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Megan Ridley-Lane, Jason Horowitz, Jonathan S. Chang; Progression and Outcomes of Fellow Eye After Unilateral Treatment for Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5529. doi: https://doi.org/.
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In the ET-ROP study 20.9% of infants had asymmetric disease with high-risk prethreshold disease in only one eye. The eyes in this category had a lower rate of unfavorable outcome (1.5%) than those in which bilateral treatment occurred (8.1%). It is the practice in some centers to treat the fellow eye in such babies so as to avoid the need for repeat general anesthesia. We undertook to investigate if a similar percentage of babies in our NICU developed ROP of sufficient severity to lead to only one eye having Type 1 ROP at the time of treatment, and to determine how often and when the fellow eye converted to treatment-requiring ROP from a lesser category.
An IRB-approved, retrospective chart review was performed of patients developing treatment-requiring ROP in one eye. Patients were analyzed for time to develop treatment-requiring ROP in the second eye, and management course and outcomes.
A total of 774 babies were screened by the ophthalmology service at Columbia University Medical Center in New York, NY, USA, from 2011 – 2015. We identified 33 patients who underwent laser treatment for ROP. Of these, 8 babies (24%) received their initial laser treatment in only one eye. Of the 8 infants treated with laser unilaterally, 2 babies (25%) underwent treatment for ROP in the second eye. One reached Type 1 ROP in the second eye 2 weeks later and received laser treatment. The second was treated with laser in the fellow eye outside standard criteria of Type 1 ROP 1 week later. Six of the infants (75%) never required fellow eye treatment and all six untreated eyes had complete regression of ROP. One baby received bilateral off-label bevacizumab injections prior to unilateral laser treatment and the fellow eye did not require laser.
In our NICU a similar percentage of babies had asymmetric treatment-requiring ROP as reported in the ET-ROP study. Of the two that later went on to receive treatment in the fellow eye, both developed disease within two weeks of initial treatment, suggesting that when progression occurs, it is usually rapid. This can be helpful for clinicians screening for ROP as well as reduce morbidity from excessive laser treatment. Further evaluation of the long-term outcomes in these patients may help guide clinical care.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1 - Retinopathy of Prematurity cases with laser treatment initiated in the first eye
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