RESULTS: The 24 infants had a median gestational age of 26 weeks (range 24-28 weeks) and a median birth weight of 762.5 g (range 540-1010 g). 17 infants were treated for threshold disease. 13 infants (54.2%) had IVH, of these eight (61.5%) had grade 1, two (15.4%) had grade 2, one (7.7%) had grade 3, and two (15.4%) had grade 4. 12 of the 13 infants (92.3%) with IVH had treatment with laser or cryotherapy for ROP compared with five of the remaining 11 infants (p = 0.023, Fisher's exact test). These data provide little evidence of any association between IVH and each of ethnic origin (p = 0.856), sex (p = 1), birth weight, or gestational age (p = 0.56 and p = 0.06 respectively) in infants with stage 3 ROP. CONCLUSIONS: These data provide strong evidence (p = 0. 023) of an association between the presence of IVH and treatment of threshold ROP. Although the numbers in this study are small the majority of infants with stage 3 ROP had grade 1 IVH, which heralds a more favourable neurological outcome. An association between the severity of ROP and severity of IVH was not demonstrated. With improvements in neonatal care and a reduction in the prevalence of severe IVH, there appears to be a weakening of the previously reported association between severe IVH and severe ROP. However, the presence of even a minor grade of IVH may be a significant risk factor for threshold ROP once stage 3 disease is encountered.     

Progression and timing of treatment of zone I retinopathy of prematurity

PURPOSE: To clarify the progression of zone I retinopathy of prematurity (ROP) and elucidate the most suitable time and method of treatment. DESIGN: Interventional case series. METHODS: Forty-six eyes of 23 zone I ROP infants were studied at a single institution. Birth weight ranged from 448 to 954 g, and gestational age ranged from 22 to 26 weeks. Fundus examination was started at 29 or 30 weeks postmenstrual age and was performed once or more per week. The first treatment was performed using laser photocoagulation or cryotherapy when zone I ROP progressed to the following criteria. Treatment criteria A included 35 eyes of 18 cases of zone I any stage ROP with plus disease (Early Treatment for Retinopathy of Prematurity [ETROP] type 1), criteria B included five eyes of three cases of zone I stage 3 ROP with or without plus disease (ETROP type 1), criteria C included six eyes of four cases of stage 1 or stage 2 ROP without plus disease; the demarcation lines belonged, in large part, within the zone I area. RESULTS: Hazy media such as corneal opacity, miotic pupil, tunica vasculosa lentis, and hazy vitreous persisted until approximately 32 weeks postmenstrual age. The mean period between stage 1 and stage 3 mild was one week, that between stage 1 and stage 3 moderate was 1.7 weeks, and that between stage 1 and stage 3 severe was 1.3 weeks. The period between stage 1 and the first treatment was zero to 20 days, and 60.9% of all the cases were treated within 10 days after stage 1. Six of 46 eyes had unfavorable outcomes. Surgical results of our treatment were comparable or better than those of other reports. CONCLUSIONS: Immediate treatment was required when zone I ROP was diagnosed behind persistent hazy media.