Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months

Abstract

Aim: To compare the visual acuity (VA), spherical equivalent refractive error, motility, and anatomical outcomes in children with treated regressed threshold stage 3 retinopathy of prematurity (ROP) and those with spontaneously regressed subthreshold stage 3 ROP. Method: 6 month and 3 year data collected from infants examined between 1989 and 1999 with regressed stage 3 ROP, with or without treatment were retrospectively reviewed. Results: 85 infants were included in this study. 40 eyes received cryotherapy, 81 eyes laser photocoagulation, and 34 eyes had spontaneously regressed subthreshold stage 3 ROP. Grating acuity score >2 cycles/degree (c/d) at 6 months was predictive of optotype acuity >6/9 in 69% of eyes and a score ,2 c/d at 6 months was predictive of acuity ,6/9 in 88% of eyes. Eyes with subthreshold stage 3 ROP were twice as likely to have VA of 6/9 or better at 36 months than the treated eyes. The mean spherical equivalent refractive error at 36 months was 26.5 dioptres (D) (221.5D to +1.38D) in cryotherapy treated eyes, 22.4D (213D to +4D) in the laser group, and 20.22D (29D to +2.25D) in the subthreshold group. Eyes within the treated groups were more myopic than the eyes within the spontaneously regressed group (p = 0.005). At 36 months, 42 out of the 85 infants (that is, 49%) had strabismus (44% in the cryotherapy group, 26% in the laser group, and 25% in the subthreshold group). There was a statistically significant association between the presence of strabismus and anisometropia (p = 0.016) and strabismus and intraventricular haemorrhage (IVH) (p = 0.005). There was a statistically significant difference in the incidence of strabismus between mild and moderate and severe grade IVH (p = 0.01). Eight out of 40 eyes in the cryotherapy group and six out of the 81 eyes in the laser group developed macular ectopia. None of the eyes in the spontaneously regressed group had macular dragging. Conclusions: In this study, the grating acuity at 6 months was a good predictor of the 3 year optotype acuity in all groups. Eyes with spontaneously regressed subthreshold stage 3 ROP were associated with better vision at 3 years of age and a lesser degree of myopia compared to the treated groups. Strabismus developed predominantly in the treated groups and was frequently associated with neurological damage and/or anisometropia. The spontaneously regressed subthreshold stage 3 group had a better anatomical outcome compared to the groups in which the retinopathy regressed following treatment.

Long-Term Refractive and Biometric Outcomes Following Diode Laser Therapy for Retinopathy of Prematurity

“…20,21 It is encouraging to note that the mean spherical equivalent and mean astigmatic error outcomes for our lasertreated eyes compare favorably with the findings of other investigators, as presented in Table 3. 7,20,[22][23][24] The shortterm refractive outcome at 1, 2, and 3 years has previously been reported for the laser-treated patients in our study. 25 In the earlier reports, as in this study, all unilateral cases and only the right eyes of cases where treatment was bilateral were selected for inclusion in the refractive analysis.…”

Refractive errors after the use of bevacizumab for the treatment of retinopathy of prematurity: 2-year outcomes

“…The reported rates range from 55.2 to 80.4% and 23.9 to 31.5%, respectively (Table 3). 3,4,6 The reported rates of myopia and high myopia were even higher in patients treated with cryotherapy, ranging from 82.9 to 92.0% and 32.0 to 52.5%, respectively (Table 3). [5][6][7] In the current study, the percentages of patients with myopia and high myopia among IVB-treated patients were 47.5 and 10.0%, respectively, which are less than the previously reported percentages for patients treated with laser treatment or cryotherapy.…”

“…9,10,12,17 Many authors have stated that myopia occurs frequently in infants who develop ROP and increases with the severity of the ROP. 5,6 The refractive error abnormalities of ROP patients have been found to present early in infancy and persist into adulthood. 16 However, myopia and high myopia occurred more frequently after pre-threshold or threshold ROP patients were treated with peripheral laser therapy.…”

“…2 However, many investigators have reported high prevalences of myopia and high myopia in preschool-and school-age children who received ablative therapy. [3][4][5][6][7] For these patients, it has been reported that laser treatment for severe ROP results in less myopia than cryotherapy. 6 In the last several years, anti-vascular endothelial growth factor (VEGF) agents have emerged as a new treatment for ROP, and promising experiences have been reported.…”

“…[3][4][5][6][7] For these patients, it has been reported that laser treatment for severe ROP results in less myopia than cryotherapy. 6 In the last several years, anti-vascular endothelial growth factor (VEGF) agents have emerged as a new treatment for ROP, and promising experiences have been reported. [8][9][10] However, only a few case series have reported the refractive outcomes after the injection of an anti-VEGF agent in these ROP patients.…”