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Paul Rychwalski, Jenny Lobo Lopez, Sarah Jordan, Carlos Abdala; Treatment Of Type I Pre-Threshold and Threshold Retinopathy Of Prematurity in Northern Colombia- Efficacy of Laser Alone. Invest. Ophthalmol. Vis. Sci. 2013;54(15):596.
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Describe the clinical characteristics and outcomes of children with Retinopathy of Prematurity (ROP) who were screened and treated in 11 Neonatal Intensive Care Units in Colombia between January 2008 - June 2012.
749 eyes were examined in 377 infants born with a gestational age (GA) of 32 weeks or less and a birth weight (BW) of 1750 g or less. All infants were screened at the fifth week of life or by 34 weeks post-conception.
152 of 377 patients (40%) had any type of ROP, affecting 299 eyes. 181 eyes of 97 patients required surgery (24%). 127 eyes of 69 patients required Laser Photocoagulation and 54 eyes of 28 patients required Rescue Therapy (Laser and intravitreal anti-VEGF). Follow-up was lost in 34 eyes of 18 patients in the laser group and in 4 eyes of 2 infants in the Rescue Therapy Group. In addition,4 eyes of 3 patients of this last group were also excluded because of progression to Stage 4 ROP. In this report we analyze the results of the Laser Group. There were 101 eyes of 51 patients with a mean GA of 28,3 weeks. More than 50‰ of infants were born between 27 and 29 weeks. 98% of the patients with ROP were born ≤ 32 weeks of gestation. The mean BW was 1057 g. 94% of the infants of this group weighed 1500 g or less at birth. 24/51 infants (47%) had a BW between 1001 and 1500 g and 24/51 (47%) had a BW of 1000 g or less. The types of ROP were Pre- threshold type 1 89 eyes of 45 patients (88%) and Threshold 12 eyes of 6 patients (12%). 16 eyes (16%) required rescue therapy to obtain regression of the ROP.
The development of ROP was related to low birth weight and gestational age, however not all babies followed this trend. In the United States it is standard to screen only those infants weighing ≤1500 g at birth. Some institutions will routinely screen only those infants born with a birth weight of ≤1250 g. In our study, 6% of the infants that required Laser Photocoagulation weighed ≥ 1500 g. and 2% of patients were born after 32 weeks gestation. Thus, we advocate that each institution carefully monitor their trends and rates of ROP in order to develop screening criteria that will capture the greatest number of infants with ROP. Laser Photocoagulation seems effective and well tolerated in most patient and in our study less that 20% needed additional treatment to promote ROP regression.
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