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      Retinopathy of Prematurity in Infants with Late Retinal Examination

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          Abstract

          Purpose

          To report the incidence, severity and risk factors of retinopathy of prematurity (ROP) in premature infants with late ROP examination in Farabi Eye Hospital.

          Methods

          In a retrospective study from January 2001 to July 2007, hospital records of premature infants who were examined later than 9 weeks after birth were reviewed to determine the incidence, severity and possible risk factors of ROP including gender, singleton or multiple gestations, gestational age (GA), birth weight (BW), oxygen therapy,blood transfusion, phototherapy, respiratory distress syndrome (RDS), mechanical ventilation,intraventricular hemorrhage and sepsis as well as age at initial examination.

          Results

          Out of a total of 797 infants referred for ROP screening during the study period,216 (27.1%) had late examinations at a mean age of 141.7± 150.4 (range 64–1,460) days. Of these, 87 (40.3%) had different stages of ROP, 65 (30.1%) had stage 4 or 5 disease including 34 (16.2%) infants with stage 5 ROP in both eyes which was untreatable. Lower GA (P<0.001), RDS (P=0.041) and blood transfusion (P=0.009) were associated with the development of ROP.

          Conclusion

          The overall prevalence of ROP and the incidence of severe ROP in particular,were unacceptably high in premature infants with late screening. These findings necessitate interventions to optimize timely referral for screening of premature infants.

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          Most cited references28

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          Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial.

          To determine whether earlier treatment using ablation of the avascular retina in high-risk prethreshold retinopathy of prematurity (ROP) results in improved grating visual acuity and retinal structural outcomes compared with conventional treatment. Infants with bilateral high-risk prethreshold ROP (n = 317) had one eye randomized to early treatment with the fellow eye managed conventionally (control eye). In asymmetric cases (n = 84), the eye with high-risk prethreshold ROP was randomized to early treatment or conventional management. High risk was determined using a model based on the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity natural history cohort. At a corrected age of 9 months, visual acuity was assessed by masked testers using the Teller acuity card procedure. At corrected ages of 6 and 9 months, eyes were examined for structural outcome. Outcomes for the 2 treatment groups of eyes were compared using chi2 analysis, combining data for bilateral and asymmetric cases. Grating acuity results showed a reduction in unfavorable visual acuity outcomes with earlier treatment, from 19.5% to 14.5% (P =.01). Unfavorable structural outcomes were reduced from 15.6% to 9.1% (P<.001) at 9 months. Further analysis supported retinal ablative therapy for eyes with type 1 ROP, defined as zone I, any stage ROP with plus disease (a degree of dilation and tortuosity of the posterior retinal blood vessels meeting or exceeding that of a standard photograph); zone I, stage 3 ROP without plus disease; or zone II, stage 2 or 3 ROP with plus disease. The analysis supported a wait-and-watch approach to type 2 ROP, defined as zone I, stage 1 or 2 ROP without plus disease or zone II, stage 3 ROP without plus disease. These eyes should be considered for treatment only if they progress to type 1 or threshold ROP. Early treatment of high-risk prethreshold ROP significantly reduced unfavorable outcomes to a clinically important degree. Additional analyses led to modified recommendations for the use of peripheral retinal ablation in eyes with ROP. Long-term follow-up is being conducted to learn whether the benefits noted in the first year after birth will persist into childhood.
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            Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control.

            Globally at least 50,000 children are blind from retinopathy of prematurity (ROP) which is now a significant cause of blindness in many middle income countries in Latin American and Eastern Europe. Retinopathy of prematurity is also being reported from the emerging economies of India and China. The characteristics of babies developing severe disease varies, with babies in middle and low income countries having a much wider range of birth weights and gestational ages than is currently the case in industrialized countries. Rates of disease requiring treatment also tend to be higher in middle and low income countries suggesting that babies are being exposed to risk factors which are, to a large extent, being controlled in industrialised countries. The reasons for this "third epidemic" of ROP are discussed as well as strategies for control, including the need for locally relevant, evidence based criteria which ensure that all babies at risk are examined.
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              An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity.

              (1984)
              Because of modern life-support systems capable of keeping tiny premature infants alive, retinopathy of prematurity has recurred. No classification system currently available adequately describes the observations of the disease being made today. A new classification system, the work of 23 ophthalmologists from 11 countries, is presented in an attempt to meet this need. It emphasizes the location and the extent of the disease in the retina as well as its stages. The term "plus" is employed with the stage to denote progressive vascular incompetence. A computer-compatible diagram for recording the results of the examination employing the new classification system is furnished.
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                Author and article information

                Journal
                J Ophthalmic Vis Res
                J Ophthalmic Vis Res
                JOVR
                Journal of Ophthalmic & Vision Research
                Ophthalmic Research Center
                2008-2010
                2008-322X
                January 2009
                : 4
                : 1
                : 24-28
                Affiliations
                Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to:Mohammad Riazi-Esfahani, MD. Associate Professor of Ophthalmology; Farabi Eye Hospital, Qazvin Sq., South Kargar St., Tehran, Iran, Postcode 13366-16351; Tel: +98 21 55418113, Fax: +98 21 55409095; e-mail: riazifahimi@ 123456yahoo.com
                Article
                JOVR-04-24
                3448383
                23056670
                a4a7148c-7723-456f-9f54-69a37b15a5db
                Copyright @ 2009
                History
                : 6 July 2008
                : 3 October 2008
                Categories
                Late ROP Examination

                Ophthalmology & Optometry
                risk factors,retinopathy of prematurity
                Ophthalmology & Optometry
                risk factors, retinopathy of prematurity

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