Screeening for ROP: 10 Years Experience

Abstract

Purpose: : in the high–income countries the improving of the neonatal intensive care is deeply modifying ROP features. The AA. examine prevalence of ROP stages over 10 years in one of the largest Italian neonatal intensive care unit (NICU).

Methods: : from January 1995 to June 2005 703 inborn preterms were screened for acute ROP in the NICU at the Catholic University Hospital in Rome. Inclusion criteria were: gestational age (GA) ≤32wks and/or a birth weight (BW) ≤1500gr, plus all preterm judged at risk. The mean BW was 1254.0gr (range 350–3560gr) and the mean GA was 29.6wks (range 23–35wks). Babies were screened on a weekly base, starting at 31wks 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). Until Dec ’03 treatment was performed within 48 hours by laser (cryo prior to Jan ’99) at threshold level. Starting from Jan ’04 type 1 ROP was treated at pre–threshold level. Babies were followed until complete retinal vascularisation or ROP regression.

Results: : ROP was diagnosed in 243 (34.6%) preterms with a mean BW of 909.6gr and a mean GA of 27.7wks. The mean BW and mean GA respectively decreased from 1392.8gr in 1995 to 1087.6gr in 2004 and from 29.9wks in 1995 to 28.0wks in 2004. Among ROP 7.1% reached stage 1, 12.4% stage 2, 8.3% stage 3, 1.4% stage 4. Plus disease was observed in 29 babies (5.6%), 4 of them with stage 2 the rest with stage 3. 101 eyes (all but one bilateral; 7.2% of whole population; mean GA 26.4wks, mean BW 727.4gr) were treated: 28 eyes with cryotherapy and 73 with laser. Scleral buckling as second procedure was performed in all 28 eyes treated with cryo and in 30 eyes treated with laser. 10 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), we observe a marked increase of ROP treated (16.82% of all ROP diagnosed from ’95 to ’99 vs 20.97% from ’00 to ’04).

Conclusions: : increased survival of smaller and sicker children in our preterm population result in an increased proportion of infants needing treatment for ROP. Although ET ROP study produced a reduction of unfavourable outcome, 35.72% of all ROP treated progress to retinal detachment clearly indicating that early laser treatment is not a panacea for severe ROP.

Keywords: retinopathy of prematurity