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Qianqian Ellie Cheng, Graham E Quinn, Ebenezer Daniel, Agnieshka Baumritter, Gui-Shuang Ying; Progression from Preplus to Plus Disease in Acute-Phase Retinopathy of Prematurity (e-ROP) Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3124.
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Preplus disease is the intermediate stage between normal and plus disease, defined as abnormal posterior pole retinal vessel dilation and tortuosity. Limited data are available describing the progression from preplus to plus based on image evaluation.This study determines the rate, timing and associated factors for progression from preplus to plus.
Secondary analyses of e-ROP data from 13 North American Centers. Infants underwent series imaging of the posterior pole and 4 peripheral quadrants with a wide-field digital camera. Two trained readers independently evaluated images for posterior pole normality (normal, preplus, or plus), stage and zone of ROP, with discrepancies adjudicated by a reading supervisor. To be eligible for preplus progression analysis, infant eyes had at least one image session showing preplus followed by at least another image session for determining progression to plus disease.
Among 681 eligible eyes of 444 infants (mean BW 773 g, mean GA 26 weeks) with preplus detected at mean (SD) PMA of 35.5 (2.1) weeks, 54 (7.9%) progressed to plus at mean PMA of 37.6 (2.4) weeks, as compared to only 7 (0.63%) of 1120 eyes progressing directly from normal to plus disease. Progression rate was higher among eyes with larger number of quadrants of preplus (44% for eyes with 4 quadrants vs. 4% with 1 quadrant, p<0.0001), earlier PMA with preplus (18% for 32 weeks PMA vs. 3% for PMA greater than 37 weeks, p=0.02), higher stage of ROP (12% for stage 3, 8% for stage 2, and 2.5% for no ROP, p<0.0001), lower zone of ROP (24% for zone I ROP, 6% for zone II ROP or no ROP, p<0.0001) (Table 1). Among the 54 eyes with progression from preplus to plus, the mean time interval for progression was 2.7 weeks (range 0.4 to 8.9 weeks). The time intervals for progression to plus varied with ROP stage and zone (Table 2), with mean intervals of 3.9 weeks in eyes with stage 2 zone II ROP and 2.2 weeks for eyes with stage 3 zone II ROP.
Using image determination of preplus and plus diseases, 8% of eyes with preplus progressed to plus disease at a mean interval of 3 weeks. More quadrants with preplus, higher stage and lower zone of ROP were associated with higher risk of progression to plus disease. Image evaluation for preplus may help identify high risk eyes for developing plus disease.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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