Final Visual Acuity Results in the Early Treatment for Retinopathy of Prematurity Study

Abstract

Objective-To compare visual acuity at 6 years of age in eyes that received early treatment for high-risk prethreshold retinopathy of prematurity (ROP) with conventionally-managed eyes.Methods-Infants with symmetrical, high-risk prethreshold ROP (N=317) had one eye randomized to earlier treatment at high-risk prethreshold disease and the other eye managed conventionally, treated if ROP progressed to threshold severity. For asymmetric cases (N=84), the high-risk prethreshold eye was randomized to either early treatment or conventional management.Main Outcome Measures-ETDRS visual acuity measured at 6 years of age by masked testers. Retinal structure was assessed as a secondary outcome.Results-Analysis of all subjects with high-risk prethreshold ROP showed no statistically significant benefit for early treatment (24.6% v. 29.0% unfavorable outcome, P=0.15). Analysis of 6-year visual acuity results according to the Type 1 and 2 clinical algorithm showed a benefit for Type 1 eyes (25.1% v. 32.8%, P=0.02) treated early, but not Type 2 eyes (23.6% v. 19.4%, P=0.37). Early treated eyes showed a significantly better structural outcome compared with conventionally managed eyes (8.9% v. 15.2% unfavorable outcome, P<0.001), with no greater risk of ocular complications. Conclusion-Early treatment forType 1 high-risk prethreshold eyes improved visual acuity outcomes at 6 years of age. Early treatment for Type 2 high-risk prethreshold eyes did not.Application to Clinical Practice-Type 1 eyes, not Type 2 eyes should be treated early. These results are particularly important considering that 52 % of Type 2 high-risk prethreshold eyes underwent regression of ROP without requiring treatment.

Structural, Visual and Refractive Outcomes of Intravitreal Aflibercept Injection in High-Risk Prethreshold Type 1 Retinopathy of Prematurity

“…Disease in zone I was the only risk factor for unfavorable visual outcome in our study. This was comparable with the conventional arm of the ETROP study but was not statistically significant [24]. We found zone I disease to be a strong risk factor (p < 0.001) for high myopia.…”

“…This was also observed in the ETROP study, i.e. that in the conventionally treated eyes, both myopia and high myopia ≥5 dpt were higher in zone I eyes compared with zone II eyes [24]. …”

“…In our study, the correlation of abnormal retinal structure with poor visual outcomes was statistically significant (p = 0.001), and zone I disease was present in 12 (46.2%) eyes. The adverse effect of ROP in zone I on the structural outcome was also observed in the ETROP study [24] in both conventionally treated and early treated prethreshold high-risk eyes. Axer-Siegel et al [5] made similar observations regarding structural outcome but did not evaluate the effects statistically.…”

“…Favorable visual outcome was present in 80.8% which was comparable with other types of anti-VEGF treatment [8,10] and LPC [24]. We studied various risk factors for structural, visual and refractive outcomes and found zone I disease to be the most important risk factor for all 3 unfavorable outcomes.…”

Diagnosis and Treatment of Coats’ Disease: A Review of the Literature

“…On the other hand, Coats’ disease misdiagnosed as retinoblastoma has also been reported to be the most common cause of wrongful enucleation [2]. Furthermore, of considerable importance is the exclusion of retinopathy of prematurity, which can be treated and not affect the vision [23,27]. Additionally, we should take into account familial exudative vitreoretinopathy, haemangioblastoma von Hippel, pars planitis, incontinentia pigmenti, which are more often bilateral, as well as ocular toxocariasis and persistent fetal vasculature, which tend to be unilateral [23].…”