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F. Molle, D. Lepore, M. M. Pagliara, C. Angora, A. Baldascino, F. Lafranceschina, L. Orazi, G. D'amico, S. Luceri, F. Focosi; Is Early Treatment for Retinopathy of Prematurity Really Effective?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5912.
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To verify the impact of ETROP study on acute ROP management
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.
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).
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.
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