Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines

Rajan, Renu P; Kohli, Piyush; Babu, Naresh; Dakshayini, C; Tandon, Manish; Ramasamy, Kim

doi:10.1007/s00417-020-04706-8

Cited by 14 publications

(27 citation statements)

References 37 publications

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“…Type 1 ROP is more severe than type 2 and requires treatment for ROP via laser photocoagulation and/or anti-VEGF therapy ( 10 ). Infants with type 2 ROP require close monitoring, and treatment may be considered if type 2 ROP is persistent past 52 weeks gestational age ( 10 , 11 ). Infants with ROP, including those who have been treated, require long-term monitoring for the development of visual impairments, such as macular dragging, myopia, and strabismus ( 4 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

et al. 2021

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Purpose: To evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes in premature neonates at 0–36 months corrected age.Methods: A retrospective chart review was performed on 228 neonates screened for ROP at the UCLA Mattel Children's Hospital between 2011 and 2018. Demographic information, clinical outcomes, ROP severity (no ROP, type 1 ROP, type 2 ROP), and Bayley-III neurodevelopmental scores were collected. Infants were grouped into corrected age cohorts (0–12, 12–24, and 24–36 months) to assess neurodevelopmental outcomes with increasing age. Within each age cohort, ANOVA and Chi-Square testing were used to detect differences in birth characteristics and neurodevelopmental scores between infants with type 1 ROP, type 2 ROP, or no ROP. Univariable analyses assessed the relationship between ROP severity and neurodevelopmental outcomes within each age cohort. A multivariable analysis was then performed to determine if ROP severity remained significantly associated with worse neurodevelopmental scores after controlling for birth weight (BW), intraventricular hemorrhage grade (IVH), health insurance type, male sex, and age at Bayley testing.Results: Without controlling for factors associated with prematurity, neonates with type 1 ROP had poorer cognition (p = 0.001) and motor (p = 0.006) scores at ages 0–12 months and poorer cognition (p = 0.01), language (p = 0.04) and motor (p = 0.04) scores at ages 12–24 months than infants without ROP, but no significant differences were detected at ages 24–36 months. After adjusting for BW, IVH, insurance type, male sex, and age at Bayley testing, ROP severity was no longer associated with worse neurodevelopmental scores in any domain.Conclusion: This study emphasizes that poorer neurodevelopmental outcomes in preterm neonates are most likely related to lower birthweight, associated co-morbidities of prematurity, and socioeconomic factors such as health insurance, not severity of ROP itself.

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Section: Introductionmentioning

confidence: 99%

Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

et al. 2021

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“…Some previous studies analyzed the treatment reasons of non-Type 1 ROP (seen in Table 5) 3,5,11,16 , but the main treatment method in these studies was laser coagulation. No literature had been studied the effect of intravitreal injection of anti-VEGF drugs on the treatment of non-type 1 ROP currently.…”

Section: Discussionmentioning

confidence: 99%

Treatment for non-type 1 retinopathy of prematurity by intravitreal injection of anti-vascular endothelial growth factor drugs

Zhang

Yang

Zheng

et al. 2022

Preprint

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To explore clinical characteristics and treatment reasons for intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs in the treatment of non-type 1 retinopathy of prematurity (ROP). A retrospective study was conducted to screen the non-type 1 ROP from the collected ROP patients who received intravitreal injection of anti-VEGF drugs in Henan Eye Hospital from September 2018 to June 2021. A total of 138 ROP cases (262 eyes) were included in this study, including 39 cases (28.3%) 65 eyes (24.8%) were the non-type 1 ROP. Compared with the type 1 ROP group, the non-type 1 ROP group had slightly later treatment time (41.1±8.9 weeks vs 38.6±5.5 weeks, P<0.05) and a higher proportion of fusion protein drugs(87.2% vs 54.5%, P<0.05). After intravitreal injection of anti-VEGF drugs, 27 eyes (41.5%) were cured and 38 eyes (58.5%) were improved in the non-type 1 ROP group, without recurrence and aggravation cases. There were more lesions in zone II (63 eyes, 96.9%), stage 2 (41 eyes, 63.1%) and stage 3 (22 eyes, 33.8%), and 58 eyes (89.2%) showed pre-plus in the non-type 1 ROP group. Treatment reasons included pre-plus in 58 eyes (89.2%), ridge changes in 22 eyes (33.8%), simultaneous treatment of the contralateral eye in 9 eyes (13.8%), no regression of lesions in persistent stage 2 or 3 over 44 weeks of follow-up in 8 eyes (12.3%), and logistical considerations in 4 eyes (6.2%). Considering some peculiar clinical characteristic, personalized treatment by intravitreal injection of anti-VEGF drugs may be necessary for some non-type 1 ROP in critical conditions.

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“…In medical ROP literature, many underlying reasons for off-label treatment have been reported. In our study, we retained these five indications outside the ETROP guidelines due to their frequency in ROP studies and their clinical relevance [ 11 , 12 , 13 ]. As mentioned above, we did not consider pre-threshold type 1 ROP in the fellow eye as an indication outside the guidelines, but we included these children in the ETROP-guidelines-treated group.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2003, the epidemiology of premature children has changed, with an increase in the survival of severely premature children. As a result, indications for treatment outside the ETROP guidelines, based on physicians’ clinical experience and collegial discussions, have been slowly increasing [ 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment outside the Recommended Guidelines for Retinopathy of Prematurity (ROP): Prevalence, Characteristics, and Issues

Lemaître

Barjol

Abdelmassih

et al. 2021

JCM

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This study aims to assess the prevalence and characteristics of preterm infants with retinopathy of prematurity (ROP) treated outside the recommended guidelines. In this retrospective monocentric cohort, we included all premature children treated in our department for ROP by laser photoablation or anti-VEGF intravitreal injection. The main outcome was treatment of both eyes for ROP less severe than pre-threshold type 1, treated outside ETROP guidelines. A total of 114 children received treatment for ROP in our department, among whom 32 (28.1%) children received treatment for indications outside the ETROP guidelines for both eyes. The indications outside the guidelines were persistent stage 2 or 3 ROP that showed no evidence of regression after 41 weeks of corrected gestational age (11 children; 34.4%), pre-plus stage (11; 34.4%), difficulties in disease staging (7; 21.9%), type 2 ROP with plus disease (2; 6.2 %), and treatment due to logistical difficulties (1; 3.1%; hospitalized in neonatal units hundreds of miles away from our department, with no fundus examination possible in the neonatal unit). To resume, in our cohort, 28.1% of children received treatment for ROP less severe than pre-threshold type 1 both eyes. The main indications for off-label treatment were the persistence of active ROP during follow-up and the presence of pre-plus-stage disease. Our data suggest the need to update ROP treatment criteria to reflect real-life practices. Additional studies are required in order to evaluate the long-term benefits and side effects of treatments outside the recommended indications, and to establish revised treatment guidelines.

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Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines

Cited by 14 publications

References 37 publications

Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

Treatment for non-type 1 retinopathy of prematurity by intravitreal injection of anti-vascular endothelial growth factor drugs

Treatment outside the Recommended Guidelines for Retinopathy of Prematurity (ROP): Prevalence, Characteristics, and Issues

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