Natural history and outcomes of stage 3 retinopathy of prematurity persisting beyond 40 weeks of post‐menstrual age: Dilemma for treatment and follow up

Abstract

Importance: To evaluate the natural history and outcomes of infants with stage-3 retinopathy of prematurity (ROP) persisting beyond 40-weeks of postmenstrual age (PMA). Background: There are no specific screening guidelines for stage-3 ROP persisting beyond 40 weeks of PMA. Persistent stage-3 disease in zone II without plus disease or in zone III with or without plus disease poses a dilemma for treatment. Design: Retrospective chart review. Participant: Neonates with stage-3 ROP persisting beyond 40-weeks of PMA. Methods: Demographic data and ROP parameters were collected. Univariate/ multivariate analyses were utilized to assess risk factors associated with requiring treatment. Main Outcome Measures: Evaluating the structural outcomes for infants with stage-3 ROP persisting beyond 40 weeks of PMA. Results: Out of 2356 screened infants, 115 infants (4.9%, 172 eyes) met inclusion criteria. In 95 infants (139 eyes, 80.8%), ROP resolved spontaneously. Twenty-one infants (33 eyes, 19.2%) were treated with laser-photocoagulation; 16 eyes had reached type 1 ROP and 17 eyes had non-type 1 ROP. No eye had unfavourable structural outcome. On multiple regression, non-type 1 ROP with ≥2 continuous clock hours of persistent stage-3 temporally crossing the horizontal midline was a significant risk factor associated with receiving treatment (OR = 27.29, 95% CI = [1.61, 462.92], P = .0221). Conclusion and Relevance: The majority of stage-3 ROP persisting beyond 40-weeks of PMA resolve spontaneously. In eyes that do not reach type 1 ROP, ≥2 continuous clock hours of persistent stage-3 crossing the temporal horizontal midline and history of pre-plus were considered important risk factors for macular drag and treatment can be considered.

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

“…1). Koucheki R et al con rmed that pre-plus was signi cantly correlated with increased ridges (≥2 continuous clock hours of persistent stage 3 crossing the temporal horizontal midline) in the eyes with stage-3 ROP persisting ≥40 weeks of PMA 17 . The ridge aggravation in this study were milder than the structural changes such as macular traction, retinal traction, or folds produced due to the tangential traction caused by the straightening of the temporal vessels in the fundus mentioned in previous studies 4,6,12 .…”

“…Some previous studies analyzed the treatment reasons of non-Type 1 ROP (seen in Table 5) 4,6,12,17 , but the main treatment method in these studies was laser photocoagulation. No literature had not been retrieved to explore the effect of intravitreal injection of anti-VEGF drugs on the treatment of non-type 1 ROP currently.…”

Treatment for Nontype 1 Retinopathy of Prematurity by Intravitreal Injection of Antivascular Endothelial Growth Factor Drugs

“…Te ridge aggravation in this study was slightly milder than the structural changes such as macular traction, retinal traction, or folds produced due to One eye of type 1 ROP and the contralateral eye of nontype 1 ROP in 6 cases (ID. 10,12,15,34,38,39). One eye of nontype 1 ROP and contralateral eye untreated in 7 cases (ID.…”

“…Some previous studies analyzed the treatment reasons of nonype 1 ROP ( Table 5 ) [ 3 , 5 , 11 , 12 ], but the main treatment method in these studies was laser photocoagulation. No literature had been retrieved to explore the effect of intravitreal injection of anti-VEGF drugs on the treatment of nontype 1 ROP currently.…”

Eye health for kids

“…There was a significant time reduction for image review with strategic in‐person examinations (high risk and prior to discharge) and documentation, versus sole use of in‐person examination and documentation. Koucheki and colleagues 6 elucidated the natural history and outcomes of stage 3 ROP persisting beyond 40 weeks post‐menstrual age and not meeting the Early Treatment for ROP (ETROP) criteria in 115 infants at the Hospital for Sick Children in Toronto, Canada. In this population, most infants' disease resolved spontaneously, with the main risk factors for poor structural outcome and thus consideration for treatment being more than 2 clock hours of persistent disease crossing the horizontal meridian—typically 9:00 position—and history of pre‐plus disease.…”