Treatment trends for retinopathy of prematurity in the UK: active surveillance study of infants at risk

Abstract

ObjectivesTo estimate the incidence of severe retinopathy of prematurity (ROP) requiring treatment and describe current treatment patterns in the UK.DesignNationwide population-based case ascertainment study via the British Ophthalmic Surveillance Unit and a national collaborative ROP special interest group. Practitioners completed a standardised case report form (CRF).SettingAll paediatric ophthalmologists providing screening and/or treatment for retinopathy in the UK were invited to take part.ParticipantsAny baby with ROP treated or referred for treatment between 1 December 2013 and 30 November 2014, treated with laser, cryotherapy, vascular endothelial growth factor (VEGF) inhibitor or vitrectomy/scleral buckling, or a combination.Main outcome measureIncidence of ROP requiring treatment.ResultsWe received 370 CRFs; 327 were included. Denominator from epidemiological data: 8112 infants with birth weight of <1500 g. The incidence of ROP requiring treatment was 4% (327/8112, 95% CI 3.6% to 4.5%). Median gestational age was 25 weeks (IQR 24.3–26.1), and median birth weight 706 g (IQR 620–821). Median age at first treatment was 80 days (IQR 71–96). 204 right eyes (62.39%) had type 1 ROP, and 27 (8.26%) had aggressive posterior ROP. Infants were also treated for milder disease: 9 (2.75%) right eyes were treated for type 2 ROP, and 74 (22.63%) for disease milder than type 1 with plus or preplus, which we defined here as ‘type 2 plus’ disease. First-line treatment was diode laser photoablation of the avascular retina in 90.5% and injection of VEGF inhibitor in 8%.ConclusionsROP treatment incidence in the UK is 2.5 times higher than previously estimated. 8% of treated infants receive intravitreal VEGF inhibitor, currently unlicensed. Research is needed urgently to establish safety and efficacy of this approach. Earlier treatment and increasing numbers of surviving premature infants require an increase in appropriate eye care facilities and staff.Trial registration numberNCT02484989.

East of England regional retinopathy of prematurity service: lessons from the first year

“…The recent British Ophthalmic Surveillance Unit study indicated that nearly 30% of babies treated have Type 2 disease. 1 Potentially unnecessary laser treatment for Type 2 ROP, with all the risks it entails, was prevented in most cases by telemedicine in this study.…”

“…(Type 1) ROP and require treatment. 1 Recognition of progression to Type 1 ROP and timely laser treatment is essential to prevent permanent visual loss, which accounts for 3% of childhood visual loss in the UK. 2 Current issues with ophthalmologist delivered screening in the UK include recruitment difficulties, inexperience of screeners and the lack of a certified programme of continued medical education.…”

“…Mutations in the OPA1 gene cause the majority of dominant optic atrophy cases. 1,2 We previously reported features of a sixgeneration dominant optic atrophy family with a particularly severe phenotype. By the end of their second decade of life, visual acuities of family members with dominant optic atrophy ranged from 20/40 to 20/80, and most family members in their seventh decade of life or older were legally blind.…”

Prediction Model for Determination of Indications for Laser or Surgical Treatment for Aggressive Posterior Retinopathy of Prematurity at the Manifestation Stage

“…При сравнении результатов ультразвукового офтальмосканирования (высота и протяженность вала ЭРП) выявлены аналогичные для данных цифровой морфо- метрии зависимости: существенное отличие для групп 1 и 2 (F = 168,1 и F = 61,5 при р < 0,01) и отсутствие различий для групп 2 и 3 (F = 1,3 и F = 0,5 для высоты и протяженности вала ЭРП, соответственно, при р < 0,01) (рис. 4,5).…”

“…Однако в ряде случаев в специализированных офтальмологических центрах при первичном поступлении продолжают встречаться впервые выявленные стадии экссудативно-тракционной отслойки сетчатки (ОС) задней агрессивной РН [3,4].…”