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Chaitra Jayadev, Anand Vinekar, Roopa Bharamshetter, Shwetha Mangalesh, Noel Bauer, K Bhujang Shetty, ; A New Classification of Retinal Immaturity in Retinopathy of Prematurity Screening: Clinical Validation to Predict Disease. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):948.
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The International Classification of Retinopathy of Prematurity (ICROP) defines ‘immature retina’ as the absence of disease in an incompletely vascularized fundus with progressive tapering retinal vessels. However, the extent of immaturity has not been defined. A sub-classification of this ‘extent’, especially at the first screening session, could provide a more objective tool for ROP experts to concur, serve as an indicator to determine the timing of follow-up and could predict progression to disease needing treatment. We propose a new sub-classification of retinal immaturity and discuss its clinical utility.
1202 eyes of 601 preterm infants were retrospectively analyzed and classified into three groups based on the extent of the retinal immaturity at the first screening visit into ‘mild’ if the vessels had reached the posterior boundary of zone 3, ‘moderate’ if the vessels had entered zone 2 anterior and ‘large’ if the vessels were in zone 1 or zone 2 posterior. Retcam (Clarity MSI, USA) images at each subsequent visit were evaluated and the proportion of eyes that progressed to Type 1 and Type 2 ROP were analyzed and compared between the groups.
601 Asian Indian premature infants (1202 eyes) with a mean birth weight of 1618 (+/- 793 grams) and a mean gestational age of 32.8 (+/- 2.2 weeks) were classified into mild (958 eyes), moderate (200 eyes) and large (44 eyes) retinal immaturity respectively. The three-way logistic linear analysis was significant in second order interaction (likelihood ratio χ2 (2) = 439.07, p<0.001). Odds ratio indicated that the presence of Type 1 (1.7% vs 5% vs 63.6%) and Type 2 ROP (15% vs 46.5%, 100%) was higher in ‘large’ when compared to moderate and mild immaturity.
Our new proposed classification of retinal immaturity at first screening visit is validated for predicting Type 1 and Type 2 ROP. ‘Large’ immaturity is more likely to progress to “treatment requiring” disease. This is a useful clinical tool for prognostication, counseling parents and scheduling follow-up
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