Cryotherapy For Retinopathy Of Prematurity Research Articles

The Male to Female Ratio in Treatment-Warranted Retinopathy of Prematurity

Literature and anecdotal evidence suggest a relationship between male sex and retinopathy of prematurity (ROP). It is not known whether a difference, if present, is sex-related pathophysiologic predisposition or sex difference in meeting ROP screening criteria. To evaluate the association of sex with the development of treatment-warranted ROP. PubMed, Embase, and Web of Science databases were searched from 2000 to 2022. The search strategy used keywords including retinopathy of prematurity or ROP or retrolental fibroplasia and treatment or anti-VEGF or bevacizumab or ranibizumab or aflibercept or conbercept or laser or cryotherapy and gender or sex or male or female and medical subject headings terms. All studies reporting on treatment with anti-vascular endothelial growth factor, laser photocoagulation, and/or cryotherapy for ROP were identified. Studies reporting sex distribution in the treatment group were included in the meta-analysis. Exclusion criteria included case reports, case series of fewer than 10 treated patients, systematic reviews, conference abstracts, letters to the editor, animal studies, and non-English records. Two reviewers independently screened and extracted the data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The proportions of treated male and female infants were combined using random-effects meta-analysis. Numbers and percentages of male and female infants treated for ROP. Of 11 368 identified studies, 316 met inclusion criteria, yielding a total of 31 026 treated patients. A higher percentage of male infants were treated for ROP (55% [95% CI, 0.54%-0.55%]), with low heterogeneity between studies (I2 = 34%; P < .001). Thirty-eight studies reported sex distribution in the screened population (170 053 patients; 92 612 [53%] male vs 77 441 [47%] female). There was no significant difference in the odds of receiving treatment between screened male and female infants (pooled odds ratio, 1.04 [95% CI, 0.91-1.18]; P = .67). More male infants are treated for ROP than female infants. This could be due to a known relative pathophysiological fragility of preterm male infants in addition to a difference in ROP screening rates, with more male infants meeting the criteria than female infants. These findings have implications for future studies and may prompt more careful clinical monitoring of male neonates.

Laser photocoagulation versus transscleral cryotherapy for threshold retinopathy of prematurity

Laser photocoagulation versus transscleral cryotherapy for threshold retinopathy of prematurity

Incidence and Early Course of Retinopathy of Prematurity

In the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (ROP), 4099 infants weighing less than 1251 g at birth underwent sequential ophthalmic examinations, beginning at age 4 to 6 weeks, to monitor the incidence and course of ROP. Overall, 65.8% of the infants developed ROP to some degree; 81.6% for infants of less than 1000 g birth weight. As expected, ROP incidence and severity were higher in lower birth weight and gestational age categories. Black infants appeared less susceptible to ROP, of all severity categories, than nonblack infants. The timing of retinal vascular events correlated more closely with postconceptional age than with postnatal age, implicating the level of maturity more than postnatal environmental influences in governing the timing of these vascular events. These results include the current incidence of various severity stages of ROP found in the United States and provide new. insight into the development of ROP.

Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation.

Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference -2.53, 95% confidence interval: -5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference -0.52, 95% confidence interval: -0.76 to -0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference -0.01, 95% confidence interval: -0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.

Current Trends in Telemedicine for Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) is a vasoproliferative disease of the retina in premature infants that can progress to blindness. Clinical ROP management standards have been established by seminal studies such as the Cryotherapy for ROP (CRYO-ROP) and Early Treatment for ROP (ET-ROP) trials, and have significantly decreased the incidence of poor visual outcomes in ROP. However, ROP continues to be a leading cause of childhood blindness worldwide.

Retinal Sequelae in Adults Treated With Cryotherapy for Retinopathy of Prematurity.

Cryotherapy, introduced in the mid-1980s, was the first treatment of severe retinopathy of prematurity (ROP) and resulted in ablation of larger retinal areas than did its later substitute, laser treatment. We defined the characteristics of the retinal structure and assessed visual function, in adult ex-preterms treated with cryotherapy. A total of 28 ex-preterms, included in a prospective study of infants born in Stockholm between September 1988 and March 1993, were treated with cryotherapy because of severe ROP. Of these individuals, 14 took part in this follow-up study and underwent ophthalmologic assessment including visual acuity, fundus photography, perimetry, and retinal imaging using optical coherence tomography (OCT) in their third decade of life. Their gestational ages were 24 to 28 (median 25) weeks at birth. The ex-preterms had reduced foveal depth (P < 0.0001) and increased thickness of the temporal retinal nerve fiber layer (RNFL; P > 0.001). A thicker temporal RNFL was not correlated with a thicker ganglion cell layer (P = 0.41, r = 0.29) as in controls (P = 0.0015, r = 0.78). Extreme thickening was seen in patients with pronounced retinal dragging. In their third decade of life, ex-preterm adults treated with cryotherapy for ROP have major microstructural retinal abnormalities in terms of reduced foveal depth and an altered distribution of the peripapillary RNFL. The main contributors seem to be gestational age and ROP rather than the cryotherapy. The possibility to evaluate the retinal structure in these individuals, with today's conventional OCT, is limited by those anatomic deviations.

Changes in Course of Retinopathy of Prematurity from 1986 to 2013: Comparison of Three Studies in the United States

To compare infant and retinopathy of prematurity (ROP) characteristics from 3 clinical studies conducted over a 27-year period in the United States. Secondary analysis of results of 3 clinical studies. Infants with birth weight (BW) <1251 g. Analysis of data from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) and Early Treatment for Retinopathy of Prematurity (ETROP) trials and the primary data from the Telemedicine Approaches for the Evaluation of Acute-Phase Retinopathy of Prematurity (e-ROP) study. Infant characteristics and onset, severity, and time course of ROP. Across the 3 studies, mean (standard deviation) BW and mean gestational age (GA) decreased over time from CRYO-ROP (954 g [185 g], 27.9 weeks [2.2 weeks]) to ETROP (907 g [205 g], 27.4 weeks [2.2 weeks]) to e-ROP (864 g [212 g], 27.0 weeks [2.2 weeks]), with an increase in the percentage of infants enrolled weighing <750 g (15.8% CRYO, 24.9% ETROP, 33.4% e-ROP; P<0.0001). The percentage of infants who developed ROP varied only minimally (65.8% CRYO, 68.0% ETROP, 63.7% e-ROP; P= 0.003). Moderately severe ROP (defined as prethreshold or referral warranted) varied (17.8% CRYO, 12.3% ETROP, 19.4% e-ROP; P<0.0001), whereas the time of onset of any ROP did not vary (34.3 weeks CRYO, 34.1 weeks ETROP, 34.8 weeks e-ROP). The BW and GA of infants enrolled in ROP studies in the United States have decreased over the past 27 years, whereas ROP prevalence and onset of disease are stable.

Concerns for Development After Bevacizumab Treatment of ROP

* Abbreviations: CLD — : chronic lung disease VEGF — : vascular endothelial growth factor Until recently, the treatment of potentially blinding retinopathy of prematurity (ROP) has been relatively straightforward. The 2003 publication1 of the multicenter ETROP (Early Treatment for Retinopathy of Prematurity) randomized trial indicated improved outcomes with the use of peripheral retinal ablation for eyes with type 1 ROP, defined as zone I ROP with plus disease (ie, abnormal dilation and/or tortuosity of the posterior pole vessels), zone I stage 3 ROP without plus disease, or zone II stage 2 or 3 ROP with plus disease. Among 401 infants with birth weights <1251 g at 26 US clinical centers, 342 of 370 survivors were examined at age 6 years.2 One in 4 had visual acuity worse than 20/200 in the laser-treated eye with type 1 ROP. This finding represents a marked improvement in visual function compared with the natural history of severe ROP found in untreated eyes in the CRYO-ROP (Cryotherapy for Retinopathy of Prematurity) study conducted 15 years earlier.3 In the earlier study, 52% of control (untreated) eyes with slightly worse than type 1 ROP had 20/200 or worse visual acuity.4 However, in CRYO-ROP,5 only 7% and, in ETROP,6 9.1% of eyes had zone … Address correspondence to Graham E. Quinn, MD, MSCE, Division of Ophthalmology, The Children's Hospital of Philadelphia, Wood Center, 1st Floor, Philadelphia, PA 19104. E-mail: quinn{at}email.chop.edu

Refraction and visual acuity in a national Danish cohort of 4-year-old children of extremely preterm delivery.

A recent threefold increase in laser treatment for advanced retinopathy of prematurity (ROP) triggered a nationwide preschool ophthalmic and developmental status among extremely preterm survivors. Here, we discuss refraction and visual acuity. Survivors (n = 178) from a national birth cohort (February 2004 to March 2006) of gestational age <28 weeks (PT) and 56 full-term (FT) controls attended for evaluation at age 4 years. Cycloplegic refraction and keratometry were achieved by Retinomax autokeratorefractor and visual acuities by symbol recognition (HOTV, logMAR). The refractive distribution presented a myopic tail (4.5%) and a hyperopic tail (11.9% ≥+2.5 D) as special preterm features, and corneas were more curved. Astigmatism and anisometropia were only marginally increased, and visual acuities were generally good. Best-corrected binocular median logMAR visual acuity was 0.1 in FT and 0.2 in PT, in Snellen equivalents 0.8 and 0.63. Snellen acuity ≤0.5 occurred across the ROP subgroups, but mainly in those with at least ROP stage 3. Two children had low vision. The overall fair outcome for refraction and function is in accordance with other recent northern Europe experience. The results differ in particular from the poorer ophthalmic outcomes reported in the pioneer US treatment studies (cryotherapy for ROP and ETROP). The diode laser ablations (n = 32) appeared effective in our series; except one child, all treated subjects had good or fair social vision at the age of 4 years.

Conjunctival Hypertrophic Scar Following Cryotherapy for Retinopathy of Prematurity

A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.

Current Role of Cryotherapy in Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology

To evaluate the role of cryotherapy in the current treatment of retinopathy of prematurity (ROP). Literature searches of PubMed and the Cochrane Library were conducted on December 2, 2009, for articles published after 1984. The searches included all languages and retrieved 187 relevant citations. Thirteen articles were deemed relevant to the assessment question and were rated according to the strength of evidence. Four articles reported results from 2 large multicenter randomized clinical trials, and the remaining 9 articles reported results of 3 small randomized trials that directly compared cryotherapy and laser. Neither of the multicenter randomized clinical trials was a direct comparison of cryotherapy with laser. These studies were used to evaluate the comparative trials based on treatment criteria, study populations, and clinical results. Higher percentages of poor structural and functional outcomes generally were seen in eyes treated with cryotherapy compared with eyes undergoing laser treatment. Higher rates of systemic complications and myopia also were identified after treatment with cryotherapy. Despite a relative paucity of level I evidence directly comparing cryotherapy and laser treatment for threshold ROP, the literature suggests that neonatal facilities should gain access to laser technology and laser-trained ophthalmic staff to achieve better outcomes for treatment of the disease.

Current Role of Cryotherapy in Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology

Current Role of Cryotherapy in Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology

Evaluation of Risk Factors for Postoperative Prolonged Intubation in Premature Infants After Cryotherapy for Retinopathy of Prematurity

Premature infants are more prone to cardiorespiratory complications after surgery than term infants. Risk factors for postoperative apnea include post-conception age, gestational age, postnatal age, birth weight, history of respiratory distress syndrome, bronchopulmonary dysplasia, anemia, necrotizing enterocolitis, use of opioids or nondepolarizing muscle relaxants, aminophylline use, history of apnea, body weight at operation, and pre-existing disease. The aim of this study was to identify the most important factors associated with postoperative extubation and respiratory outcomes among premature infants undergoing cryotherapy for retinopathy of prematurity (ROP). We retrospectively analyzed the clinical records of 62 premature infants, with mean +/- standard deviation gestational age of 26.4 +/- 2.3 weeks, birth weight of 914.8 +/- 208.5 g, postconception age of 37.0 +/- 2.8 weeks, and body weight at the time of operation of 1970.0 +/- 446.8 g, who underwent cryotherapy for ROP. Only 17 infants were successfully extubated within 2 hours after operation. The most predictive factor for successful or unsuccessful extubation was body weight at the time of operation. Body weight at the time of operation was the most important factor associated with postoperative ventilatory support among premature infants under-going cryotherapy for ROP.

Prevalence of retinopathy of prematurity: an institutional cross-sectional study of preterm infants in Brazil

Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in most developed countries. This study aimed to verify ROP prevalence among all very low birth weight (VLBW) preterm infants admitted to a level-3 teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil. Institutional cross-sectional study of 407 premature infants with birth weight < or = 1,500 g or gestational age (GA) < or =32 weeks between 2002 and 2007. All infants screened for ROP were examined after the fourth week of life and followed up until the 45th week of adjusted GA. ROP prevalence was estimated at a 95% confidence level. Some degree of ROP in one or both eyes occurred in 25.5% (104) of all screened infants, and severe ROP (threshold stage 3 or higher, requiring treatment to prevent vision loss, as per the criteria of the U.S.-based Multicenter Trial of Cryotherapy for Retinopathy of Prematurity, CRYO-ROP) occurred in 5.8% (24). Based on the criteria of The International Classification for Retinopathy of Prematurity (ICROP, 1984/1987), the disease reached stages 1, 2, and 3 in 11.3% (46), 8.4% (34), and 5.4% (22), respectively. One infant developed the disease up to stage 4 (partial retinal detachment), and one progressed to stage 5 (complete retinal detachment, resulting in 0.2% overall prevalence for ROP-induced blindness). Overall incidence of ROP in this institutional study (25.5%) was comparable to international results from developed countries. A comprehensive countrywide survey on ROP in Brazil is recommended to determine any regional differences in disease prevalence.

Impact of the Cryotherapy for Retinopathy of Prematurity Randomized Clinical Trial

T HE TRUE IMPACT OF THE CRYOTHERAPY FOR Retinopathy of Prematurity (ROP) randomized trial, or CRYO-ROP trial as it came to be known, cannot be measured apart from the development of the international classification of ROP (ICROP), which served as the backbone of the trial’s organization. The trial served as a necessary and sufficient test of the validity of the classification itself. Both were validated by the exercise. A brief overview of the background of the ICROP is in order to understand how closely entwined the two were and how both were born in response to the upsurge of ROP following a more liberal policy of oxygen use in the decade of the 1960s and the sporadic reports of the beneficial effects of photocoagulation and cryotherapy (coming from Japan and Israel primarily). The need for a new classification became obvious because studies had shown in previous decades that spontaneous regression of ROP indeed occurred. A better way of describing the eyes that truly needed treatment was required to separate a true response to therapy from the natural history of the disease itself. In answer to the need, some 23 members from 11 countries with an interest in ROP assembled in Calgary, Alberta, Canada, in 1981 to map out a rough sketch of a classification system that they agreed to use for a year without publication. The group then reconvened on the campus of the National Institutes of Health, Bethesda, Maryland, to finalize the document, which was published in 1984. The direct results of these efforts were the conception, planning, and implementation of the Cryotherapy for ROP randomized clinical trial of cryotherapy against observation (no treatment). A group of ophthalmologists from the United States intimately involved in the development of knowledge of ROP and its classification, among them Earl Palmer, MD, the study’s principal investigator, David Schafer, MD, Graham Quinn, MD, Dale Phelps, MD, myself, and others, put together the manual of procedure. In this effort, we were joined by Robert Hardy, PhD, professor of epidemiology and biostatistics at the School of Public Health, University of Texas, Houston, who lent design and biostatistical expertise and served as study coordinating center principal investigator during this and subsequent studies. The study manual of procedure outlined in exquisite detail every step in the selection of eligible infants, examining technique, diagnosis of the disease, threshold for treatment, technique of treatment, and follow-up of the infant’s treatedeye.Because thediseasewasmostoftensymmetrical in patients ( 80%), one eye served as the treated eye and the other as its control. The threshold for treatment was greater than 5 clock hours of grade 3 ROP in zone 1 or 2 accompanied by plus disease—defined for the study as dilated and tortuous veins and arteries of the posterior pole vessels. Twenty-three centers were enrolled in the study and their principal investigators were trained in the study protocol, applying ICROP to the disease as they examined premature infants of birth weight less than 1251 gandaccuratelydiagnosingROPand its severity.Aftercareful peer review, the National Eye Institute fully supported the study and subsequent follow-up of the enrolled infants. The study compared treatment with cryotherapy to the avascular retina for threshold ROP vs observation and no treatment for threshold disease in the opposite eye. Subjects were randomized by eye when the level of ROP was equal in both eyes and by patient when one eye was at the threshold but the other was not. Unfavorable outcome was definedasa total retinaldetachmentoraretinal fold through the macula destroying central vision. The results, both anatomical and later functional, were positive for cryotherapy. The finding of an unfavorable outcome in the treated eye was reduced by 50% (to approximately 25%) over its nontreated control (unfavorable outcome in approximately 46%). Some 291 premature infants were entered in the trial. At that point, the trial was stopped as it became clear that even if all future infants needed to attain sample size had failed cryotherapy, the study results would not be reversed. The infants enrolled in the study have been carefully followed up for 15 years. And although the visual results have not been as striking as had been hoped, they have nevertheless maintained a statistically significant edge over the results in the untreated eye. Author Affiliation: Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York. The articles that follow are part of an ongoing series that aims to review collaborative prospective studies supported by the National Eye Institute. The first article, written by investigators, will remind readers of the rationale, goals, methods, findings, and recommendations. The second article, written by an expert who did not participate in the investigations, will offer a constructive critique and attempt to estimate the impact of the study on the practice of ophthalmology.

Morphine analgesia as an alternative to general anaesthesia during laser treatment of retinopathy of prematurity

To determine the feasibility and efficacy of morphine sedation/analgesia in the laser treatment of retinopathy of prematurity (ROP). A retrospective study was carried out on all infants who underwent laser treatment for ROP over a 7 year period. Morphine infusion commenced 6 hrs prior to treatment at a rate of 10 microg/kg/hr. This rate increased to 20 microg/kg/hr at the start of laser treatment. Subsequent infusion rate was titrated according to tolerance of the laser and cardio and respiratory system changes and evidence of infant distress (truncal and limb movements) up to a maximum rate of 40 microg/kg/hr. Following treatment, morphine was weaned over 6 hrs. Infant ventilation status was recorded prior to and during morphine infusion and during laser treatment. The incidences of adverse cardiac or respiratory events occurring during laser treatment were determined. One hundred and nine infants treated from 1998 to 2005 were involved in the study. One hundred and thirty-six treatments were performed and mean gestational age at the time of treatment was 36 weeks. In 130 treatments, respiratory status remained stable and was not adversely affected. Infants were mechanically ventilated because of morphine-induced apnoea during three treatments, because of poor laser tolerance during two treatments and because of post-procedure apnoea in one case. In 65 treatments, minor alterations in oxygen saturation (< 90%), bradycardia or tachycardia occurred. This study demonstrates that morphine analgesia can be used as an alternative to general anaesthesia.

Severe visual impairment in children with mild or moderate retinal residua following regressed threshold retinopathy of prematurity

To describe clinical features of patients from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) trial who, after developing severe ROP in infancy, had minimal or moderate retinal residua in at least one eye but a visual acuity of worse than 20/200 in both eyes at the 10 year examination. Data from the 10 year CRYO-ROP Trial follow-up exams were evaluated to identify all patients with retinal outcomes of no retinopathy of prematurity (ROP) residua, straightened temporal vessels, or macular heterotopia in at least one eye, but visual acuity less than 20/200 in both eyes. Presence of optic atrophy, nystagmus, and optic disk cupping and developmental survey results were examined. Of 247 patients examined at 10 years, 16 met our inclusion criteria. At the last age at which the following data were recorded, seven had optic atrophy at the 10 year examination, one had optic disk cupping >0.5 at the 5(1/2) year examination, and eight had nystagmus under binocular conditions at the 24 month examination. Nine patients had a below-normal developmental test score on the Functional Independence Measure for Children (WeeFIM). After clinical data interpretation, we concluded that the predominant cause of visual impairment was postgeniculate disease in five patients, ROP in six patients, and combined anterior and posterior visual pathway disease in two patients; in three patients data were insufficient to make a determination. Poor visual function with mild to moderate retinal residua of severe ROP in at least one eye is relatively rare. In such patients, anterior, posterior, or combined visual pathway disease can occur.

Screening and cryotherapy for retinopathy of prematurity

目的 评价早产儿视网膜病(retinopathy of prematurity,ROP)冷凝治疗效果,探讨围手术期管理模式.方法 对370例符合筛查指征的早产儿进行眼底筛查,对25例阈值或Ⅰ型阈值前期病变ROP患儿进行冷凝治疗,术前术后在新生儿病房管理,新生儿科医师负责处理围手术期全身并发症,眼科医师术后定期随访检查眼底.结果 ROP的发生率为22%,阈值和Ⅰ型阈值前期病变发生率为6.8%.56例1期、2期病变未治疗,定期随访眼底恢复正常.25例50只眼阈值、Ⅰ型阈值前病变冷凝治疗成功率为92%,2例4只眼冷凝治疗后发生部分视网膜脱离,经玻璃体视网膜手术病变控制.随访9个月病变控制眼底正常的有44只眼(88%),出现视网膜脱离或后极部视网膜皱褶的有6只眼(12%).6例术后12 h内发生呼吸暂停,3例术后第1天出现窦性心动过速.结论 冷凝治疗可以作为治疗ROP阈值病变的选择,近期疗效较好.ROP围手术期处理的重点是呼吸管理.ROP患儿围手术期处理需要眼科医师和新生儿科医师密切合作共同管理。

50 Years Ago in The Journal of Pediatrics: Incidence of retrolental fibroplasias: Past and present

Shapira TM, Schall SM, Feinhandler H, Kane D. J Pediatr 1956;48:640-647 Fifty years ago, the incidence of retrolental fibroplasia (RLF) resulting in blindness at the Premature Station of the Sarah Morris Hospital for Children at the Michael Reese Hospital was noted to be around 5% in infants with birth weights of < 1250 g. The study was prompted by prior reports of RLF. The authors presented two studies of retrolental fibroplasia in infants: the first covered the time period from 1922 to 1951 and included 415 babies with a blindness rate of 5.3%; the second study included 432 infants with 8% showing signs of RLF and 2.5% progressing to blindness. The authors concluded that that incidence of RLF was greatly increased in infants < 1500 g. RLF is now known as retinopathy of prematurity (ROP). Although advances have been made over the past 50 years, we have a long way to go to get to prevention, early intervention, and cure for ROP. The association of oxygen and ROP was described in the 1950s which resulted in oxygen restriction. Following oxygen restriction, ROP occurred less often, but re-emerged in the 1960s and 1970s. The International Classification of ROP (ICROP) was developed in 1984 (with modifications in 1987 and 2005) resulting in uniform examination guidelines to facilitate the development of large multicenter clinical trials and to better understand ROP. The cryotherapy for retinopathy of prematurity (CRYO-ROP) trial results provided a new therapy for ROP—retinal ablation can significantly reduce the risk of blindness. This was a major advance as there was no prior treatment that had been shown to be effective for ROP. This was followed by the introduction of laser therapy and early treatment of ROP to improve visual outcome. Surgical treatment for ROP is used when the disease is advanced. Preventive and early intervention therapies are lacking in current medical practice for ROP. Much of the work with retinopathy has been focused at the basic and translational level to further understand the interaction of oxygen, hypoxia, and growth factors such as vascular endothelial cell growth factor and the IGF (insulin-like growth factor) family of growth factors. The incidence of ROP today is approximately 70% for infants < 1250 g birth weight; severe ROP occurs in slightly > 10% of these infants. If one compares these numbers to the numbers of 50 years ago, progress would appear to be minimal. However, medical advancements and improvements in survival of premature infants have shifted the distribution of ROP to the smallest, sickest, and most preterm infants. Eradication of blindness and serious visual impairment from ROP is a worthy goal for the next 50 years.

Visual Acuity at 10 Years in Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Study Eyes

To describe recognition (letter) acuity at age 10 years in eyes with and without retinal residua of retinopathy of prematurity (ROP). Presence and severity of ROP residua were documented by a study ophthalmologist. Masked testers measured monocular recognition visual acuity (Early Treatment of Diabetic Retinopathy Study) when the children were 10 years old. Two hundred forty-seven of 255 surviving Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) randomized trial patients participated. A reference group of 102 of 104 Philadelphia-based CRYO-ROP study participants who did not develop ROP was also tested. More severe retinal residua were associated with worse visual acuity, regardless of whether retinal ablation was performed to treat the severe acute-phase ROP. However, within each ROP residua category, there was a wide range of visual acuity results. This is the first report of the relation between visual acuity (Early Treatment of Diabetic Retinopathy Study charts) and structural abnormalities related to ROP in a large group of eyes that developed threshold ROP in the perinatal period. Visual deficits are greater in eyes with more severe retinal residua than in eyes with mild or no residua. However, severity of ROP residua does not predict the visual acuity of an individual eye because within a single residua category, acuity may range from near normal to blind.