Is Early Treatment for Retinopathy of Prematurity Really Effective?

Abstract

Purpose: : To verify the impact of ETROP study on acute ROP management

Methods: : 1024 inborn preterm were screened for ROP between Jan 95 to Jun 09 in the NICU at the Catholic University Hospital in Rome. Inclusion criteria were: gestational age (GA)≤ 32weeks and/or birth weight (BW) ≤1500 grams, plus all preterm judged at risk. The mean BW was 1248.2 gr.(range 350-3560gr) and the mean GA was 29,6weeks (23-35wks). ROP was diagnosed in 359 preterm (35.1% of all babies) with a mean BW of 914.9 gr. and a mean GA of 27.7wks. We retrospectively analyzed data record of all preterm that reached pre-threshold, as defined by Cryo-ROP and verify their progression to threshold or regression. From January 95 until June 99 peripheral retina ablation was performed using CryoROP indications with cryotherapy; from July ’99 until December ‘03 retinal ablation was performed using laser. Starting from Jan 04 we applied ETROP criteria and therefore began to treat all type 1 pre-threshold ROP.

Results: : Pre-threshold ROP was diagnosed in 149 preterm (296 eyes; 14.6 % of all preterm; mean GA 26.5wks, mean BW 787.3 gr). According to ETROP Study 90 eyes (45 babies) were classified as type 1 pre-threshold (mean BW 654.4 gr; mean GA 25.8wks) and 206 eyes (104 babies) type 2 (mean BW 844.9 gr; mean GA 26.8wks). 30 eyes were ZI,St3+; 0 eyes ZI,St1 no+; 8 eyes ZI,St1-2+; 2 eyes ZI,St1-2 no+; 92 ZII,St3+;146 eyes ZII,St3 no+; 2 eyes ZII,St2+. 148eyes (50.3% of all pre-threshold) underwent treatment. Favorable and good outcomes (as defined by Cryo-ROP) were achieved in 89 eyes (60.1%). From Jan 04 we applied ETROP study indication and treated 25 eyes type1 pre-threshold ROP and 22 eyes type 2 progressed to "classical" threshold; favorable and good outcome were achieved in 68 eyes (73,1%). Using Cryo-ROP threshold from Jan 95 to Dec 03 we treated 55 eyes; unfavorable outcome was observed in 34 eyes ( type 1 and type 2 pre-threshold).

Conclusions: : the application of ETROP criteria deeply modified ROP management with a significant improvement of favorable and good outcome. The price that we paid is probably represented higher rate of ROP undergoing laser treatment.

Keywords: retinopathy of prematurity • retina