Favorable Structural Outcomes Research Articles

Safety and efficacy of intravitreal anti vascular endothelial growth factor for severe posterior retinopathy of prematurity with flat fibrovascular proliferation.

Intravitreal anti-vascular endothelial growth factor (IVA) injection is known to cause contraction of fibrovascular proliferation (FVP), when present in severe retinopathy of prematurity (ROP). To assess the structural outcomes of IVA injection in the treatment of severe posterior ROP with significant FVP. It was a retrospective study in which 36 eyes of 18 preterm babies who developed > 4 clock hours of FVP in zone I or posterior zone II, were treated with either intravitreal 0.625 mg bevacizumab or intravitreal 0.2 mg of ranibizumab. Favorable structural outcome included resolution of plus disease and FVP without the development of tractional retinal detachment. Secondary outcome measure included either full retinal maturation at follow-up or development of recurrent disease requiring additional treatment. Adverse outcomes included progression to retinal detachment. The mean gestational age of the 18 preterm babies was 30 wk (range 27-36), and mean birth weight was 1319 g (range 650-1980 g). Mean post-menstrual age (PMA) at the time of primary treatment was 35.5 wk (range 31-41 wk). All eyes showed regression of plus disease and FVP. 5 eyes of 3 babies showed reactivation of disease and were treated with repeat IVA (n = 2 eyes) or peripheral laser photocoagulation (n = 3 eyes) respectively. 16 out of 36 (44%) reached retinal vascular maturation at final follow up at 5 years. There was good resolution of severe posterior ROP with FVP with IVA, with retinal maturity of 44% at 5 year follow-up and a reactivation rate of 13.8%. When the IVA injection is given prior to 37 wk PMA, while disease is in phase 2, it is less likely to cause contracture of pre-existing FVP.

Long-term outcomes of type 1 retinopathy of prematurity following monotherapy with bevacizumab: a Canadian experience

ObjectifPrésenter les résultats structurels, visuels et réfractifs à long terme après l'administration d'une injection intravitréenne de bévacizumab à titre de monothérapie. NatureExamen rétrospectif des dossiers médicaux d'une cohorte de patients. ParticipantsUn total de 56 nourrissons prématurés présentant une rétinopathie du prématuré (RDP) de type 1. MéthodesIl s'agissait de l'examen des dossiers médicaux réalisé dans 2 établissements canadiens. Les critères d'inclusion comprenaient l'injection unique d'une dose de 0,625 mg de bévacizumab par voie intravitréenne et un âge minimum de 3 ans au moment de la dernière visite de suivi. Le paramètre principal reposait sur la structure de la rétine. Les paramètres secondaires comprenaient l'erreur de réfraction en équivalent sphérique, l'acuité visuelle monoculaire, le strabisme et l'amblyopie. RésultatsAinsi, 56 nourrissons (101 yeux) répondaient aux critères d'inclusion. Leur poids de naissance moyen s’élevait à 707 ± 178 g (fourchette : 420–1520 g), tandis que leur âge gestationnel moyen était de 25,0 ± 1,3 semaines (fourchette : 22,9–29,7 semaines). On a diagnostiqué une RDP de zone I dans 24 yeux (24 %) et de zone II dans 77 yeux (76 %). L’âge postmenstruel moyen au moment du traitement était de 36,9 ± 2,1 semaines (fourchette : 32,8–42,0 semaines). Lors de l'examen à un âge moyen de 5,4 ± 1,6 ans (fourchette : 3,0–8,0 ans), les résultats structurels étaient favorables dans tous les yeux, sans réactivation ayant nécessité un traitement. L'acuité visuelle monoculaire moyenne se chiffrait à 0,29 ± 0,27 logMAR (fourchette : 0,0–1,3 logMAR; 89 yeux sur 101), et l’équivalent sphérique moyen était de –1,98 ± 4,91 D (fourchette :–16,63 à +5,38 D; 101 yeux sur 101). Les résultats visuels se déclinaient comme suit: prévalence d'emmétropie (> –1,0 à ≤ 1 D) de 43,6 %, de faible myopie (≥ 1,0 à < 5 D) de 17,8 %, de forte myopie (≥ 5 à < 8 D) de 8,9 %, de très forte myopie (≥ 8,0 D) de 12,9 % et d'hyperopie (> 1 D) de 16,8 %. Enfin, 12 enfants (23 %) présentaient une amblyopie, et 17 (32 %), un strabisme. ConclusionsTous les patients ont bénéficié de résultats favorables sur le plan structurel grâce à l'administration d'une seule injection de bévacizumab sans traitement au laser. Nous recommandons une surveillance régulière après la régression d'une RDP aiguë plutôt que le recours systématique à un traitement au laser préventif prévu à une date ultérieure. De plus amples études devront être réalisées afin d’évaluer d'autres aspects de la fonction visuelle.

English

BACKGROUND Retinopathy of prematurity (ROP) is a disease affecting the retina of premature infants due to retinal neovascularization and the spectrum of outcome findings in ROP ranges from the most minimal sequelae without affecting vision in the mild cases to bilateral, irreversible, and total blindness in more severe cases.In India children less than 1500 g have almost 38 percent chance of developing any stage of ROP and 7 – 16 % chance of developing threshold ROP or blinding ROP. (2)Laser photocoagulation has replaced cryotherapy as the established treatment for ROP in most centers and this study aims to evaluate the functional and structural outcome in preterm infants who received laser photocoagulation for retinopathy of prematurity. In this study we wanted to find out the structural outcome of retinopathy of prematurity infants who underwent laser photocoagulation. We also wanted to find out the functional outcome of ROP preterm infants who underwent laser photocoagulation and identify the factors affecting the structural outcome in retinopathy of prematurity. METHODS A hospital based descriptive study was conducted among 31 preterm infants with retinopathy of prematurity who received laser photocoagulation treatment after obtaining parental consent in the Retina clinic, Regional Institute of Ophthalmology, Trivandrum. Screening examination was done at 34 weeks or 4 weeks postnatal whichever was earlier. Those infants who were detected to have ROP and were given laser photocoagulation by the ophthalmologist were followed up till retina becomes stable / ROP regresses. Thereafter follow up examinations were performed at 3 months, 6 months and 10 months. Structural outcome was classified as favorable and unfavorable. Visual or functional outcome was assessed by noting the fixation pattern, ocular alignment for strabismus and by performing cycloplegic refraction (retinoscopy) to rule out refractive errors. Data was entered into excel sheet and statistical analysis was done using SPSS trial version. RESULTS The study was conducted in 31 preterm infants with Retinopathy of Prematurity who underwent laser photocoagulation in Regional Institute of Ophthalmology Trivandrum. The structural and functional outcome was assessed at 3months, 6 months and 10 months. Of the 62 eyes of 31 infants, stage2 and 3comprised 48.4%each.3.2% of eyes had stage1 disease affecting zone1.None had stage 4 or 5.Of the 62 eyes, majority had zone 2 disease (83.9%). Only 10 eyes had zone1 disease. Out of the 60 eyes, 54 eyes had a favorable structural outcome at 3months.The functional outcome was assessed in terms of visual behavior by assessing the fixation of light, whether child is following light and by preferential looking pattern. Out of the 30 babies only 1 had an unfavorable visual behavior. The baby was not fixing and following light. Out of the 30 infants, 2 had (6.6%) strabismus at 6months and 10 months. Myopia was the predominant refractive error in the studied group accounting for about 55%. Among the study group 16.7 % had hypermetropia. CONCLUSIONS The incidence of favorable structural outcome in our study was 90%.Low gestational age and low birth weight were associated with an unfavorable structural outcome. There is a high prevalence of refractive errors in our study group accounting for about 71.5 % at 6 months. The refractive errors increased at 10 month follow up to 77%. Among the refractive errors, myopia predominates accounting 55% at 6 months and 61 % at 10 months. KEY WORDS Laser Photocoagulation, Retinopathy of Prematurity

Combined intravitreal ranibizumab and zone I sparing laser ablation in infants with posterior zone I retinopathy of prematurity.

Purpose:To evaluate the efficacy of combined intravitreal ranibizumab (IVR) and zone I sparing laser ablation in infants with posterior zone I Retinopathy of Prematurity (ROP).Methods:This was a retrospective, interventional case series including premature infants diagnosed with posterior zone I ROP (n = 24) on ROP screening. Charts and RetCam images of preterm infants with posterior zone I ROP treated with immediate IVR and zone I sparing laser ablation at 4 weeks between April 2016 and September 2019 were reviewed. Data were analyzed and tabulated using frequency and descriptive statistics to describe the demography, morphology, and treatment outcomes. Primary outcome measure was structural outcome at 6 months. It was further categorized as favorable and unfavorable.Results:Twenty-four infants (48 eyes) with a mean gestational age of 28.54 ± 1.98 weeks and birth weight of 1180.33 ± 280.65 grams were analyzed. Thirty-six (75%) eyes had persistent tunica vasculosa lentis and twenty-six (54.1%) eyes had iris neovascularization. All eyes had features of aggressive posterior retinopathy of prematurity (APROP) limited to posterior zone I. The mean duration between IVR and zone I sparing laser ablation was 29.62 ± 6.36 (range: 24-34) days. One infant (2 eyes) received a second IVR treatment for recurrence of plus disease and persistent new vessels close to the fovea. Laser augmentation was done in 13 (27.1%) eyes. A favorable structural outcome was seen in 45 (93.7%) eyes.Conclusion:Posterior zone I ROP presents as APROP. Combined IVR and zone I sparing laser ablation appears effective treatment option in these eyes.

Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity.

Purpose:The aim of this study was to report the treatment outcomes of early and deferred laser in infants of aggressive posterior retinopathy of prematurity (APROP) after initial treatment with intravitreal Ranibizumab (IVR).Methods:In a prospective, randomized, interventional study, infants with APROP received IVR (0.25 mg) and were randomized into two groups prior to laser. Laser was done at 1 week (group 1) or at 6 weeks or earlier if there was a recurrence of plus disease (group 2). The structural outcome, number of laser spots, duration of laser procedure and refractive error at 6 months were compared. Favorable structural outcome was defined as, complete regression of disease at 6 weeks after laser.Results:63 eyes of 32 infants with APROP were enrolled. Mean gestational age (GA) and birth weight (BW) were 30.2 ± 2.3 weeks and 1294 ± 372.8 grams respectively. GA, BW, and disease severity were comparable at baseline. 27 (90%) eyes in group 1 and 29 (93.5%) eyes in group 2 had favorable structural outcome (P = 0.61) at 6 weeks after laser. Eyes in group 2 (2149.8 ± 688.7) required lesser number of laser spots than group 1 (2570.8 ± 615) (P = 0.01). At six months, more eyes in group 1 had myopic refractive error (Mean spherical equivalent: –1.0D ± 1.3) than those in group 2 (Mean spherical equivalent: 0.5D ± 1.9) (P = 0.002).Conclusion:Infants with APROP receiving IVR have comparable structural outcomes after an early or deferred laser. Moreover, eyes undergoing deferred laser require less number of laser spots and have a less myopia at 6 months after laser.

One-year visual outcomes after laser for Type 1 prethreshold retinopathy of prematurity among very low birth weight neonates at a tertiary center in western India – A prospective cohort study

Objective: To evaluate the visual outcomes after laser treatment for retinopathy of prematurity (ROP) among very-low-birth-weight neonates at 1-year corrected age in population of western India.Methods: In this prospective cohort study, 35 neonates received laser treatment for type 1 prethreshold ROP. Structural and refractive status were assessed at 1-year corrected age in these neonates.Results: Total 32 neonates (64 eyes) were followed-up at the age of 1 year. The mean gestational age and birth weight were 27.6 weeks and 900 g, respectively. All 64 eyes reported favorable structural outcome. The mean refractive error was −1.82 D (range: −11 to +4 D). Prevalence of myopia was 62.5% [43.8% low myopia; 18.8% high myopia]. Eight eyes (12.5%) had insignificant hyperopia.Conclusion: We concluded that timely and adequate screening of eyes of preterm neonates followed by early and appropriate laser treatment improves the later visual outcomes. High refractive error is common and may be the cause of visual impairment.

Retinopathy of prematurity like retinopathy in full-term infants.

PURPOSE:The purpose of this study is to assess clinical characteristics, risk factors, and management outcomes of retinal changes similar to retinopathy of prematurity (ROP), seen in full-term infants.PATIENTS AND METHODS:This is a retrospective review of 46 eyes of 23 patients, born at full term or near full term and diagnosed to have active ROP-like retinopathy or sequelae of ROP-like retinopathy.RESULTS:Mean birth weight (BW) and gestational age (GA) were 2342 ± 923 g (range, 1200–4160 g) and 38.5 ± 1.85 weeks (range, 37–40 weeks). Mean age at the time of diagnosis was 3.5 ± 8.75 years (range, 1 month–16 years). Stage 1 and 2 of retinopathy was seen in 10 eyes (21.7%), threshold disease with plus disease in 12 eyes (26%) and Stage 4 or 5 in 14 eyes (30.4%). Involutional sequelae were noted in 10 eyes (21.7%). Twenty-one eyes (45.6%) underwent appropriate treatment in the form of laser, cryotherapy, or retinal detachment surgery. Eight eyes (17.4%) with advanced sequelae such as total closed funnel retinal detachment and macular fold were not treated. Mean follow-up was 3 years (range, 1 month to 12 years). At the last follow-up, 29 eyes (63%) had a favorable structural outcome (P < 0.001). Among the patients in whom visual acuity could be assessed (16 eyes), favorable visual outcome was noted in 9 eyes (56.2%). Low BW (P = 0.038), multiple births (P = 0.013), respiratory distress syndrome (RDS) (P = 0.001), phototherapy (P = 0.001), and oxygen administration (P < 0.001) were significantly associated with the development of ROP-like retinopathy in these full-term infants.CONCLUSIONS:ROP-like retinopathy can occur in full-term and near full-term infants and can potentially lead to permanent visual impairment. Screening of infants with risk factors such as oxygen administration, RDS, multiple births, and low BW, regardless of GA, may reduce visual impairment.

A comparative study between intravitreal ranibizumab and peripheral laser ablation in cases of prethreshold type I retinopathy of prematurity

Purpose: The aim was to evaluate the efficacy and safety of intravitreal injection of ranibizumab for treatment of prethreshold type 1 retinopathy of prematurity (ROP) with conventional laser photocoagulation given for the same disease level. Subjects and Methods: In this retrospective comparative study, the charts of 16 premature babies, presenting from July 2009 to May 2014, were reviewed. All infants were diagnosed with prethreshold ROP (type 1). Patients received either intravitreal ranibizumab (0.625 mg/0.025 ml of solution) (group A, 12 eyes of 6 infants) or conventional diode laser (group B, 28 eyes of 14 infants), bilaterally. The main evaluated outcomes included time of regression, decrease of plus signs and incidence of recurrence. Infants were followed till 55 weeks postmenstrual age. The confidentiality of the patients was respected. Results: The mean age of the studied infants was 35.63 ± 1.58 weeks ranging from 33 to 39 weeks. The stage of ROP in the studied infants was either stage 2 in 7 cases (43.8%) or stage 3 in 9 cases (56.3%). The zones of ROP were zone I in 3 cases (18.8%) and zone II in 13 cases (81.3%). Group A had a mean gestational age (GA) of 36.6 ± 1.5 weeks, while cases in group B had mean GA of 35 ± 1.3 weeks. This was statistically significant ( P = 0.037). The stage did not significantly affect the choice of treatment ( P = 0.09). Looking at the subgroup analysis 66.7% (two cases) of cases with zone I disease were treated with intravitreal ranibizumab, whereas 69.2% (nine cases) with zone II disease were treated with conventional laser. The incidence of recurrence was not affected by the zone of the disease ( P = 0.71) nor by the stage of the ROP or by the presence of plus sign ( P = 0.29, P = 0.68, respectively). There was no statistically significant difference between the two treatment groups about the incidence of recurrence ( P = 0.701). The mean GA for cases with recurrence of ROP (35.25 ± 2.6 weeks), did not differ significantly with the mean GA of the infants who did not suffer from recurrence 35.75 ± 1.2 weeks ( P = 0.7). Conclusion: Both intravitreal ranibizumab and conventional laser were proven effective in the treatment of prethreshold type 1 ROP. Long-term favorable structural outcome may require extended observation and retreatment. Further large-scale studies are needed to address the long-term safety and efficacy.

Clinical characteristics of children with severe visual impairment but favorable retinal structural outcomes from the Early Treatment for Retinopathy of Prematurity (ETROP) study

To describe visual function and associated characteristics at the 6-year examination in children enrolled in the Early Treatment for Retinopathy of Prematurity Study who had unfavorable visual outcomes despite favorable structural outcomes in one or both eyes. The clinical examination records of children completing the 6-year follow-up examination were retrospectively reviewed. Eligible subjects were those with visual acuity of ≤20/200 in each eye (where recordable) and a normal fundus or straightening of the temporal retinal vessels with or without macular ectopia in at least one eye. Data regarding visual function, retinal structure, presence of nystagmus, optic atrophy, optic disk cupping, seizures/shunts, and Functional Independence Measure for Children (ie, WeeFIM: pediatric functional independence measure) developmental test scores were reviewed. Of 342 participants who completed the 6-year examination, 39 (11%) met inclusion criteria. Of these, 29 (74%) had normal retinal structure, 18 (46%) had optic atrophy, and 3 (8%) had increased cupping of the optic disk in at least one eye. Latent and/or manifest nystagmus occurred in 30 children (77%). The presence of nystagmus was not related to the presence of optic atrophy. Of the 39 children, 28 (72%) had a below-normal WeeFIM score. In 25 participants (7%) completing the 6-year examination, cortical visual impairment was considered the primary cause of visual loss. The remainder likely had components of both anterior and posterior visual pathway disease. Clinical synthesis of ocular anatomy and visual and neurologic function is required to determine the etiology of poor vision in these children.

Coats disease in a Nigerian man with a favorable structural outcome following retinal laser photocoagulation

Coats disease in a Nigerian man with a favorable structural outcome following retinal laser photocoagulation

Correlation of Recognition Visual Acuity With Posterior Retinal Structure in Advanced Retinopathy of Prematurity

OBJECTIVE To compare Early Treatment Diabetic Retinopathy Study visual acuity outcome with retinal structural outcome at the 6-year follow-up examination of infants randomized in the Early Treatment for Retinopathy of Prematurity study. METHODS We compared the results in 606 eyes of subjects in whom both functional (visual acuity) and retinal structural assessments were obtained at age 6 years. Visual acuity assessments were performed by masked testers, and retinal examinations were performed by certified ophthalmologists. MAIN OUTCOME MEASURES Visual acuity and retinal structure at age 6 years. RESULTS Concordant outcomes occurred in 462 eyes (76.2%): 402 eyes had favorable functional and structural outcomes and 60 eyes had unfavorable functional and structural outcomes. Discordant outcomes occurred in 92 eyes (15.2%): 86 eyes had unfavorable functional and favorable structural outcomes and 6 eyes had favorable functional and unfavorable structural outcomes. Of the 86 eyes with unfavorable functional and favorable structural outcomes, 43 had optic atrophy (23 eyes) and/or retinal abnormalities that were less severe than those considered to be unfavorable (32 eyes). In 52 eyes (8.6%), retinal structure could not be assessed or the visual acuity was untestable. CONCLUSION Posterior pole appearance correlates well with visual acuity in 6-year-old infants with a history of advanced retinopathy of prematurity. APPLICATION TO CLINICAL PRACTICE When the retinal structure is normal but visual acuity is poor in infants with a history of severe retinopathy of prematurity, other diagnoses such as optic atrophy and cortical visual impairment could at least partially account for the discrepancy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00027222.

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To compare Early Treatment Diabetic Retinopathy Study visual acuity outcome with retinal structural outcome at the 6-year follow-up examination of infants randomized in the Early Treatment for Retinopathy of Prematurity study. We compared the results in 606 eyes of subjects in whom both functional (visual acuity) and retinal structural assessments were obtained at age 6 years. Visual acuity assessments were performed by masked testers,and retinal examinations were performed by certified ophthalmologists. Visual acuity and retinal structure at age 6 years. Concordant outcomes occurred in 462 eyes(76.2%): 402 eyes had favorable functional and structural outcomes and 60 eyes had unfavorable functional and structural outcomes. Discordant outcomes occurred in 92 eyes (15.2%): 86 eyes had unfavorable functional and favorable structural outcomes and 6 eyes had favorable functional and unfavorable structural outcomes.Of the 86 eyes with unfavorable functional and favorable structural outcomes, 43 had optic atrophy (23 eyes) and/or retinal abnormalities that were less severe than those considered to be unfavorable (32 eyes). In 52 eyes (8.6%), retinal structure could not be assessed or the visual acuity was untestable. Posterior pole appearance correlates well with visual acuity in 6-year-old infants with a history of advanced retinopathy of prematurity.

Reactivation of Retinopathy of Prematurity After Bevacizumab Injection

To report late reactivation and progression of retinopathy of prematurity (ROP) after intravitreal bevacizumab monotherapy. Retrospective review of 9 patients (17 eyes) with recurrence of ROP after initial treatment with intravitreal bevacizumab monotherapy. Data collected included (1) location and stage of ROP activity, (2) number and timing of treatments, and (3) structural outcomes. Mean age at treatment-requiring recurrence was 49.3 weeks (SD, 9.1 weeks; minimum, 37 weeks; maximum, 69 weeks) postmenstrual age (PMA). The mean time between initial treatment and treatment-requiring recurrence was 14.4 weeks, with a minimum of 4 and maximum of 35 weeks. Fives eyes progressed to retinal detachment (4 eyes stage 5, 1 eye stage 4a). Age at retinal detachment ranged from 49 to 69 weeks PMA with a median of 55 weeks PMA and mean of 58.4 weeks PMA. No eye that received laser treatment for recurrence progressed to retinal detachment. Although intravitreal bevacizumab treatment is effective in inducing regression of ROP, the effect may be transient. Recurrence can occur later in the course than with conventional laser therapy. Late retinal detachment can occur despite early regression. Longterm favorable structural outcome may require extended observation and retreatment. Laser may be a useful treatment for recurrences.

Prevalence and course of strabismus through age 6 years in participants of the Early Treatment for Retinopathy of Prematurity randomized trial

To present strabismus data for children who participated in the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. The prevalence of strabismus, categorized as present or absent, was tabulated for all children with history of high-risk prethreshold retinopathy of prematurity (ROP) who participated in the ETROP randomized trial and were examined at 9 months to 6 years of age. Relationships among strabismus and demographic measures, eye characteristics, and neurodevelopmental factors were analyzed. Among the 342 children evaluated at 6 years, the prevalence of strabismus was 42.2%. Even with favorable acuity scores in both eyes, the prevalence of strabismus was 25.4%, and with favorable structural outcomes in both eyes the prevalence of strabismus was 34.2%. Of children categorized as visually impaired as the result of either ocular or cerebral causes, 80% were strabismic at the 6-year examination. Of 103 study participants who were strabismic at 9 months, 77 (74.8%) remained so at 6 years. Most strabismus was constant at both the 9-month (62.7%) and the 6-year examination (72.3%). After multiple logistic regression analysis, risk factors for strabismus were abnormal fixation behavior in one or both eyes (P < 0.001), history of amblyopia (P < 0.003), unfavorable structural outcome in one or both eyes (P = 0.025), and history of anisometropia (P = 0.04). Strabismus surgery was performed for 53 children. By 6 years, the cumulative prevalence of strabismus was 59.4%. Most children with a history of high-risk prethreshold ROP develop strabismus at some time during the first 6 years of life.

Retinopathy of Prematurity in Infants Weighing Less Than 500 Grams at Birth Enrolled in the Early Treatment for Retinopathy of Prematurity Study

To describe patient characteristics, classification, and onset of prethreshold retinopathy of prematurity (ROP), and ocular findings at 6 months corrected age in infants with birth weights <500 g who were enrolled in the Early Treatment for Retinopathy of Prematurity (ETROP) Study. Multicenter randomized clinical trial. Sixty-three infants with birth weights <500 g who developed ROP and were enrolled in the ETROP Study. Infants <1251 g at birth were logged at 26 study centers from October 1, 2000, to September 30, 2002, and underwent examinations for ROP. Infants who developed ROP and whose parents/legal guardians consented were enrolled in the ETROP Study. Infants who developed high-risk prethreshold ROP were randomized; 1 eye was treated early with peripheral retinal ablation and the other eye was managed conventionally, or, in asymmetric cases, the high-risk eye was randomized to early peripheral retinal ablation or conventional management. All eyes reaching prethreshold ROP were examined when infants reached 6 months corrected age. Retinopathy of prematurity incidence, characteristics, and ocular findings among participants. Thirty-four infants reached prethreshold or worse severity in 1 or both eyes. Retinopathy of prematurity was located in zone I in 43.3% of all prethreshold eyes, and plus disease was present in 46.7%. Median postmenstrual age for diagnosis of all prethreshold ROP was 36.1 weeks, but earlier (35.1 weeks) for eyes that developed high-risk prethreshold ROP. In the 27 surviving infants with prethreshold ROP, ophthalmic examination at 6 months corrected age showed a normal posterior pole in 22 (81.5%), a favorable structural outcome with posterior pole abnormalities in 4 (14.8%), and an unfavorable structural outcome (stage 4B) in 1 (3.7%). One infant developed amblyopia, 4 infants developed nystagmus, 4 infants developed strabismus, and 8 infants developed myopia >-5.00 diopters. This is the first report on characteristics of prethreshold ROP in infants with birth weights <500 g. These infants are at high risk for developing prethreshold ROP, although many initially achieve a favorable structural outcome. They are at risk of developing strabismus, nystagmus, high myopia, and abnormal retinal structure and should therefore receive continued long-term follow-up. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Structural Sequelae and Refractive Outcome After Successful Laser Treatment for Threshold Retinopathy of Prematurity

To study the structural sequelae and refractive outcome in eyes with a favorable structural outcome following laser treatment for threshold retinopathy of prematurity (ROP). Premature infants with threshold ROP had laser treatment with a minimum follow-up of 1 year. Complete ocular examination and refraction was done. Analysis and correlation of structural sequelae and refractive outcome was done. One hundred eighty-four eyes of 93 preterm infants were followed up. Structural changes such as vascular tortuosity, narrowing of arcades, temporal crescent, disc drag, and macular heterotopia were seen. Mean refractive error observed was -4.71 D spherical equivalent. Myopia was seen in 80.43% of eyes. The study revealed various structural sequelae and their correlation with refractive outcome.

Retinopathy of prematurity in practice. II: long-term results following treatment for threshold disease.

To determine the long-term outcome of treatment for threshold retinopathy of prematurity (ROP) in one UK unit. A total of 35 infants diagnosed with threshold ROP were treated by a single ophthalmologist (DGC) between 1987 and 1998. The parents of the 29 surviving patients were contacted; 21 brought their child for special review of acuity, motility, refraction and fundoscopy (Group 1). Of the eight patients who were unable to attend, six patients (Group 2) had sufficient follow-up detail in their records to be included in the study. A total of 40 eyes in the 21 patients in Group 1 had been treated; 10 had received cryotherapy (eight bilateral) and 11 had bilateral laser. Mean follow-up was 5 years (range 2-12 years). A total of 23 treated eyes (in 16 patients) had an acuity of 6/12+ (57.5% of treated eyes). Four eyes of three patients had no light perception. Seven eyes in four patients had myopia of more than 3 D. Eight patients had a manifest squint: six esotropia, two exotropia. The retinal status of 36 eyes (90%) showed a favourable outcome. The four blind eyes had stage 5 disease. In Group 2, four eyes of two patients (33%) had 6/12+ acuity recorded; five eyes in three patients had stage 5 disease and no perception of light. In total, a favourable structural outcome was achieved in 81.4% and favourable functional outcome observed in 74.6%. These results show that the favourable outcomes reported in the CRYO-ROP trial can be achieved in routine practice and maintained after long follow-up.

Three year visual outcome for treated stage 3 retinopathy of prematurity: cryotherapy versus laser

BACKGROUND/AIMSIn the management of retinopathy of prematurity (ROP), several studies have demonstrated laser photocoagulation to be as effective as cryotherapy in reducing the incidence of unfavourable structural outcome. However, few...

Echocardiography 1994

<b>Aims:</b> To assess the long term functional and structural outcomes of premature babies who received diode laser photocoagulation for threshold retinopathy of prematurity (ROP). <b>Methods:</b> 25 patients (43 eyes) treated with laser were recalled for assessment at a mean follow up of 11 years. A further seven patients (14 eyes) with subthreshold ROP, which had regressed spontaneously without laser treatment, were also examined. All children underwent distance acuity, near acuity, contrast sensitivity (CS), and colour vision assessments followed by a dilated fundal examination and cycloplegic autorefraction. <b>Results:</b> The laser treated eyes had a mean distance visual acuity of 0.37 logMAR, a mean near visual acuity of 0.39 logMAR, a mean contrast sensitivity of 1.49 log CS units, and a mean spherical equivalent of −2.10D. An unfavourable distance visual acuity outcome occurred in five eyes (13.5%). An unfavourable near visual acuity outcome was also noted in the five eyes (13.5%) with poor distance visual outcome. 7% had an unfavourable structural outcome. On comparison with the control group, there was no significant difference in near acuity, CS, refraction, or colour vision between the two groups. However, there was a statistically significant difference in terms of distance visual acuity (p = 0.03). <b>Conclusions:</b> Laser treated eyes with favourable structural outcome have a good visual outcome. The results show a long term benefit from diode laser photocoagulation in preserving distance and near vision in eyes with threshold ROP.