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Lorenzo Orazi, Domenico Lepore, Antonio Baldascino, Salvatore Luceri, Pierdavide Perrini, Guglielmo D'Amico, Monica M. Pagliara, Fernando Molle; Screening for ROP:16 years experience. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5880.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate prevalence of ROP stages over 16 years in one of the largest Italian neonatal intensive care unit (NICU).
From January 1995 to June 2011 1196 inborn preterms were screened for acute ROP in the NICU at the Catholic University Hospital in Rome. Inclusion criteria were: gestational age (GA) ≤32 wks and/or a birth weight (BW) ≤1500gr, plus all preterm judged at risk. The mean BW was 1243.78 gr.(range 350-3560 gr) and the mean GA was 29,58 weeks (23-36 wks). ROP was diagnosed in 419 preterm (35.0% of all babies) with a mean BW of 1170 gr. (range 350-1340 gr.) and a mean GA of 28.5 wks (range 23-30 weeks). Babies were screened weekly , starting at 31 wks postconceptional age (PCA) until Dec ’03 and then at 29wks PCA. When pre-threshold was reached fundus was examined every 3 days (with RETCAM starting from 2004). From January '95 until June '99 peripheral retina ablation was performed by cryotherapy.From July ’99 until December ‘03 retinal ablation was performed using laser at threshold level. Starting from Jan 04 we applied ETROP criteria and treat all type 1 pre-threshold ROP. Follow up was performed until complete retinal vascularisation or ROP regression. From September 2009 a randomized monolateral controlled injection of Bevacizumab was performed in prethreshold ROP .The controlateral eye underwent to classical laser treatment.
ROP was diagnosed in 419 (35.2%) preterms with a mean BW of 915.8 grams and a mean GA of 27.7 wks. The mean BW and mean GA respectively decreased from 1392,8gr in 1995 to 915.8 gr in 2011 and from 29.9wks in 1995 to 27.7 wks in 2011. Among ROP 19.3% reached stage 1, 36.8% stage 2, 24.6% stage 3. Plus disease was observed in 71 babies (16.9%), all with stage 3. 181 eyes (all but one bilateral; 7.6% of whole population; mean BW 26.2wks, mean BW 710.6 gr.) were treated: 14 eyes with cryotherapy and 167 with laser. Scleral buckling as second procedure was performed in all 14 eyes treated with cryo and in 8 eyes treated with laser. 18 eyes underwent lens-sparring vitrectomy after laser. Although prevalence of ROP remain similar (34.19% from ’95 to ‘99 vs 34.93% from ’00 to ’04 vs 35.67% from ’05 to June ‘11), we observed a marked increase of ROP treated (16.82% of all ROP diagnosed from ’95 to ’99 vs 20.97% from ’00 to ’04 vs 28,72% from ’05 to June ‘11).
The evolution of the neonatal intensive care has improved survival of extreme preterm babies increasing proportion of infants needing treatment for ROP. ET ROP study produced a reduction of unfavourable outcome. The use of Intravitreal injection of Bevacizumab remain an open question in the future ROP management.
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