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Wei Pan, Graham E Quinn, Ebenezer Daniel, Agnieshka Baumritter, Gui-Shuang Ying; Risk Factors for the Development of Plus Disease in the Telemedicine Approaches to Evaluating of Acute-Phase ROP (e-ROP) Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5541.
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Plus disease is a critical feature of severe retinopathy of prematurity (ROP) that indicates need for treatment to decrease the risk of blindness. This study determines risk factors associated with development of plus disease in ROP.
Secondary analyses of data from infants with birth weight (BW) of <1251g who had at least two ROP examinations for determining later development of plus disease by study-certified ophthalmologists. Non-physician trained readers evaluated retinal images for characteristics of ROP, posterior pole vessel abnormality, and retinal hemorrhages. Univariate and multivariate logistic regression modeling were performed to determine independent risk factors for plus disease including demographics, postnatal weight gain and ocular findings based on evaluation of images from the first image session.
Among 983 eligible infants without plus disease in the first eye exam, 83 (8.4%) infants later developed plus disease in one or both eyes as determined by clinical exam. In a multivariate model (Table 1), significant risk factors for plus disease were: gestational age [odds ratio (OR)=3.2 for ≤24 weeks vs. ≥28 weeks, p=0.004], race [OR=2.4 for White vs. Black, p=0.01], respiratory support [OR=7.1 for the need of high frequency oscillatory ventilation vs. no respiratory support], slow weight gain [1.5 for weight gain ≤12 vs. >18 g/day, p=0.03], and the image findings at the first image session including: preplus/plus disease [OR=2.7 preplus/plus vs. normal, p=0.003], stage of ROP [OR=4.2 for stage 3 ROP vs. No ROP, p=0.006] and blot hemorrhage [OR=3.1 for presence vs. absence, p=0.003]. These risk factors predicted plus disease with an area under ROC curve of 0.85 (95% CI: 0.81-0.89). BW, gender, multiple birth were not associated with plus disease (p>0.05).
Lower gestation age, White race, need of respiratory support, slower postnatal weight gain, the presence of preplus disease, higher stages of ROP, and presence of blot hemorrhage are independently associated with later development of plus disease. These risk factors may help identify infants needing increased surveillance to detect the need for treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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